Postorgasm illness syndrome--a spectrum of illnesses

A clinical guide to rare male sexual disorders

Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.

Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome

Introduction

Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear.

Aim

This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy.

Methods

The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen.

Outcomes

Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro.

Results

The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization.

Clinical Implications

Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients.

Strengths and Limitations

This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen.

Conclusions

IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.

Postorgasmic illness syndrome: one or several entities? A retrospective cohort study

BACKGROUND

Postorgasmic illness syndrome (POIS) is a rare syndrome in which patients experience various physical and cognitive symptoms after ejaculation, and its pathophysiology remains unknown.

AIM

The aim of this study was to characterize the clinical presentations, disease course, and treatment outcomes in outpatients, as well as to examine the validity of the preliminary criteria and symptom clusters of POIS.

METHODS

This retrospective monocentric study was conducted in a neurourology department, with patients included from 2010 to 2023. The diagnostic criteria and symptom cluster descriptions were based on previous studies.

OUTCOMES

The study focused on the clinical features of POIS, the complementary tests performed, the treatments tried, and their effectiveness.

RESULTS

Thirty-seven men were included in the study, with symptom onset occurring at a mean ± SD age of 23.6 ± 7.4 years. The mean time from ejaculation to symptom onset was 1 hour 22 minutes ± 3 hours 42 minutes. The mean duration of symptoms was 4.7 ± 3.4 days. Seventeen patients (46%) developed the symptoms primarily, whereas in 20 (54%) they appeared secondarily. All preliminary criteria were met in 19 patients (51%). The most common symptom clusters were "general" in all 37 patients (100%; eg, asthenia and concentration difficulties) and "head" in 35 patients (95%; mostly headache and a foggy feeling). In terms of treatments, antihistamines and nonsteroidal anti-inflammatory drugs were tried and partially improved symptoms for some patients.

CLINICAL IMPLICATIONS

This study helps to further characterize POIS by specifying the most frequent symptoms and comparing them with the initial criteria.

STRENGTHS AND LIMITATIONS

To our knowledge, this is one of the largest cohorts of patients consulting for symptoms suggestive of POIS. There are limitations due to the retrospective nature of the data collection, such as missing data and imprecision of treatment efficacy.

CONCLUSION

The majority of participants met at least 3 of the preliminary diagnostic criteria, with a majority of symptoms in the general and head clusters. However, the determination of predictive factors for treatment response based on the typology of the disorders remains to be established.

Recognition and practice patterns of sexual medicine experts towards postorgasmic illness syndrome

Post-orgasmic illness syndrome (POIS) is a rare, but debilitating cluster of symptoms, occurring after ejaculation with unknown mechanism and uncertain treatment. To the best of our knowledge, this study, which is thought to be the first in the literature, is aimed to investigate the practice patterns of sexual medicine experts towards POIS. Worldwide sexual medicine experts were invited to participate anonymously in an online, open survey using SurveyMonkey between November 14, 2022, and January 15, 2023. In total 211 sexual medicine experts filled the survey. The majority of the participants were urologists (83.9%). Most participants stated that the available information about POIS was inadequate for both patients and physicians. 47.9% of the participants stated psychological disorder, 46.4% stated bio-psycho-social reasons for the responsibility for the pathophysiology of POIS. 56.4% of the participants stated that they would refer the patient for psychotherapy/sexual therapy to a sexologist, 41.7% would prefer antihistamine drugs to manage symptoms. Only 18% of participants reported symptom improvement in more than 30% of the patients. This survey study among sexual medicine experts from different parts of the world has developed representative estimates of knowledge, attitudes and practice patterns regarding POIS worldwide.

Post-orgasmic illness syndrome with positive intradermal test for autologous semen

Post-orgasmic illness syndrome (POIS) is a rare disease characterized by flu-like symptoms persisting for 2-7 days after ejaculation. POIS has been chiefly attributed to allergic reactions to autologous seminal plasma. However, the exact pathophysiology remains unclear, and there is no effective treatment. We present the case of a 38-year-old man with a 10-year history of recurrent episodes of flu-like symptoms of 1-week duration after ejaculation. The patient was diagnosed with irritating bowel syndrome because of fatigue, myalgia, and lateral abdominal pain. After starting infertility treatment and increasing the frequency of intercourse with his wife, the patient noticed these symptoms after ejaculation. Based on these episodes and symptoms, POIS was suspected. To diagnose POIS, a skin prick test and an intradermal test were performed using his seminal fluid, with the latter yielding a positive result. The patient was diagnosed with POIS, and treatment with antihistamines was continued. Due to its rarity, POIS is often underdiagnosed and underreported; however, the skin test can be a valid diagnostic tool. In this case, the intradermal test result was positive according to the broadly accepted criteria for POIS. Although quality of life is often severely affected in patients with POIS, a lack of a clear understanding of the pathogenesis of POIS prevents early diagnosis. To make diagnoses earlier, it is undoubtedly important to take a detailed medical history and perform skin allergy tests, although the latter requires further validation.

