View source for Postorgasmic illness syndrome

{{Short description|Ejaculation-induced chronic symptoms}}
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'''Postorgasmic illness syndrome''' ('''POIS''') is a [[syndrome]] involving chronic physical and cognitive symptoms following [[orgasm]].<ref name=Waldinger2016 /> The symptoms usually onset within seconds, minutes, or hours, and last for up to a week.<ref name=Waldinger2016 /> The cause and prevalence are unknown;<ref name=Wylie2015 /> it is considered a [[rare disease]].<ref name=GARD /> It typically affects men but in rare instances can affect women.<ref name=Waldinger2016 />

== Signs and symptoms ==
The distinguishing characteristics of POIS are:

# the rapid onset of symptoms after orgasm;
# the presence of an overwhelming systemic reaction.<ref name=Waldinger2016 />

POIS symptoms, which are called a "POIS attack",<ref name=Waldinger2016 /> can include some combination of the following: cognitive dysfunction, [[aphasia]], severe [[myalgia|muscle pain]] throughout the body, severe [[fatigue (medical)|fatigue]], weakness, and flu-like or allergy-like symptoms,<ref name=Waldinger2002 /> such as sneezing, itchy eyes, and nasal irritation.<ref name=Balon2005 /><ref name=Wylie2015 /><ref name=Jiang2015 /> Additional symptoms include headache, dizziness, lightheadedness, extreme hunger, sensory and motor problems, intense discomfort, irritability, [[anxiety]], [[gastrointestinal]] disturbances, craving for relief, susceptibility to nervous system stresses, depressed mood, and difficulty communicating, remembering words, reading and retaining information, concentrating, and socializing.<ref name=Balon2005 /><ref name="Nguyen2018" /> Affected individuals may also experience intense warmth or cold.<ref name=Waldinger2002 /> An online anonymous self-report study found that 80% of respondents always experienced the symptom cluster involving fatigue, insomnia, irritation, and concentration difficulties.<ref name=":0">{{Cite journal|last=Strashny|first=Alex|date=September 2019|title=First assessment of the validity of the only diagnostic criteria for postorgasmic illness syndrome (POIS)|url=https://www.nature.com/articles/s41443-019-0154-7|journal=International Journal of Impotence Research|language=en|volume=31|issue=5|pages=369–373|doi=10.1038/s41443-019-0154-7|pmid=31171851|s2cid=174814433|issn=1476-5489|url-access=subscription}}</ref>

The symptoms usually begin within 30 minutes of [[orgasm]],<ref name=Balon2005 /> and can last for several days, sometimes up to a week.<ref name=Waldinger2002 /> In some cases, symptoms may be delayed by 2 to 3 days or may last up to 2 weeks.<ref name="pmid31832334">{{cite journal | vauthors = Bolanos J, Morgentaler A | title = Successful treatment of Post-orgasmic illness syndrome with human chorionic gonadotropin | journal = Urol Case Rep | volume = 29 | issue = | pages = 101078 | date = March 2020 | pmid = 31832334 | pmc = 6889685 | doi = 10.1016/j.eucr.2019.101078 | url = }}</ref>

In some men, the onset of POIS is in puberty, while in others, the onset is later in life.<ref name=":3" /> POIS that is manifest from the first ejaculations in adolescence is called ''primary type''; POIS that starts later in life is called ''secondary type''.<ref name=Waldinger2016 />

Many individuals with POIS report lifelong [[premature ejaculation]], with [[intravaginal ejaculation latency time]] (IELT) of less than one minute.<ref name=Waldinger2016 /><ref name=Jiang2015 />

<blockquote>The 7 clusters of symptoms of criterion 1:<ref name=":3">{{Cite journal|last1=Paulos|first1=Mark R.|last2=Avelliino|first2=Gabriella J.|date=2020-01-01|title=Post-orgasmic illness syndrome: history and current perspectives|journal=Fertility and Sterility|language=en|volume=113|issue=1|pages=13–15|doi=10.1016/j.fertnstert.2019.11.021|pmid=32033716|s2cid=211064753|issn=0015-0282|doi-access=free}}</ref><poem>
# General: Extreme fatigue, exhaustion, palpitations, problems finding words, incoherent speech, dysarthria, concentration difficulties, quickly irritated, cannot stand noise, photophobia, depressed mood
# Flu-like: Feverish, extreme warmth, perspiration, shivery, ill with flu, feeling sick, feeling cold
# Head: Headache, foggy feeling in the head, heavy feeling in the head
# Eyes: Burning, red injected eyes, blurred vision, watery, irritating, itching eyes, painful eyes
# Nose: Congested nose, watery/runny nose, sneezing
# Throat: Dirty taste in mouth, dry mouth, sore throat, tickling cough, hoarse voice
# Muscle: Muscle tension behind neck, muscle weakness, pain in muscles, heavy legs, stiff muscles
</poem></blockquote>

