San Diego Sexual Medicine's POIS Research / Kit's Case

[Kit]

A 24 year old male at the time.

Please consult with a healthcare professional that you trust, if you need medical support. I really like Rena Malik’s M.D POIS video on YouTube. Try sharing it with a doctor. As for psychiatry, I think it may be a good idea for some patients as the psychiatrist can actually help the Primary doctor determine that what you are going through is not something you are making up, and you can come up with a plan with the psychiatrist. I like to think of the psychiatrist, as a doctor who can help your primary doctor to come up with a plan to stop/manage your POIS.

I also recommend seeing Sex Addicts Anonymous if you have trouble sharing what you are experiencing, with porn, sex, etc. if are so ashamed to do so with any other person, including healthcare professionals. This is important because this can make you POIS worse, by making you more aroused, susceptibility to more ejaculation (POIS), and more chances of a wet dream/ NE to occur. It is also important to know that simply, pornography addiction with other factors could be the cause of your POIS. Refraining from porn and/or ejaculation with successful management of POIS and pornography addiction could decrease the severity of your POIS or elimination of it, so it would be plausible to believe that my type of POIS (the syndrome all together) may not be chronic forever. I recommend lots of support from your family members if you get worse. Personally, it is the mature family members that are most likely to support you. Honesty is key!

For me the balance was simply, to masturbate alone, to not set my standards too high, when it comes to a healthy sex life. If you are too lenient with yourself, you might not get sober. If you’re too strict with yourself, you might restrict yourself from healthy behaviors that you did not need to give up, and an inability to meet higher standards could set you up for failure.

[Kit]

I shared my symptoms here and one member mentioned that they were very much like withdrawal symptoms.

I recommend sharing just the main POIS symptoms. That would be good enough.

Personally I don't recommend staying here for too long, as it could cause obsession, and that is not good for your healing.

[Kit]

Reserved

[Kit]

I tried Gadolinium for an MRI before and I just wanted to let members do the research on it, but they always give you a sheet explaining it during the appointment.

[Kit]

This is where I am currently at when it comes to finding some relief or complete relief for my POIS and chronic symptoms. I am still seeking care from my doctors and other healthcare professionals.

The only thing that has truly helped me to maintain a stable life is water. I would drink about 32oz - 64oz a day and this would give me the proper energy I need for the day. When I am hydrated, I would feel “OK” some days and for other days, not so much. I’ve tried niacin (the flush was too much for me), Multi-vitamins, CDB-oil, a gluten-free diet, Lexapro 5mg for about 3 weeks, ginger, garlic pills, GABA, Taurine (GERD prevents further use of Taurine), Vitamin D, Clonazepam and nothing is giving me relief so far (0%-10% relief). NSAID’s (Alka-Seltzer) I think helped at some point for brain fog and muscle pain, but I can’t rely on NSAID’s in the long run. I know that there are many other relief methods that I could try from resources like the Chart of POIS types, everyone’s threads, articles and so forth and I will post here if anything is working for me.

Could an annular tear really be contributing to my POIS symptoms? I still believe that the cause of my POIS, is a result of porn and masturbation use, even if that is not the case for other people.
...

I know this is alot to share, so I really appreciate the time members have taken to look into this. I am not trying to give any false hopes! I do not claim what the cause of POIS is or in anybodys case. I will also gladly give the time to help members! I also hope my post can make a contribution to better understand POIS! At this point, I am more concerned about my chronic state than POIS symptoms, so if anybody has a clue as to what is going on with me, I would really love to know! Like I said before, I will always discuss feedback from my doctors first!

I would also like to say: When doing research for your own well-being, don’t forget to also do the other things you love and enjoy doing! It is ok to do research for your own well-being but there is a fine line where too much information just creates unnecessary anxiety and stress. Always rest when needed and don’t push yourself too hard because your health is always first!

Like I said before, I will be updating and modifying this thread!

Thanks for reading and take care everyone!

-Kit

[Journey]

During stress acutely I get eye floaters, diaphragm and stomach muscles tightening, neck and shoulder area tightening and slight pressure in the forehead eye area

When I stimulate my glans I get this overwhelming tingly kind of sensation somewhere in the lower area of spine, like how when are you being tingled by somebody and it is too much and you contract your muscles except it happens like at the 3rd/4th level from the bottom in the spine

[Journey]

Can I tell that spinal problems could be related to POIS when talking about it on other forums without mentioning you specifically but saying that some POISer/-s have discovered possible spinal problems that could be related to it and probably even could be causing it?

[Mushnikk]

Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?

[Kit]

Can I tell that spinal problems could be related to POIS when talking about it on other forums without mentioning you specifically but saying that some POISer/-s have discovered possible spinal problems that could be related to it and probably even could be causing it?

Hi Journey! Of course you can, just mention me as Kit!

[Kit]

Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?

