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

Post-Orgasmic Illness Syndrome Successfully Treated with Omalizumab: A Case Report

Post-orgasmic illness syndrome (POIS) is a rare disorder associated with a debilitating symptoms post-ejaculation associated with significant impairment in quality of life. The mechanism of the disease is unclear, but hypersensitivity to semen and/or seminal fluid has been postulated. We present a case of POIS successfully treated with omalizumab suggesting a possible role for this therapy in POIS treatment and management.

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.

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.

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.

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.

Analysis of the Symptomatology, Disease Course, and Treatment of Postorgasmic Illness Syndrome in a Large Sample

BACKGROUND

Postorgasmic illness syndrome (POIS) is a rare syndrome of unknown etiology where patients experience distressing physical and psychological after ejaculatory sequelae.

AIM

To better characterize the epidemiology, symptomatology, disease course, and treatment of POIS, with specific interest placed on examining relationships between disease presentation and measures of disease burden.

METHODS

A 30-item questionnaire was distributed to an online community of patients with POIS from June 2019 to January 2020. We assessed diagnostic criteria and clusters of symptomatology described in prior studies. Outcome measures include self-reported measures of symptom severity, disease burden, and behavioral changes. Statistical correlations were assessed with Pearson's chi-squared (χ²) and ordinal regression analyses.

OUTCOMES

The main outcome measures of this study are self-reported measures of symptom severity, disease burden, and behavioral changes.

RESULTS

The sample consisted of 302 men (mean age: 32.6 ± 11.4 years, mean age of onset: 19.1 ± 7.8 years) with 89% satisfying ≥3 diagnostic criteria. Common symptoms were difficulty concentrating (254, 84%), extreme fatigue (250, 83%), irritability (225, 74%), and muscle weakness (212, 70%). Common symptom clusters were general (219, 72%), muscle (137, 45%), and head (93, 31%). Common behavioral modifications were avoiding masturbation (215, 71%), schedule changes (213, 71%), and abstinence (186, 62%). Head and throat symptom clusters demonstrated worse disease burden outcomes. Professional medical advice was sought by 51% of participants. Attempted treatments included pharmacotherapy, vitamins, supplements, and herbs with variable efficacy.

CLINICAL IMPLICATIONS

This study further characterizes POIS, including how patients respond to the condition, how it is treated in the community, and presentations that may be associated with more severe disease.

STRENGTHS & LIMITATIONS

This is the largest study to date that concerns patients suffering from POIS and includes a diverse, global population. Limitations include that the survey was only administered in English and within 1 online community, that results were self-reported, and that the response rate was low (32%).

CONCLUSIONS

Characterizing symptom cluster, but not number of diagnostic criteria, may offer prognostic value, and investigation to elucidate pathophysiology and potential treatments for POIS is necessary. Natale C, Gabrielson A, Tue Nguyen HM, et al. Analysis of the Symptomatology, Disease Course, and Treatment of Postorgasmic Illness Syndrome in a Large Sample. J Sex Med 2020;17:2229-2235.

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.