There are many POIS theories but given the treatments and things that impact POIS it seems as it's an immune and inflammatory type disorder especially the fact that many kinds of stressors give POIS symptoms not just sexual activities so perhaps immunity is rewired in a way that it thinks it must react during orgasm the strongest and it reacts to other stressors too it could be a latent infection or simply nerve and/or immune dysregulation or specific chemical released during stressors AND sexual activities one that's in higher concentrations during sexual activities than during stressors given that sexual activities give the worst POIS and stressors usually weaker one.