Published Case Study (2016)
"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 5th 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."
(https://i.imgur.com/ceDV0bW.png)
From Post-orgasmic illness syndrome: a case report (AM Attia, 2016) (https://f1000research.com/articles/2-113/v1)
keywords: testosterone, prolactin, cortisol, DHEA, thyroid stimulating hormone, alanine transanimase, aspartate transanimase
(https://i.imgur.com/57VPVG0.png)
"Case 1
The first case is that of a 57-year-old male... Over the 6 years preceding presentation, he had noticed a gradual onset of symptoms following orgasm. The patient describes experiencing severe physical and mental tiredness and lethargy soon after orgasm. He also complained of flu-like symptoms with myalgia, especially in his legs, excessive sweating, and poor concentration with mental dullness. These symptoms were at times associated with right-sided headache. The collection of symptoms lasts up to 3 days, during which the patient feels that his ability to perform his normal physical and mental activity is impaired.
...After engaging in sexual activity without having orgasm, he does not experience any symptoms. He is a physically active and fit man who exercises regularly, and is able to ride a bike for several hours a week. He does not report any similar symptoms while exercising. The only other situation in which he has experienced similar symptoms is following excessive alcohol ingestion.
...The patient denies any sexual or genital pain. There is no history or clinical features of psychiatric illness, and specifically he has never been diagnosed with depression, anxiety, or psychosis.
...His past medical history includes irritable bowel syndrome and mild hypercholesterolemia.
-From: Ashby J, and Goldmeier D. Postorgasm illness syndrome: A spectrum of illnesses. J Sex Med 2010;7:1976-1981. (https://www.ncbi.nlm.nih.gov/pubmed/20214722)
(https://i.imgur.com/W4Fy9kW.png)
De Amicis, K., et. al., "Immunophenotypical Characterization of a Brazilian POIS (Post-Orgasmic Illness Syndrome) Patient: Adding More Pieces to Puzzle" (2019) (https://www.tandfonline.com/doi/abs/10.1080/0092623X.2019.1677835)
The patient tested negative for HIV.
Table 1 shows an immune deficiency of natural killer (NK) cells and B cells. Also there is an over expression of CD56- NK cell subclass, showing impairment of the innate immune response. There is overexpression of monocytes relative to the healthy controls.
"When a detailed evaluation of the effector cells involved in the immune response was performed, a monocyte increase and an NK cell decrease were observed in the patient with POIS in comparison to the controls, with a reduction in total B cells and normal T cells count. Some studies have shown a decrease of NK cell percentage in association with a reduction of activity of these cells in peripheral blood of patients with depression. Other mental disorders such as mental stress, autism and obsessive-compulsive disorder have also been reported to present lower NK cell activity."
-De Amicis, K., et. al., "Immunophenotypical Characterization of a Brazilian POIS (Post-Orgasmic Illness Syndrome) Patient: Adding More Pieces to Puzzle" (2019) (https://www.tandfonline.com/doi/abs/10.1080/0092623X.2019.1677835)
Table 2 shows that autologous semen injection immune therapy was ineffective.
"In conclusion, we did not confirm the hypothesis that POIS is an auto allergic IgE-mediated syndrome and the patient showed no improvement after immunotherapy."
-De Amicis, K., et. al., "Immunophenotypical Characterization of a Brazilian POIS (Post-Orgasmic Illness Syndrome) Patient: Adding More Pieces to Puzzle" (2019) (https://www.tandfonline.com/doi/abs/10.1080/0092623X.2019.1677835)
My results from a recent checkup with an endocrinologist (in German, but you will hopefully still be able to figure out what was tested for).
Test was performed when I was not experiencing POIS symptoms. Results are in the final column, reference range in the second-to-final column.
(https://i.imgur.com/aO9BqBF.png)
(https://i.imgur.com/0Z500vy.png)
POIS case study involving "subcutaneous injections of human chorionic gonadotropin (hCG)... 1500IU injected subcutaneously three times per week": Successful treatment of Post-orgasmic illness syndrome with human chorionic gonadotropin (2019) (https://www.sciencedirect.com/science/article/pii/S221444201930453X?fbclid=IwAR141vgIvBqRmEQQ6ohjbqO8SrhZ16Vo2xgIKfj1dY-laV5fN3Q_yFHvT_c)
Note: Direct quotes from the linked paper are italicized.
"A 25 year old single heterosexual man was seen for a chief complaint of anxiety, low energy and weakness following ejaculation, accompanied by mental fog and difficulty with word-finding. He avoided social contacts during his symptomatic period. Onset of symptoms could be immediate or delayed by 2-3 days, and would last 1-2 weeks. Symptoms began at 16 years with sexual maturity and continued to the present time, regardless of whether ejaculation occurred via masturbation or intercourse with a female partner...
...he was single and orgasm frequency was once every 2-3 months..