Bloating? Yes! Fatigue after carbs? I believe so! My dietician recommend that I eliminate corn from my diet to see if this would help with my fatigue after eating. It turns out, when I eliminate corn tortillas and corn products in general from my diet, it helps to reduce my fatigue after eating. It could be that the carbs from the corn tortilla is what was causing the fatigue for me. I would have to experiment with rice and low-non carb foods to confirm this. I am unsure if gut issues are the cause of POIS for me. My gut issue/food sensitivities did not develop until around December of 2019 and Janurary 2020, about four years after the onset of my POIS. I did have gas after eating in the fall of 2018, but I believe that was only because I eat a lot of junk food and fast food. I may have had gut issues, since the onset of my POIS, I just don’t remember anything vividly.

I will be doing a food sensitivity test soon and I hope that with this test, I will be able to regain tolerance to some foods and that it will also help to heal my gut and simultaneously my POIS. My dietician will be guiding me through this. I will also share my results when I get the chance.

I am interested in trying a specific diet to help find relief of my symptoms. So far, I have only tried a gluten-free diet and it didn’t really help. I will discuss diets further with my dietician when I see her again. Have you tried a specific diet that has helped you?

It’s interesting that you say this! I did rely on porn/masturbation, similarly to that of an opioid addiction. I had this issue for more than 2 years and I could not discuss this with anyone until I did with my family. I was able to manage this addiction around July of 2019 and have been able to decrease the amount of times I watched porn/masturbation because of how much it was negatively affecting my life. I relied on porn/masturbation to ironically improve mood, focus, and energy but I would still get POIS symptoms like brain fog, headaches, irritation, but I was able to somewhat overcome my POIS symptoms from the improved mood, focus, energy, stress relief or you can call it, a ‘high’ feeling, after porn/masturbation. Does anyone know what I’m talking about? I had difficulty discussing this with anyone, even my own family. It was a strange but messed up time in my life. This would be a great topic to discuss with my sex therapist. I think I may also look into the realm of opioid addiction/withdrawal research and treatment and see if a type of treatment can help with my POIS. Thank you very much for this comment!

I have not tried Tramadol. I don’t suffer from any moderate to severe pain now thankfully! At the worst, a symptom would be at a 3/10 pain/bothersome severity, but it’s not very often.

Yes, I have been experimenting with CBD oil 750mg oil 5 drops in the morning and before bedtime and I titrate up to a dropperful in the morning and before bedtime for about a month now. There were times where I had missed to take it in the morning or at night, but I think it would have had an effect on me by now. Currently, I am only taking 2 drops at night and I will let you guys know if I get any benefit from that.

I have tried walking, 7 minute jogging, and skateboarding after O and it doesn’t do much for my POIS. I still have brain fog, irritation, just not feeling at 100%. I can still do some movement like jogging and skateboarding, but I can’t do any running or moderate-high intensity cardio. For weight training, I find it best to wait until my POIS symptoms have resolved to do at most a 20-30min up to an hour minute weight training session and to do so safely and not push myself. Even then, it still feels like my body is not responding properly to the workout the way it should be, and I listen to this and stop if I feel that it not a good idea to continue any further. I can probably do lighter weights and shorter sessions to have a consistent workout session in and out of POIS. I will let you know how this goes!

Interesting! How would Silodosin help?

[Prospero]

Tramadol is an opioid which, like codeine, may give you an indication regarding problems with endorphin production or receptors, if it helps you. It's not about pain. Pain is absolutely not a major symptom for me and opioids suppress my post-orgasmic symptoms. I also have a story of a kind of addiction to masturbation, in the years when my Pois appeared.
Tramadol/codeine may help for other reasons than opioid issues though, it may notably inhibit microglia or glutamate, it seems.
If you really have problems with opioid receptors, low dose Naltrexone has also been discussed as a possible treatment by some people. I don't know anyone here who reported having used it, though.

[Mushnikk]

Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?

Bloating? Yes! Fatigue after carbs? I believe so! My dietician recommend that I eliminate corn from my diet to see if this would help with my fatigue after eating. It turns out, when I eliminate corn tortillas and corn products in general from my diet, it helps to reduce my fatigue after eating. It could be that the carbs from the corn tortilla is what was causing the fatigue for me. I would have to experiment with rice and low-non carb foods to confirm this. I am unsure if gut issues are the cause of POIS for me. My gut issue/food sensitivities did not develop until around December of 2019 and Janurary 2020, about four years after the onset of my POIS. I did have gas after eating in the fall of 2018, but I believe that was only because I eat a lot of junk food and fast food. I may have had gut issues, since the onset of my POIS, I just don’t remember anything vividly.

I will be doing a food sensitivity test soon and I hope that with this test, I will be able to regain tolerance to some foods and that it will also help to heal my gut and simultaneously my POIS. My dietician will be guiding me through this. I will also share my results when I get the chance.

