Postorgasmic illness syndrome
Postorgasmic illness syndrome is a syndrome in which men have chronic physical and cognitive symptoms immediately following ejaculation in the absence of a local genital reaction. The symptoms last for up to a week. The cause and prevalence are unknown; it is considered a rare disease.
|Postorgasmic illness syndrome|
|Specialty||Andrology, Allergy, Endocrinology|
Signs and symptoms
The distinguishing characteristics of POIS are:
- the rapid onset of symptoms after ejaculation;
- the absence of any local genital reaction; and
- the presence of an overwhelming systemic reaction.
POIS symptoms, which are called a "POIS attack", can include some combination of the following: cognitive dysfunction, aphasia, severe muscle pain throughout the body, severe fatigue, weakness, and flu-like or allergy-like symptoms, such as sneezing, itchy eyes, and nasal irritation. Additional symptoms include headache, dizziness, lightheadedness, sensory and motor problems, intense discomfort, irritability, anxiety, gastrointestinal disturbances, craving for relief, susceptibility to nervous system stresses (e.g. common cold), depressed mood, and difficulty communicating, remembering words, reading and retaining information, concentrating, and socializing. Affected individuals may also experience intense warmth or cold.
In some men, the onset of POIS is in puberty, while in others, the onset is in their twenties. POIS that is manifest from the first ejaculations in adolescence is called primary type; POIS that starts later in life is called secondary type.
Many POIS sufferers report lifelong premature ejaculation, with intravaginal ejaculation latency time (IELT) of less than one minute.
Synonyms and related conditions
Dhat syndrome is a condition, first described in 1960 in India, with symptoms similar to POIS. Dhat syndrome is thought to be a culture-bound psychiatric condition and is treated with cognitive behavioral therapy along with anti-anxiety and antidepressant drugs.
Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts anywhere from five minutes to two hours. PCT, which affects both men and women, occurs only after sexual intercourse and does not require an orgasm to occur, and in that its effects are primarily emotional rather than physiological. By contrast, POIS affects only men, consists primarily of physiological symptoms that are triggered by ejaculation and that can last, in some people, for up to a week. While PCT and POIS are distinct conditions, some doctors speculate that they could be related.
An array of more subtle and lingering symptoms after orgasm, which do not constitute POIS, may contribute to habituation between mates. They may show up as restlessness, irritability, increased sexual frustration, apathy, sluggishness, neediness, dissatisfaction with a mate, or weepiness over the days or weeks after intense sexual stimulation. Such phenomena may be part of human mating physiology itself.
Sexual headache is a distinct condition characterized by headaches that usually begin before or during orgasm.
The cause of POIS is unknown. Some doctors hypothesize that POIS is caused by an auto-immune reaction. Other doctors suspect a hormone imbalance as the cause. While other causes have been proposed as well, none of the proposed causes seem to fully explain the disease.
Autologous seminal peptides or peptides released from the disrupted urethral lining cells, contact the inner mucosal epithelium of the urethra. During this contact, antigen(s) of semen and / or seminal fluid is recognized and taken up by dendritic cells in the epithelium. These cells then wander to the T-cell zones of lymph nodes, where they present the seminal fluid antigen(s) to naïve T-cells and initiate the cascade of events of a hypersensitivity reaction.
POIS could also be caused by an auto-immune reaction not to semen itself, but to another substance that is released during ejaculation, such as to cytokines.
The allergy hypothesis has been disputed. According to one study, "IgE-mediated semen allergy in men may not be the potential mechanism of POIS". A case report considered that the skin test to autologous semen was negative.
POIS could be caused by a defect in neurosteroid precursor synthesis. In this case, the same treatment may not be effective for different sufferers. Different sufferers may have different missing precursors, ultimately leading to a deficiency of the same particular neurosteroid, causing similar symptoms.
POIS could also be caused by hyperglycemia or by chemical imbalances in the brain.
Sexual activity for the first time may set the stage for an associated asthma attack or may aggravate pre-existing asthma. Intense emotional stimuli during sexual intercourse can lead to autonomic imbalance with parasympathetic over reactivity, thereby causing release of mast cell mediators that can provoke postcoital asthma and / or rhinitis in these patients.
None of the currently proposed causes for POIS explain the connection between POIS and lifelong premature ejaculation.
There is no generally agreed upon diagnostic criteria for POIS. One group has developed five preliminary criteria for diagnosing POIS. These are:
- one or more of the following symptoms: sensation of a flu-like state, extreme fatigue or exhaustion, weakness of musculature, experiences of feverishness or perspiration, mood disturbances and / or irritability, memory difficulties, concentration problems, incoherent speech, congestion of nose or watery nose, itching eyes;
- all symptoms occur immediately (e.g., seconds), soon (e.g., minutes), or within a few hours after ejaculation that is initiated by coitus, and / or masturbation, and / or spontaneously (e.g., during sleep);
- symptoms occur always or nearly always, e.g., in more than 90% of ejaculation events;
- most of these symptoms last for about 2–7 days; and
- disappear spontaneously.
POIS is prone to being erroneously ascribed to psychological factors such as hypochondriasis or somatic symptom disorder.
There is no standard method of treating or managing POIS. Patients need to be thoroughly examined in an attempt to find the causes of their POIS symptoms, which are often difficult to determine, and which vary across patients. Once a cause is hypothesized, an appropriate treatment can be attempted. At times, more than one treatment is attempted, until one that works is found.
Affected individuals typically avoid sexual activity, especially ejaculation, or schedule it for times when they can rest and recover for several days afterwards. In case post-coital tristesse (PCT) is suspected, patients could be treated with selective serotonin reuptake inhibitors.
Another patient, in whom POIS was suspected to be caused by cytokine release, was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) just prior to and for a day or two after ejaculation. The patient took diclofenac 75 mg 1 to 2 hours prior to sexual activity with orgasm, and continued twice daily for 24 to 48 hours.
One POIS patient with erectile dysfunction and premature ejaculation had much lower severity of symptoms on those occasions when he was able to maintain penile erection long enough to achieve vaginal penetration and ejaculate inside his partner. The patient took tadalafil to treat his erectile dysfunction and premature ejaculation. This increased the number of occasions on which he was able to ejaculate inside his partner, and decreased the number of occasions on which he experienced POIS symptoms. This patient is thought to have Dhat syndrome rather than true POIS.
Two patients, in whom POIS was suspected to be caused by auto-immune reaction to their own semen, were successfully treated by allergen immunotherapy with their own autologous semen. They were given multiple subcutaneous injections of their own semen for three years. Treatment with autologous semen "might take 3 to 5 years before any clinically relevant symptom reduction would become manifest". A case report used a technique known as "Intralymphatic Immunotherapy", the treatment has been successful in improving 60-90% of symptoms. The patient received only five injections of the autologous semen using this technique.
Treatments are not always successful, especially when the cause of POIS in a particular patient has not been determined. In one patient, all of whose routine laboratory tests were normal, the following were attempted, all without success: ibuprofen, 400 mg on demand; tramadol 50 mg one hour pre-coitally; and escitalopram 10 mg daily at bedtime for 3 months.
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