For those wondering about what cytokines, following is an explanation I hope is easy to understand. I know this post is longer than what most POISers attention span can accept, if you have brain fog as a major symptom and you are currently in POIS, but I think it will be helpful in understanding what researchers are talking about in POIS papers. I think that Dr Waldinger may refer to
cytokines as part of the cause of POIS symptoms, in his future work, so this will help you understand what he is writing about. I also had written here about the role I think cytokines have in some POIS symptoms clusters, but I think I never took the time to really explain what they are, so I thought it would be a great time to do it, considering the latest review article of Dr Waldinger ( for the link to the article, see
http://poiscenter.com/forums/index.php?topic=2346.0 )
You can think of cytokines as "micro-hormones", like small hormones produced at the cells level. These micro-hormones are produced by a limited number of cells at a time, in a specific region of the body, like mast cells of the prostate region, for example ( POIS-related example!). The effect of cytokines are usually short range or limited in range, meaning they will not affect the whole body, but some specific cells, usually not so far away, and not every cells of the body. In contrast, hormones are produced by a massive amount of cells grouped in a gland, and they often have long-reaching effects, and may even affect every cells in the body ( like thyroid hormones, or insulin, which is produced by the pancreas, and affect all cells in the body ). But there is no definite frontier between hormones and cytokines in current medical science, there are gray zones and exceptions. So, some cytokines can act as immune messengers that have profound effects on the whole body... which is what Dr Waldinger is proposing as part of POIS pathophysiology, now. Cytokines like interleukin-1 (IL-1), interleukin-6, or TNF-alpha ( Tumor Necrosis Factor alpha) , and many others, are powerful and have effects on the whole body even if produced in small amount. Part of this power is due to the "domino effect" that can be seen in the immune system. For example, mastocytes cells ( mast cells, a kind of white blood cells that act as immune "sentinel") can release cytokines following a reaction in a small part of the body ( for example, like maybe the case in POIS, in the prostate region), and this reaction will spread from one region of the body to another, activating other cytokines and other hormones, spreading like a wave, and also spreading through the blood stream, which will transport those cytokines/immune messengers away, like into the brain.
This rather slow progression of the cytokines "domino effect" from one group of cell to the next may explain the delay seen for POIS symptoms to be fully activated ( the survey done by the Rutgers team with members here show a mean delay of 2 to 3 hours after ejaculation before the full POIS attack has developed). This fits exactly with a "delayed hypersensitivity reaction", the type IV hypersensitivity reactions, a term Dr Waldinger was already using as a hypothesis for POIS in his 2011 article ( part 1). He said at the time that POIS seems to imply both a Type I ( immediate) and a Type IV ( delayed) hypersensitivity reaction.
It is important to note that once this spreading wave of inflammation reach the liver, a major event occurs: the liver, in reaction, produce the powerful "acute phase proteins", another type of immune messenger, including the well-known C-Reactive protein ( CRP), that will further intensify the whole body reaction ( fever, flu-like symptoms, etc). This can be detected in blood tests, directly ( CRP levels), or indirectly ( ESR, erythrocytes sedimentation rate). I mention that because it could happen that CRP and ESR blood test results could be talked about in Dr Waldinger future papers as well. They are usually high in auto-immuen diseases, so I wouldn't be surprised if he would measure them in POIS subjects during POIS attack.
The faster spreading of some symptoms, like brain fog seconds after O for some members, could be explained by a fast delivery of some specific cytokines through the blood stream to the brain ( like a morphine injection will reach the brain quite fast through the blood stream), or by a type I, immediate hypersensitivity reaction ( but that may be the same thing than fast delivery through the blood stream !). These immediate brain symptoms could also be caused by the neurotransmitters released in the brain at the time of orgasm, but that is a neurologic cause, and
that would imply that POIS could be a combination of 3 types of different causes: immediate immune effects, immediate neurologic effects, and delayed immune effects. It is still too soon to discern which are really present in POIS or not. Do not hesitate to ask questions about cytokines or the immune system, and I will do my best to come up with a valid and easy to understand answer.