I am interested in trying a specific diet to help find relief of my symptoms. So far, I have only tried a gluten-free diet and it didn’t really help. I will discuss diets further with my dietician when I see her again. Have you tried a specific diet that has helped you?

It’s interesting that you say this! I did rely on porn/masturbation, similarly to that of an opioid addiction. I had this issue for more than 2 years and I could not discuss this with anyone until I did with my family. I was able to manage this addiction around July of 2019 and have been able to decrease the amount of times I watched porn/masturbation because of how much it was negatively affecting my life. I relied on porn/masturbation to ironically improve mood, focus, and energy but I would still get POIS symptoms like brain fog, headaches, irritation, but I was able to somewhat overcome my POIS symptoms from the improved mood, focus, energy, stress relief or you can call it, a ‘high’ feeling, after porn/masturbation. Does anyone know what I’m talking about? I had difficulty discussing this with anyone, even my own family. It was a strange but messed up time in my life. This would be a great topic to discuss with my sex therapist. I think I may also look into the realm of opioid addiction/withdrawal research and treatment and see if a type of treatment can help with my POIS. Thank you very much for this comment!

I have not tried Tramadol. I don’t suffer from any moderate to severe pain now thankfully! At the worst, a symptom would be at a 3/10 pain/bothersome severity, but it’s not very often.

Yes, I have been experimenting with CBD oil 750mg oil 5 drops in the morning and before bedtime and I titrate up to a dropperful in the morning and before bedtime for about a month now. There were times where I had missed to take it in the morning or at night, but I think it would have had an effect on me by now. Currently, I am only taking 2 drops at night and I will let you guys know if I get any benefit from that.

I have tried walking, 7 minute jogging, and skateboarding after O and it doesn’t do much for my POIS. I still have brain fog, irritation, just not feeling at 100%. I can still do some movement like jogging and skateboarding, but I can’t do any running or moderate-high intensity cardio. For weight training, I find it best to wait until my POIS symptoms have resolved to do at most a 20-30min up to an hour minute weight training session and to do so safely and not push myself. Even then, it still feels like my body is not responding properly to the workout the way it should be, and I listen to this and stop if I feel that it not a good idea to continue any further. I can probably do lighter weights and shorter sessions to have a consistent workout session in and out of POIS. I will let you know how this goes!

Interesting! How would Silodosin help?

Re Silodosin, see this study, it worked for me as well: https://sci-hub.se/10.1038/s41443-020-0314-9

Have you tried CBD oil 90 minutes before orgasm with a higher dosage? This was the first thing that made a difference for me. Likely a similar mechanism that is involved with Tramadol. Successful here: https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184

SIBO/low-fodmaps diets and cutting out all sugar also seems to have improved my POIS. Definitely look more into that with a SIBO breath test, and perhaps, if you can through your doctor, get a D-Lactate urine test.

[Kit]

Tramadol is an opioid which, like codeine, may give you an indication regarding problems with endorphin production or receptors, if it helps you. It's not about pain. Pain is absolutely not a major symptom for me and opioids suppress my post-orgasmic symptoms. I also have a story of a kind of addiction to masturbation, in the years when my Pois appeared.
Tramadol/codeine may help for other reasons than opioid issues though, it may notably inhibit microglia or glutamate, it seems.
If you really have problems with opioid receptors, low dose Naltrexone has also been discussed as a possible treatment by some people. I don't know anyone here who reported having used it, though.

Hi Prosperos! Problems with opioid/endorphin production or receptors would make sense for my case. It could explain the lack of a “euphoric” feeling after exercise and other certain activities like massage and self-massage (sometimes) that would help to make me feel good during or after the activity. I may have screwed up my endogenous opioid system. Congrats on your relief method, I hope that it helps to better understand your post-orgasmic symptoms! What type of opioid(s) do you use to suppress your POIS symptoms, is one of them Tramadol? I have already read the summary Mushnikk has sent me regarding POIS and the endogenous opioid system, so thank you guys for that! I will be discussing this with Dr. I. Goldstein when I have the chance!

[Mushnikk]

I can say that tramadol works for me as well. Almost no symptoms with 25mg Tramadol 1 1/2 hours before orgasm plus my premature ejaculation ist gone.

Muon pointed out why both CBD oil and Tramadol work for me:

 

A lower dose of tramadol may be needed when you combine it with CBD:
Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors

plus the Opioid thread here: https://poiscenter.com/forums/index.php?topic=2042.15

and the paper by Jiang et al. discussing the opioid hypothesis: https://sci-hub.se/10.1111/jsm.12813

[Kit]

Re Silodosin, see this study, it worked for me as well: https://sci-hub.se/10.1038/s41443-020-0314-9

Have you tried CBD oil 90 minutes before orgasm with a higher dosage? This was the first thing that made a difference for me. Likely a similar mechanism that is involved with Tramadol. Successful here: https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184

SIBO/low-fodmaps diets and cutting out all sugar also seems to have improved my POIS. Definitely look more into that with a SIBO breath test, and perhaps, if you can through your doctor, get a D-Lactate urine test.

https://sci-hub.se/10.1038/s41443-020-0314-9
Thank you!