=== Synonyms and related conditions ===
POIS has been called by a number of other names, including "postejaculatory syndrome",<ref name=Waldinger2002 /> "postorgasm illness syndrome",<ref name=Ashby2010 /> "post ejaculation sickness",<ref name=Goldstein2011 /> and "post orgasmic sick syndrome".<ref name=GARD />

[[Dhat syndrome]] is a condition , [[N. N. Wig]] first coined the term and described in 1960 in India,<ref>{{Cite journal |last=Rao |first=T. S. Sathyanarayana |date=2021 |title=History and mystery of Dhat syndrome: A critical look at the current understanding and future directions |journal=Indian Journal of Psychiatry |volume=63 |issue=4 |pages=317–325 |doi=10.4103/psychiatry.IndianJPsychiatry_791_20 |doi-access=free |issn=0019-5545 |pmc=8363894 |pmid=34456344}}</ref> with symptoms similar to POIS.<ref name=Ashby2010 /> Dhat syndrome is thought to be a [[culture-bound syndrome|culture-bound]] [[psychiatry|psychiatric]] condition and is treated with [[cognitive behavioral therapy]] along with anti-anxiety and antidepressant drugs.<ref>{{cite book|url=https://books.google.com/books?id=DXHBBwAAQBAJ&pg=PA521|page=521|title=Clinical Manual of Cultural Psychiatry|last=Lim|first=Russell F.|edition=2d|publisher=American Psychiatric Pub|year=2015|isbn=978-1-58562-439-3}}</ref>

[[Post-coital tristesse]] (PCT) is a feeling of [[depression (mood)|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. POIS affects both men and women but more frequently affects men, consists primarily of physiological symptoms that are triggered by orgasm 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.<ref name=Ashby2010 />

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<ref name=Burri2011 /> over the days or weeks after intense sexual stimulation. Such phenomena may be part of [[mating (human)|human mating physiology]] itself.

[[Sexual headache]] is a distinct condition characterized by headaches that usually begin before or during orgasm.<ref>{{cite web|url=https://globalnews.ca/news/3560226/sexual-headaches-what-are-they-who-gets-them-and-are-they-dangerous/|title=Sexual headaches: What are they, who gets them and are they dangerous?|publisher=[[Global News]]|date=28 June 2017|access-date=24 February 2020}}</ref>

== Mechanism ==
{{More medical citations needed|date=February 2019}}
The cause of POIS is unknown. Some doctors hypothesize that POIS is caused by an [[autoimmunity|auto-immune reaction]].<ref>{{cite book|url=https://books.google.com/books?id=vdKiDwAAQBAJ&pg=PA256|page=256|title=Psychopathology in Women: Incorporating Gender Perspective into Descriptive Psychopathology|last=Sáenz-Herrero|first=Margarita|edition=2d|publisher=Springer|year=2019|isbn=978-3-030-15178-2}}</ref> Other doctors suspect a [[endocrine disease|hormone imbalance]] as the cause. Different causes have also been proposed. None of the proposed causes can fully explain the disease.

=== Allergy hypothesis ===
According to one hypothesis, "POIS is caused by [[Type I hypersensitivity|Type-I]] and [[Type IV hypersensitivity|Type-IV]] allergy to the males' own semen".<ref name=Waldinger2016 /><ref name=Farley2011 /><ref name=Reuters2002 /> This was conditioned by another study stating "[[Immunoglobulin E|IgE]]-mediated semen allergy in men may not be the potential mechanism of POIS".<ref name=Jiang2015 />

Alternatively, POIS could be caused by an auto-immune reaction not to semen, but to a different substance released during ejaculation, such as [[cytokine]]s.<ref name=Ashby2010 />

=== Hormone hypothesis ===
According to another hypothesis, POIS is caused by a hormone imbalance, such as low [[progesterone]],{{medcn|date=January 2017}} low [[cortisol]], low [[testosterone]], elevated [[prolactin]], [[hypothyroidism]], or low [[DHEA]].<ref name=Attia2013 />

POIS could be caused by a defect in [[neurosteroid]] precursor synthesis. If so, the same treatment may not be effective for all individuals. Different individuals could have different missing precursors leading to a deficiency of the same neurosteroid, causing similar symptoms.{{medcn|date=January 2017}}