Postorgasmic Illness Syndrome: An Update

Postorgasmic illness syndrome (POIS) is a rare condition affecting men who experience a cluster of flu-like and allergic symptoms after ejaculation. POIS can occur after intercourse, masturbation, or spontaneous ejaculation, and may persist for up to 7 d. Recurrent symptoms often negatively impact quality of life and sexual activity, leaving those affected with mental sequelae, diminished concentration, and mood changes. While it has been shown that various treatment options can alleviate symptoms in the short term, acute management remains controversial. In addition, follow-up data are severely lacking, resulting in the absence of established long-term management options for men suffering from POIS. This review highlights hallmark studies and the current state and promising developments surrounding clinical approaches to POIS. PATIENT SUMMARY: In this review, we discuss what is known about postorgasmic illness syndrome (POIS), a disease that causes flu-like symptoms in some men after ejaculation. Little research has been on POIS, so its causes, diagnosis, and appropriate treatments are poorly understood.

The first Tunisian case of postorgasmic illness syndrome: A case report

Postorgasmic illness syndrome (POIS) is a rare and singular syndrome. About fifty cases have been reported in the medical literature. Through a clinical observation, we illustrate the first case diagnosed in Tunisia and the difficulties in the etiological diagnosis and the therapeutic management of this syndrome. Given the shortage of cases reported in the literature, the syndrome of POIS remains poorly identified and subsequently misdiagnosed. The clinical diagnosis is relatively simple, yet etiological and therapeutic questions remain to overcome.

Post Orgasmic Illness Syndrome (POIS) and Delayed Onset Muscle Soreness (DOMS): Do They Have Anything in Common?

Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome last about 2–7 days after an ejaculation. The current hypothesis proposes that the primary injury in post orgasmic illness syndrome is an acute compression proprioceptive axonopathy in the muscle spindle, as is suspected in delayed onset muscle soreness. The terminal arbor degeneration-like lesion of delayed onset muscle soreness is theorized to be an acute stress response energy-depleted dysfunctional mitochondria-induced impairment of Piezo2 channels and glutamate vesicular release. The recurring symptoms of post orgasmic illness syndrome after each ejaculation are suggested to be analogous to the repeated bout effect of delayed onset muscle soreness. However, there are differences in the pathomechanism, mostly attributed to the extent of secondary tissue damage and to the extent of spermidine depletion. The spermidine depletion-induced differences are as follows: modulation of the acute stress response, flu-like symptoms, opioid-like withdrawal and enhanced deregulation of the autonomic nervous system. The longitudinal dimension of delayed onset muscle soreness, in the form of post orgasmic illness syndrome and the repeated bout effect, have cognitive and memory consequences, since the primary injury is learning and memory-related.

Case of post-orgasmic illness syndrome associated with hypogonadism

INTRODUCTION

Post-orgasmic illness syndrome is a rare condition that occurs after ejaculation and persists for 2-7 days and is characterized by flu-like symptoms, which can significantly reduce quality of life.

CASE PRESENTATION

A 21-year-old unmarried man was referred to our hospital due to flu-like symptoms that developed after ejaculation by masturbation and persisted for about 2 days. The patient's free testosterone level was slightly lower than normal. Nonsteroidal anti-inflammatory drugs were initially administered and helped relieve headache and muscle pain. Thereafter, the patient was able to ejaculate three times a week. In addition, after administering testosterone enanthate once or twice a month, his general fatigue significantly improved, and he could ejaculate every day.

CONCLUSION

The pathophysiology of post-orgasmic illness syndrome has not been fully elucidated. The treatments for this condition must be accurately selected according to pathophysiology.

