Post-orgasmic Illness Syndrome

There are many rare and unusual disorders in neuropsychiatry that have captured attention in recent years; these range from misophonia ¹ to leg stereotypy disorder ² . There are many rare and unusual disorders in sexual medicine, as well; these include Koro ³ , persistent genital arousal syndrome^4,5, coital cephalgia^6,7, hypoactive sexual desire disorder specifically in men ⁸ , and post-orgasmic illness syndrome (POIS), the subject of this editorial.

What triggered our interest in this subject? Two unmarried young men recently presented to us. One was aged 22 and the other, 32 years. These patients reported similar symptoms. Briefly, after every or nearly every ejaculation, they experienced feelings of weakness, fatigue, and bodyache with associated work-related impairments that lasted for about 3 days after the ejaculation. In consequence, they were ‘afraid’ of masturbation and ejaculation and, although they wanted to marry, they were reluctant to do so. Unfortunately, both patients did not follow up after the diagnosis was discussed. Both men appeared to meet criteria for POIS.

POIS was first described in 2 male subjects in 2002 ⁹ . Currently, the diagnosis of the disorder is based on straightforward criteria. The syndrome must comprise flu-like symptoms such as feverishness, sweating, muscle pain, headache, weakness, fatigue, nasal congestion or runny nose, impaired attention and concentration, mood disturbances, and others; these symptoms must arise within minutes to hours after (nearly every) ejaculation, whether by masturbation or intercourse; and the syndrome must remit spontaneously in 2-7 days ¹⁰ .

POIS has been reported almost exclusively in men; a similar syndrome has been reported after orgasm in only one woman ¹¹ , to our knowledge. POIS commonly develops during teenage years but can arise at any time of life; these are described as ‘primary’ and ‘secondary’ POIS, respectively ¹¹ . Readers may note that the use of these terms here is at variance with medical literature. ‘Primary’ is usually used to describe a condition that arises on its own and ‘secondary’, a condition that arises as a result of a preexisting disorder. Early-onset POIS and late-onset POIS would be more appropriate descriptors.

The exclusive occurrence in men, the swift onset of symptoms after ejaculation, and the nonspecific, flu-like symptoms suggest that POIS may be an allergic response to an antigen in semen. In this context, positive skin-prick tests to autologous semen were identified in 88% of 33 patients ¹¹ and gradual improvement but not remission was described through desensitization using subcutaneous injection of autologous semen in 2 patients ¹² . Improvement using antihistamine and other treatments have also been described^13,14.

A PubMed search for post-orgasmic illness syndrome, conducted on April 22, 2023, identified only 32 publications between the first one in 2002 and the most recent one in 2023. A recent case report and review ¹⁴ listed only 55 previous cases in world literature, making a total of only 56 cases, in all. No reports of POIS have so far been published from India; it is possible that the 2 men whom we describe in this editorial will be the first on record for this country. One is reminded of how borderline personality disorder was once considered to be a rare or even questionable disorder, then a disorder diagnosed chiefly by western psychiatrists, and finally a disorder that has been reported from all over the world.

Will POIS remain a medical oddity or will it emerge as recognized medical entity? Only time will tell. We hope that this editorial will sensitize readers to the existence of this condition, and that epidemiological studies will define its prevalence, if indeed it is identifiable through population surveys. Awareness of the disorder and of its prevalence could facilitate earlier diagnosis, better study, and formulation of interventional strategies. Until then, the disorder may take up to a decade to be diagnosed in affected men ¹⁴ or may remain unrecognized.