=== Withdrawal hypothesis ===
The majority of POIS symptoms like fatigue, muscle pains, sweating, mood disturbances, irritability, and poor concentration are also caused by [[withdrawal symptoms|withdrawal]] from different drug classes<ref>{{Cite journal|last1=West|first1=Robert|last2=Gossop|first2=Michael|date=1994|title=Overview: A comparison of withdrawal symptoms from different drug classes|journal=Addiction|language=en|volume=89|issue=11|pages=1483–1489|doi=10.1111/j.1360-0443.1994.tb03747.x|pmid=7841860|issn=1360-0443}}</ref> and natural reinforcers.<ref>{{Cite journal|last=Olsen|first=Christopher M.|date=2011-12-01|title=Natural rewards, neuroplasticity, and non-drug addictions|url= |journal=Neuropharmacology|series=Synaptic Plasticity and Addiction|language=en|volume=61|issue=7|pages=1109–1122|doi=10.1016/j.neuropharm.2011.03.010|pmid=21459101|issn=0028-3908|pmc=3139704}}</ref> It is  unknown whether there is a relationship between [[hypersexuality]], [[pornography addiction]], [[Sexual addiction|compulsive sexual behavior]] and POIS. Some evidence indicates that POIS patients have a history of excessive masturbation, suggesting that POIS could be a consequence of sex addiction. There is anecdotal evidence on porn addiction internet forums, that many men experience POIS like symptoms after ejaculation.<ref>{{Cite book|last1=Tsai|first1=Chengchung|last2=Li|first2=Minyi|title=Proceedings of the 2nd International Conference on Contemporary Education, Social Sciences and Ecological Studies (CESSES 2019) |chapter=A New Exploration of the Combined Treatment of Symptoms and Social Work Psychology in Male Sexual Addiction Patients |date=October 2019|url=https://www.atlantis-press.com/proceedings/cesses-19/125920296|language=en|publisher=Atlantis Press|doi=10.2991/cesses-19.2019.118|isbn=978-94-6252-816-1|doi-access=free}}</ref>

=== Other possibilities ===
POIS could be caused by [[hyperglycemia]]<ref name=Attia2013 /> or by chemical imbalances in the brain.<ref name=Friedman2009 />

[[Virginity|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, releasing [[mast cell]] mediators that can provoke postcoital asthma and / or [[rhinitis]] in these patients.<ref name="Shah2001" />

It is also possible that the causes of POIS are different in different individuals. POIS could represent "a spectrum of syndromes of differing" causes.<ref name=Ashby2010 />

None of the proposed causes for POIS can fully explain the connection between POIS and [[Premature ejaculation|lifelong premature ejaculation]].<ref>{{Cite journal|last1=Abdessater|first1=Maher|last2=Elias|first2=Sandra|last3=Mikhael|first3=Elie|last4=Alhammadi|first4=Abdalla|last5=Beley|first5=Sebastien|date=2019-09-03|title=Post orgasmic illness syndrome: what do we know till now?|journal=Basic and Clinical Andrology|volume=29|pages=13|doi=10.1186/s12610-019-0093-7|issn=2051-4190|pmc=6721082|pmid=31508233 |doi-access=free }}</ref>

==Diagnosis==
There is no generally agreed upon diagnostic criteria for POIS. One group has developed five preliminary criteria for diagnosing POIS. These are:
<blockquote><poem>
# 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.<ref name=Waldinger2016 />
</poem></blockquote>

POIS is prone to being erroneously ascribed to psychological factors such as [[hypochondriasis]] or [[somatic symptom disorder]].<ref name=Waldinger2002 />

An online survey study suggested that only a small number of self-reported POIS fulfill entirely the five criteria. This study proposed to change the Criterion 3 with “In at least one ejaculatory setting (sex, masturbation, or nocturnal emission), symptoms occur after all or almost all ejaculations.”<ref name=":0" />

==Management==
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.{{citation needed|date=November 2020}}

Affected individuals typically avoid sexual activity,<ref name=Waldinger2002  /> especially ejaculation,<ref name=Waldinger2016 /> or schedule it for times when they can rest and recover for several days afterwards.<ref name=Balon2005  /> In case [[post-coital tristesse]] (PCT) is suspected, patients could be treated with [[selective serotonin reuptake inhibitor]]s.<ref name=Ashby2010 /><ref name=Friedman2009 />

In one patient, the POIS symptoms were so severe, that he decided to undergo removal of the testicles, prostate, and seminal vesicles in order to relieve them. The POIS symptoms were cured by this.<ref name=TLC2011 />