...Adderall provided some benefit for the brain fog. He was under the care of a psychiatrist for anxiety, treated with propranolol. Alprazolam was prescribed as needed for POIS, but provided minor benefit. Trials of treatment for POIS with bupropion, and Vyvanse (lisdexamfetamine dimesylate) were unsuccessful."
height: 6 feet
weight: 175 lbs
BMI: 23.7
His testosterone levels were tested twice prior to hCG treatment period.
2 years prior to treatment:
serum total testosterone: 293 ng/dl ref range: 249-836 ng/dL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
calc free testosterone: 33 pg/mL ref range: 32-168 pg/mL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
During the study, before starting the hCG treatment:
serum total testosterone: 374 ng/dl ref range: 249-836 ng/dL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
free testosterone: 140 pg/mL ref range: 32-168 pg/mL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
luteinizing hormone 4.7 mIU/L
hematocrit 44.7%
During the study, after 6 weeks of hCG treatment:
serum total testosterone: 952 ng/dl ref range: 249-836 ng/dL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
free testosterone: 280 pg/mL ref range: 32-168 pg/mL (https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html)
Luteinizing Hormone "...LH and FSH were below threshold limits."
6 week follow-up (POIS symptoms completely resolved):
"At six-week follow-up his symptoms had resolved completely, and he had discontinued use of alprazolam. He ejaculated more frequently, and experienced no weakness, anxiety, brain fog, or malaise afterwards. He noted improved mood, overall energy, and libido...He reported this was the first time since he was 16y that he could experience orgasm without negative physical or emotional consequences afterwards."
6 month (~24 week) follow-up (POIS symptoms partially returned):
"At six months of follow-up he continued hCG treatment, was happy, and masturbated several times per month. He still described mild POIS symptoms immediately following orgasm, but these resolved within 12 h and were not bothersome. Importantly, he no longer experienced dread with anticipated sexual activity."
Note: Both the 6 week and 6 month follow-ups were assessed while the patient was receiving 1500IU subcutaneous hCG injection treatments.
Arata, Kenta, et al. "Nonsteroidal anti‐inflammatory drugs are effective against postorgasmic illness syndrome: A case report. (https://onlinelibrary.wiley.com/doi/full/10.1002/cia2.12123)" Journal of Cutaneous Immunology and Allergy (2020).
Note: Direct quotes from the linked paper are italicized.
" A 28‐year‐old male visited our hospital due to problems he was experiencing after ejaculating. He had suffered from sweating, discomfort, fatigue, nasal discharge, headaches, and generalized erythema for several days since the first time he ejaculated at the age of 13. The symptoms were always induced after masturbation. He had no partner, had never had sexual intercourse, and experienced premature ejaculation. In addition, he had suffered from moderate atopic dermatitis (AD). Serum total IgE level was 415 IU/mL. He had been treated with antihistamines and herbal medicines for his symptoms after ejaculation, but they were ineffective. He was clinically diagnosed with postorgasmic illness syndrome (POIS), because his symptoms were consistent with the five diagnostic criteria described by Waldinger et. al. (Table S1) (https://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2010.02166.x). We performed skin prick tests (SPT) and intradermal tests (IDT) according to the methods reported previously (Jiang, Xi, Li, Yin, 2015 (https://onlinelibrary.wiley.com/doi/10.1111/jsm.12813)). The SPT and IDT were conducted using autologous semen at dilutions of x1 to x1/10 000, and x1/100 to x1/10 000, respectively. It has been shown that SPT (x1 to x1/10 000) and IDT (x1/1000 and x1/10 000) reactions to autologous semen were not seen in control subjects. In our case, SPT reactions were greatly increased at dilutions of x1 to 1/100, and IDT reactions were observed at dilutions of x1/100 to 1/1000 (Table 1 and Figure S1). These reactions continued for 1‐2 days. We also measured the level of seminal fluid‐specific IgE in the patient's serum using ImmunoCAP(R), which was shown to be <0.100 UA/mL. Serum levels of antinuclear and anti‐DNA antibodies were not detected."
TABLE 1. The results of skin tests to autologous semen
(https://i.imgur.com/ut6LjJm.png)
" We treated our patient with the NSAID, diclofenac 25 mg twice a day, according to a previous report (Ashby and Goldmeier, 2010 (https://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2010.01707.x)). And his post‐ejaculation symptoms disappeared completely...
Skin reactions to autologous semen were reduced at 90 minutes after the oral administration of diclofenac 25 mg (Table 1 and Figure S2). Furthermore, the oral administration of celecoxib 100 mg once a day was also effective against the patient's symptoms.
In our case, no semen‐specific IgE was detected...We also found that celecoxib was as effective as diclofenac. These findings indicate that POIS could be caused by inflammatory mediators that are inhibited in the cyclooxygenase (COX) 2 pathway by the administration of these drugs."