Postorgasmic illness syndrome

Postorgasmic illness syndrome (POIS) is a condition characterized by debilitating symptoms following orgasm that last for a few hours to several days.^[1][2][3] The phenomenon was first described in 2002.^[4]

Symptoms

Symptoms usually appear within half an hour of orgasm and resolve after a few days.^[3][4]

One can experience mental symptoms, physical symptoms, or both. Common mental symptoms include cognitive dysfunction, intense discomfort, irritability, anxiety, craving for relief, susceptibility to nervous system stresses (e.g. cold), depressed mood, and difficulty communicating, remembering words, reading and retaining information, concentrating, and socialising.^[1][3][4][5] Physical symptoms include severe fatigue, mild to severe headache, and flu-like and allergy-like symptoms, such as sneezing, itchy eyes, nasal irritation, and muscle pain.^[3][4] Affected individuals may also experience intense warmth.^[1][2]

Diagnosis

Waldinger says this condition is prone to being erroneously ascribed to psychological factors or hypochondria.^[2] In a 2010 British Medical Journal case study, Dexter links a form of coital headache with POIS, and references a science forum in which hundreds of sufferers (a number which is rapidly growing) have detailed their condition.^[3][5] Dexter's patient was found to have low progesterone.^[3] Others on the referenced forum have tested low in testosterone, high in cortisol, and a contrast enhanced dedicated pituitary MRI has found pituitary abnormalities in three cases: a pituitary microadenoma was found in two, and a partially empty sella in the other.

Management

POIS patients are beginning to be treated using hyposensitation techniques for semen allergies.^[6]

Dexter's patient, who had been symptomatic for 27 years, was completely treated by 5 to 10 mg doses of norethisterone, half an hour before, and in the minutes just after orgasm.^[3]

Affected individuals typically avoid sexual activity,^[2] especially orgasm, or schedule it for times when they can rest and recover for several days afterwards.^[4]

One physician has treated two people, whose primary symptoms were intense depressed mood, with selective serotonin reuptake inhibitors.^[7]

Pathophysiology

Most recently, in early 2011, Professor Waldinger and collaborators further characterized POIS, proposed a specific immunological mechanism, and empirically supported their hypothesis on 45 Dutch Caucasian males. This study concluded that both Type-1 and Type-4 allergy to male's own semen contribute to symptoms of the illness.^[1]

Dexter speculates that POIS could be caused by a lack of progesterone, a powerful neurosteroid, or a defect in neurosteroid precursor synthesis. In the latter 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.

An array of more subtle, lingering symptoms after orgasm, which would 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 ^[8] over the days or weeks after intense sexual stimulation. Such phenomena may be part of human mating physiology itself. Habituation to a mate can drive the search for novel mates (the Coolidge effect). Possible neurochemical mechanisms behind such effects are discussed in "The Passion Cycle."^[9]

One researcher suggests that the symptoms may be produced by an autoimmune reaction against any of various hormones or other substances secreted during and after sex.^[10] Another suggests that chemical imbalances in the brain may cause the symptoms.^[7]

It is difficult to demonstrate a causal relationship based on patient reports.^[11]

Epidemiology

POIS could affect between 0.25% and 1% of the population.^[12]

POIS is recognized as a rare disorder by the National Institutes for Health (NIH), Office of Rare Diseases Research^[13]. It is also listed in the organizational database of the National Organization for Rare Disorders(NORD)^[14]

See also

• Coital cephalalgia
• Post-coital tristesse

References

External links

• Semen allergy suspected in rare post-orgasm illness (Reuters, January 17, 2011)