Tom held (on/out) long enough so Mary could have an orgasm.
What's the correct alternative and why?
Heavily depends on the specific activities happening.
Hold means to be still or not move.
Hold on means to sustain some effort or position over time, or to wait until something.
Hold out - I like Google's definition - "resist or survive in dangerous or difficult circumstances."
If you have no other information other than your sentence, I would select "hold on", hold out won't work unless we know Mary is dangerous or difficult.