Clinical experience with post-orgasmic illness syndrome (POIS) patients-characteristics and possible treatment modality

Post-orgasmic illness syndrome (POIS) is a rare condition that includes a cluster of post-ejaculatory symptoms with debilitating physical and psychological consequences. The prevalence and incidence of POIS remain unknown as well as the pathophysiology of the syndrome, and there are no well-studied recognized treatment modalities. The current retrospective observational study describes a series of 14 highly selected patients who were actively looking for medical help as POIS has a significant effect on patients and their partners. The aim is to increase knowledge about this syndrome and possible treatment modality. According to a standard protocol, patients have been systematically interviewed, had a physical examination, laboratory blood tests, and treatments. Mean age was 34.07 ± 6.65 years. The majority of patients had only one symptom in common-extreme fatigue. The most prevalent complaints were head pressure/heaviness, nose congestion and muscle tension; all patients suffered from more than 1 symptom. POIS started on average within 30 min of ejaculation and lasted for 3.5 days. The patients reported emotional and psychosocial burden of their symptoms, which also influence their partner and relationships. Immunoglobulin-E measurements did not show elevated levels and/or significant increase within 24 h after ejaculation. Silodosin, a highly selective alpha1A-blocker, which actually causes anejaculation, was effective treatment in 57% of the patients.

Post-orgasmic illness syndrome: history and current perspectives

Post-orgasmic illness syndrome is a rare disorder causing a debilitating cluster of flu-like and allergic type symptoms that occur within seconds, minutes or hours after ejaculation. Symptoms occur after intercourse, masturbation or spontaneous ejaculation and last from 2 to 7 days. The condition is chronic and follows a primary pattern occurring in adolescence and a secondary acquired pattern with onset later in life. The true incidence is unknown as the condition is likely under-reported and under-diagnosed. The pattern of symptoms suggests an allergic or auto-immune etiology; however, the exact pathophysiology is unknown and there is no effective treatment. Men suffering from post-orgasmic illness syndrome describe emotional trauma and significant impairment of their quality of life.

Immunophenotypical Characterization of a Brazilian POIS (Post-Orgasmic Illness Syndrome) Patient: Adding More Pieces to Puzzle

Post-orgasmic illness syndrome (POIS) is a rare condition characterized by post-ejaculatory symptoms. Here is reported the first Brazilian POIS patient. Immunological investigation did not confirm the previous hypothesis of a hypersensitivity reaction. Cell immunophenotyping comparing healthy individuals produced evidence of abnormalities not associated to clinical manifestations. The patient was submitted to specific immunotherapy with transient clinical response and was referred to a psychologist but did not demonstrate clinical improvement of symptoms. Therefore, etiology of POIS remains unclear.

Post orgasmic illness syndrome: what do we know till now?

BACKGROUND

Peri orgasmic dysfunctions are very rare and little information exists on their diagnosis and treatment. One of these conditions is post-orgasmic illness syndrome (POIS), manifesting by a debilitating cluster of symptoms affecting men within seconds, minutes, or hours after ejaculation. The aim of this article is to do a thorough literature review about POIS, in order to elucidate the pathophysiology, the diagnosis and the management of this rare disease.

RESULTS

Updated literature review on Pubmed was done, using the following terms: "orgasm illness", "post-orgasmic" and "postorgasmic illness syndrome". The references of the 17 identified publications were also reviewed for additional 8 relevant articles that were all included in the results.POIS has 5 preliminary diagnostic criteria and criterion 1 has 7 described clusters. Pathophysiological hypotheses include: immunological phenomenon (most relevant), opioid-like withdrawal, neuroendocrine response, transient deregulation of the autonomic nervous system, hypersensitivity and disordered cytokines. Differential diagnoses include: chronic prostatitis, orgasmolepsy, benign orgasmic cephalgia, sneezing and rhinorrhea, postcoital dysphoria, post-coital asthma and rhinitis. Patients have been symptomatically treated with antihistamines, non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful.

CONCLUSION

POIS is a rare condition that is underdiagnosed, most probably because of its unclear pathophysiology leading to a lack of treatment options. Further studies are warranted to investigate the prevalence, pathophysiology, and management of this debilitating condition.