Another patient, in whom POIS was suspected to be caused by cytokine release, was successfully treated with [[nonsteroidal anti-inflammatory drug]]s (NSAIDs) just prior to and for a day or two after ejaculation. The patient took [[diclofenac]] 75&nbsp;mg 1 to 2 hours prior to sexual activity with orgasm, and continued twice daily for 24 to 48 hours.<ref name=Ashby2010 />

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.<ref name=Ashby2010 />

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.<ref name=Waldinger2016 /> Treatment with autologous semen "might take 3 to 5 years before any clinically relevant symptom reduction would become manifest".<ref name=Waldinger2016 />

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 [[medical laboratory|routine laboratory tests]] were normal, the following were attempted, all without success: [[ibuprofen]], 400&nbsp;mg on demand; [[tramadol]] 50&nbsp;mg one hour pre-coitally; and [[escitalopram]] 10&nbsp;mg daily at bedtime for 3 months.<ref name=Attia2013 />

==Epidemiology==
The prevalence of POIS is unknown.<ref name=Wylie2015 /> POIS is listed as a [[rare disease]] by the American [[National Institutes of Health]]<ref name=GARD /> and the European [[Orphanet]].<ref name=orpha /> It is thought to be underdiagnosed and underreported.<ref name="Nguyen2018" /> POIS seems to affect mostly men from around the world, of various ages and relationship statuses.<ref name=":0" />

===Women===
It is possible that a similar disease exists in women, though, as of 2016, there is only one documented female patient.<ref name=Waldinger2016 />

== References ==

{{Reflist
|refs=

<!-- Academic papers -->

<ref name=Shah2001>{{cite journal | url=http://medind.nic.in/iae/t01/i3/iaet01i3p135.pdf | title=Asthma and sex. | author=Shah A | journal=Indian J Chest Dis Allied Sci. | date=Jul 2001 | volume=43 | issue=3 | pages=135–7 | pmid=11529431 }}{{Dead link|date=December 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

<ref name=Waldinger2002>{{cite journal | title=Postorgasmic illness syndrome: two cases|last1=Waldinger|first1=MD|last2=Schweitzer|first2=DH | journal=[[Journal of Sex & Marital Therapy]]|date=May 2002  | volume=28 | issue=3 | pages=251–5 | doi=10.1080/009262302760328280 | pmid=11995603|s2cid=27162173}}</ref>

<ref name=Ashby2010>{{cite journal | title=Postorgasm illness syndrome--a spectrum of illnesses. |last1=Ashby|first1=J|last2=Goldmeier|first2=D | journal=[[The Journal of Sexual Medicine]]|date=May 2010  | volume=7 | issue=5 | pages=1976–81 | doi= 10.1111/j.1743-6109.2010.01707.x| pmid=20214722}}</ref>

<ref name=Farley2011>{{cite journal | title=Sexual dysfunction: Postorgasmic illness syndrome |author=Farley SJ | journal=[[Nature Reviews Urology]] |date=March 2011  | volume=8 | issue=3 | pages=121 | doi=10.1038/nrurol.2011.17 | pmid=21513019| doi-access=free }}</ref>

<ref name=Attia2013>{{cite journal | title=Post-orgasmic illness syndrome: a case report|vauthors=Attia AM, Yasien HA, Al-Ziny MH | journal=[[Faculty of 1000|F1000Research]] | year=2013 | volume=2 | issue=113 | pages=113 | doi=10.12688/f1000research.2-113.v1| doi-access=free }}</ref>

<ref name=Jiang2015>{{cite journal | title=Postorgasmic illness syndrome (POIS) in a Chinese man: no proof for IgE-mediated allergy to semen. |vauthors=Jiang N, Xi G, Li H, Yin J | journal=[[The Journal of Sexual Medicine]]|date=Mar 2015  | volume=12 | issue=3 | pages=840–5 | doi=10.1111/jsm.12813 | pmid=25630453}}</ref>

<ref name=Nguyen2018>{{cite journal |title=Post-Orgasmic Illness Syndrome: A Review |vauthors=Nguyen HM, Bala A, Gabrielson AT, Hellstrom WJ |journal=Sexual Medicine Reviews |date=January 6, 2018 |volume=6 |issue=1 |pages=11–15 |doi=10.1016/j.sxmr.2017.08.006 |pmid=29128269|doi-access=free }}</ref>

<!-- Secondary sources -->

<!-- <ref name=Berger2002>{{cite news | title=Allergic to sex? (Indications) | work=Family Practice News | date=1 June 2002 | agency=International Medical News Group | author=Berger, Joanne M.}}</ref> -->

