Post-orgasmic illness syndrome: a case report

Introduction

Post-orgasmic illness syndrome (POIS) was first reported and named by Waldinger and Schweitzer in 2002¹. This recently described syndrome may be more prevalent than one might expect, but has not received much attention and, we think, many cases may be misdiagnosed.

To the best of our knowledge, aside from two cases reported by Waldinger and Schweitzer¹, two by Ashby and Goldmeier², and one each by Dean (personal communication), Mullhal (personal communication) and Ashworth (personal communication), and the self reported cases on the site of the Naked Scientist’s discussion forum (www.thenakedscientists.com/forum), no more scientific discussion on POIS exists in textbooks, medical journals, or scientific meetings or congresses.

POIS appears to be principally a male orgasmic disorder, as most of the reported cases are males. Its manifestations start within seconds after orgasm and may continue for 4–7 days. These manifestations differ in their severities but, in most cases they are severe enough to make the patient abstain from the sexual activities; especially ejaculation and orgasm. They are not uniform for each patient and can be grouped based on having a specific cluster of symptoms^1,2.

The most commonly reported manifestations are cognitive disorders and flu-like symptoms. The former is described by the patient as including brain fog, with inability to focus, communicate or process information. Some patients may suffer from temporary aphasia, irritability, anxiety, inability to relax and social phobias. The flu-like manifestations are; fever, sore throat, headache, chill, over-sweating with severe muscular, and bone and joint pains to the extent of severe exhaustion and fatigue¹. One patient reported transient memory loss after each orgasm².

Nothing is currently known regarding the underlying etiopathology of POIS, but the presence of manifestations in symptom clusters and absence of uniformity may point to different etiologies of the disease. It has been theorized that an allergic reaction could be responsible¹. Waldinger and Schweitzer stated that during ejaculation and orgasm, many chemicals are released in the blood and an allergic reaction may occur in response to one (or more) of them, causing POIS manifestations. Alternatively, a psychosomatic disorder theory has been proposed by Krishnamurti and Ashoor (personal communications), who stated that these manifestations occur in individuals who believe that loss of vital fluid from the body (i.e. semen) causes weakness. Hypothyroidism (Dean, personal communication), hyperglycemia, hypertension, cortisol depletion, decreased (Dehydroepiandrosterone) DHEA, decreased testosterone, elevated prolactin and disorders of the CNS including alterations in serotonin, catecholamine and endorphin activity, are other suggested theories for this syndrome¹ (Dean, personal communication; Ashworth, personal communication).

There is currently no effective treatment for POIS. Strong analgesics, such as NSAIDs, tramadol HCl and selective serotonin re-uptake inhibitors, taken one hour pre-coital may help some patients but are of no benefit in others^1,2.

Case

Here we present a 45 year old Egyptian engineer who had been in a stable marriage for 10 years and had 3 children. Shortly post-orgasm (within 4–5 seconds), he feels severe fatigue, tiredness and exhaustion with severe muscular, bone and joint pains so that opening his hands becomes very painful. The condition is accompanied by headache, a pale face, eye irritation, low concentration, anxiety and dizziness with severe itching. The patient reported that these manifestations started early with puberty and increased in severity with age and occur with all orgasms whatever the type of sexual activity; night emission, masturbation or vaginal ejaculation. These manifestations are so severe that during the first 2 days post-orgasm he can't go to work, though they gradually fade and disappear by the 5^th day. The patient abstains from sexual activity, although he has a strong desire and rigid erections. He has no history of chronic diseases, operations or drug intake except for life-long atopic manifestations of bronchial asthma, allergic rhinitis and neurodermatitis and occasionally uses symptomatic treatment to treat these manifestations.

On examination the patient had fair general health, was well built and had complete secondary sex characters. His weight was 97 kg, height was 177 cm and blood pressure was 125/85 mm/Hg.

The results of routine laboratory tests (complete blood picture, renal function, blood sugar and prostatic smear) were all normal. The results of other laboratory tests are shown in Table 1.

The patient received strong analgesics in the form of Ibubrofen (400 mg on demand) and tramadol (50 mg one hour pre-coitally) but there was no reported benefit. A selective serotonin re-uptake inhibitor (escitalopram 10 mg daily at bedtime for 3 months) was also tried with no benefit.

Discussion

The exact etiopathology of POIS is currently unknown. The presentation of symptoms appear in clusters and the differences from one patient to another suggests that there may be more than one cause for this syndrome. Hyperglycemia¹, low cortisol, low testosterone, elevated prolactin (Ashworth, personal communication), hypothyroidism (Dean, personal communication) and low DHEA¹ have all been proposed to explain the etiopathology of POIS. All of these parameters were assessed in this patient and proved to be normal. We believe that the psychosomatic theory, where the belief that loss of vital fluid (i.e. semen) causes weakness, is not applicable to this patient as he is highly educated, successful in his job, has an intact personality and a stable marital life. The elevated liver enzymes in this patient are not related to his problem as his POIS manifestations have been present since puberty.

What should be considered in this patient is his life-long atopy, including neurodermatitis. He reported severe itching after each orgasm as one of his POIS manifestations. We believe this factor to be very interesting, as it may point to and support an allergic etiology¹ in this patient. Previously reported cases did not inquire about or evaluate allergic reactions^1,2. As such, we believe that it is very important to re-evaluate these cases and any forthcoming reported ones for any allergic and hypersensitive reactions.

Conclusion

Much more attention to POIS is necessary to avoid misdiagnosis, to determine its exact etiopathology and to identify an effective treatment. A possible association with different allergic reactions is worthy of further investigation and evaluation.