First assessment of the validity of the only diagnostic criteria for postorgasmic illness syndrome (POIS)

Postorgasmic illness syndrome (POIS) is a rare condition that affects men and about which little is known. According to Waldinger and colleagues, men with POIS fulfill three or more of five preliminary diagnostic criteria regarding symptoms, time to onset, setting, duration, and spontaneous disappearance. We conducted a self-report study to assess, for the first time, the validity of these criteria. One hundred and twenty-seven men with self-reported POIS have completed the survey, making this the largest study of such men to date. Almost all respondents fulfill a majority of the criteria for POIS; a large minority fulfills all five criteria. Almost all respondents always experience symptoms after ejaculating in at least one ejaculatory setting (sex, masturbation, or nocturnal emission), though only a small majority fulfill the criterion that symptoms occur after all ejaculations because a large minority always experience symptoms in one setting but not always in another. The most common symptom cluster from the criteria, involving fatigue, irritation, and concentration difficulties, is always experienced by 80% of respondents. Median symptom severity is 8 on a 0-10 scale. While almost all men with POIS fulfill a majority of the preliminary diagnostic criteria, there is room for refining some of the criteria.

Postorgasmic illness syndrome (POIS) in a Chinese man: no proof for IgE-mediated allergy to semen

INTRODUCTION

Postorgasmic illness syndrome (POIS) is a rarely described syndrome characterized by transient flu-like symptoms and cognition disorders. Recent studies suggest that immunogenic reactivity to autologous semen is the underlying mechanism in POIS. However, there are no data published on immunoglobulin E (IgE)-mediated allergy to autologous semen in men without POIS.

AIM

The purpose of the current work was to characterize the first diagnosed POIS patient in China and to study the allergic response of autologous semen in the affected patient and in three healthy males.

METHODS

Specific IgE was tested with seminal fluid and common perennial aeroallergens in vitro. Skin prick tests and intracutaneous tests with autologous diluted semen were performed in the patient and three healthy donors. The pattern of IgE reactivity to patient's semen was identified using immunoblotting and ELISA.

MAIN OUTCOME MEASURE

Clinical features of POIS, skin reactions with autologous diluted seminal fluid, and the IgE reactivity patterns of immunoblotting and ELISA in vitro.

RESULTS

A patient was diagnosed with POIS. The patient complained of lifelong premature ejaculation symptoms and allergic rhinitis. Routine laboratory and hormonal assessments were generally within normal range. The patient had a positive skin test with his own semen. Three healthy donors also showed positive skin tests. No semen-specific IgE to autologous semen was detected in the serum of the affected patient or healthy males.

CONCLUSIONS

This is the first report of a man with POIS in China. He had positive skin reactions after injection of autologous seminal fluid but no detectable serum concentrations of specific IgE antibodies. IgE-mediated semen allergy in men may not be the potential mechanism of POIS.

Hyposensitization therapy with autologous semen in two Dutch caucasian males: beneficial effects in Postorgasmic Illness Syndrome (POIS; Part 2)

INTRODUCTION

Postorgasmic illness syndrome (POIS) is a post-ejaculatory complex of local and/or systemic symptoms that nearly always occurs within seconds, minutes, or hours post-masturbation, coitus, or spontaneous ejaculation. Recent data suggest an autoimmunogenic/allergic underlying mechanism.

AIM

To treat males with POIS by hyposensitization with their own semen (autologous semen).

METHODS

Two males suffering from POIS, of which one male with coincidental lifelong premature ejaculation (PE) were investigated. Based on their local and systemic symptoms including a positive dermatologic reaction after skin-prick testing with autologous semen, auto-allergy to semen was likely an underlying mechanism. A hyposensitization program was initiated, including multiple subcutaneous (SC) injections with autologous semen, initially at 2 weeks intervals in the first year and gradually at 4 weeks intervals in the second and third year. From initial semen dilutions of 1 on 40,000 and 1 on 20,000, the titers were gradually increased to 1 on 20 and 1 to 280, respectively.

MAIN OUTCOME MEASURES

Evaluation with a dedicated questionnaire about severity of POIS symptoms and specialized interviews on self-perceived intravaginal ejaculation latency times (IELT) before and during the desensitization program.

RESULTS

POIS was confirmed in both subjects, PE was confirmed in one male, and skin-prick tests with autologous semen in both subjects were positive. During the program, gradual reduction of complaints resulted in 60% and 90% amelioration of POIS complaints at 31 and 15 months, respectively, which coincided in one male with a delay of the IELT from 20 seconds at baseline to 10 minutes after 3 years of treatment. The cause of this association with IELT is unknown and remains to be elucidated.

CONCLUSIONS

Two males with POIS were successfully treated by hyposensitization with autologous semen, which supports an immunogenic/allergic etiology and underscores the clinical implication for immunological sexual medicine.