<ref name=Balon2005>{{cite book | title=Handbook of Sexual Dysfunction | publisher=Taylor & Francis |veditors=Balon R, Segraves RT | year=2005 | isbn=9780824758264}}</ref>

<ref name=Wylie2015>{{cite book | url=https://books.google.com/books?id=oH64CAAAQBAJ&q=Post%20orgaasmic%20illness%20syndrome&pg=PA75 | title=ABC of Sexual Health | publisher=John Wiley & Sons | year=2015 | pages=75 | isbn=9781118665565 | editor=Wylie KR}}</ref>

<ref name=GARD>{{cite encyclopedia | title=Postorgasmic illness syndrome | encyclopedia=Genetic and Rare Diseases Information Center (GARD) | publisher=[[National Institutes of Health]] | access-date=30 July 2015 | year=2015 | url=https://rarediseases.info.nih.gov/gard/10809/postorgasmic-illness-syndrome/resources/1 | archive-date=5 March 2016 | archive-url=https://web.archive.org/web/20160305193016/https://rarediseases.info.nih.gov/gard/10809/postorgasmic-illness-syndrome/resources/1 | url-status=dead }}</ref>

<ref name=orpha>{{cite encyclopedia | title=Postorgasmic illness syndrome | encyclopedia=Orphanet | access-date=7 August 2015 | year=2015 | url=http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=279947}}</ref>

<ref name=Waldinger2016>{{cite encyclopedia | title=Post-Orgasmic Illness Syndrome | encyclopedia=Handbook of Clinical Sexuality for Mental Health Professionals | publisher=Routledge | author=Waldinger MD |veditors=Levine S, Risen CB, Althof SE | year=2016 | edition=3rd | pages=380 | isbn=9781317507451}}</ref>

<!-- Media -->

<ref name=Reuters2002>{{cite news | url=http://www.freerepublic.com/focus/news/665820/posts | title=Dutch Doctor Identifies Post-Orgasmic Syndrome | work=Reuters Health | date=April 12, 2002 | agency=Reuters | access-date=30 July 2015 | location=Amsterdam}}</ref>

<ref name=Friedman2009>{{cite news | url=https://www.nytimes.com/2009/01/20/health/views/20mind.html | title=Sex and Depression: In the Brain, if Not the Mind | work=The New York Times | date=January 19, 2009 | access-date=30 July 2015 | author=Friedman, Richard A.}}</ref>

<ref name=TLC2011>{{cite episode | title=Weight For It & Desperate Measures | series=[[Strange Sex]] | network=TLC | airdate=May 22, 2011 | season=2 | url=https://www.youtube.com/watch?v=6sdaR18vw1s |archive-url=https://ghostarchive.org/varchive/youtube/20211215/6sdaR18vw1s |archive-date=2021-12-15 |url-status=live}}{{cbignore}}</ref>

<ref name=Goldstein2011>{{cite news | url=http://en.allexperts.com/q/Urology-Male-issues-989/2011/8/post-ejaculation-sickness.htm | title=Urology: Post ejaculation sickness | date=10 Aug 2011 | agency=AllExperts | access-date=30 July 2015 | author=Goldstein A | url-status=dead | archive-url=https://web.archive.org/web/20160417172954/http://en.allexperts.com/q/Urology-Male-issues-989/2011/8/post-ejaculation-sickness.htm | archive-date=17 April 2016 }}</ref>

<!-- Non-POIS-related -->

<ref name=Burri2011>{{cite journal | title=An epidemiological survey of post-coital psychological symptoms in a UK population sample of female twins. |vauthors=Burri AV, Spector TD | journal=Twin Res Hum Genet |date=Jun 2011  | volume=14 | issue=3 | pages=240–8 | doi=10.1375/twin.14.3.240 | pmid=21623654|s2cid=24204845 | doi-access=free }}</ref>
}}

== External links ==
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|  MeSH            = D004542
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|  Orphanet        = 279947
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{{wiktionary|POIS}}

{{Post-orgasmic diseases}}
{{Hypersensitivity and autoimmune diseases}}
{{Gonadal disorder}}
{{General symptoms and signs}}
{{Male diseases of the pelvis and genitals}}
{{Sex}}
{{Human reproductive physiology}}

[[Category:Sexual health]]
[[Category:Rare syndromes]]
[[Category:Orgasm]]
[[Category:Ejaculation]]
[[Category:Urology]]
[[Category:Autoimmune diseases]]