If one is severely sexually exhausted he will be unable to produce firm erections by thought alone and it will be even harder in an upright position. Physical stimulation will be needed, which is usually a bad idea. Mechanical stimulation on the skin will release additional histamine and prostaglandin E2 through the skin's neuro-endocrine circuitry. Prostaglandin E2 will stimulate the hypothalamic-pituitary-adrenal-testicular axis for additional norepinephrine and epinephrine release, alternate the brain chemistry, and sensitize the local nerves.
Sexual activities with exhausted hypothalamus-pituitary-adrenal-testicular functions will be constantly inducing excessive dopamine-norepinephrine-epinephrine conversion and keep heightened prostaglandin E2 levels in the local tissues and bloodstream.
Excessive dopamine-norepinephrine-epinephrine conversion may result in heightened cortisol and prolactin and deficiency of dopamine and oxytocin, which will delay the post orgasmic recovery. If the dopamine levels remain sufficient, one will experience persistent sexual arousal with sexual exhaustion. The PSAS symptoms may become even worse if high levels of androgen hormones, oxytocin, and histamine are observed.