No, I have not tried CBD oil 90 minutes before orgasm with a higher dosage. Congrats on finding treatments that have worked for you, may it help you to find the long-term relief that you are looking for! Dosages that are over 750mg are fairly expensive. Is there a certain strength that you would suggest? Brand? And how many drops would you take before 90 minutes or some other time interval for the CBD oil strength you had?

https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184
Wonderful!

I already cut out all added sugars from my diet, or at least I do my very best to! A low-FODMAP diet will be tough. I will consider a SIBO breath test and D-Lactate urine test! They look like they are worth looking into.

[Mushnikk]

Hi Kit!

May you also find relief! 

Perhaps exercise helps me because of the opioid link (raises endomorphin), I will look for other ways to naturally increase the bindung at that receptor. Or perhaps some gut bacteria produce metabolites that are somehow involved in the opioid system (perhaps a specific prebiotic with that attribute exists?). And a impaired gut makes in "incompetent" immune system leading to virus activation as laid out by nanna1.

I live in Germany and thus cannot recommend you a CBD brand. Perhaps have a look at the CBD subreddit for a recommendation. I take ~ 12 drops of 10% oil before orgasm, and three drops the next morning and night. I also go to bed right after orgasm. And look for a full-spectrum oil.

[Prospero]

@Kit: I used codeine because I had a bad experience the second time I took Tramadol (seemingly serotonin symptoms). However I don't take codeine often (I did so only two times, in fact), because I somewhat fear tolerance in the long run, and also because it causes me constipation (like all opioids) while I'm already constipated ordinarily. So most of the time I only take Paracetamol after O. (My trials with both Tramadol and codeine were with brands associating them with Paracetamol; Paracetamol alone is already rather efficient [50 to 80% symptoms reduction], but not as much as with opioids [100%].)

@Mushnikk: If Tramadol helps you for premature ejaculation, it may be because of its serotonergic properties. As for me I don't have this problem of PE.
It may be noticed that Paracetamol is said to act also on cannabinoid receptors, maybe a link with CBD oil?

Regarding Silodosin and blocking Alpha1-A receptors, can there be a link with nanna1's theories, the POIS cascade triggered by A1A overexpression, or generally speaking by norepinephrine?

[Kit]

I can say that tramadol works for me as well. Almost no symptoms with 25mg Tramadol 1 1/2 hours before orgasm plus my premature ejaculation ist gone.

Muon pointed out why both CBD oil and Tramadol work for me:

 

A lower dose of tramadol may be needed when you combine it with CBD:
Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors

plus the Opioid thread here: https://poiscenter.com/forums/index.php?topic=2042.15

and the paper by Jiang et al. discussing the opioid hypothesis: https://sci-hub.se/10.1111/jsm.12813

That’s good to hear! It’s interesting how Tramadol helped your PE.

Muon is awesome, he and nanna1 have helped me with the technical aspects of the forum.

Ok, so there is a correlation with cannabinoid and opioid receptors. I will need to study up on that!

And thanks for the other links, there is so much more to learn!

[Kit]

Or perhaps some gut bacteria produce metabolites that are somehow involved in the opioid system (perhaps a specific prebiotic with that attribute exists?). And a impaired gut makes in "incompetent" immune system leading to virus activation as laid out by nanna1.

I live in Germany and thus cannot recommend you a CBD brand. Perhaps have a look at the CBD subreddit for a recommendation. I take ~ 12 drops of 10% oil before orgasm, and three drops the next morning and night. I also go to bed right after orgasm. And look for a full-spectrum oil.

Hi Mushnikk, sorry for the very late reply, I needed time to focus on managing my mental health. All of that seems very interesting. With so many treatment options for my POIS, I would need to prioritize what treatment/therapy options would be best for me. I have never tested positive for any viruses, which makes experimenting for immune competence therapy not as urgent as other treatment options, but I can sure experiment when I am ready and see if it is a prepack that will work for me.

No problem, I found a CBD Full-Spectrum Oil 1,000mg which is also organic. I took 12 drops and 20 drops of oil 90 minutes before orgasm, but unfortunately, it did not help to reduce my POIS symptoms. The 20 drops delayed my symptoms up to an hour. I tried taking CBD oil before with a few drops in the morning and before bedtime, but I would get nightmares when I take it this way. When I decided to not take CBD Oil on the fifth day of this regime, I had a pleasant dream that night. This has happened to me a couple of times and I am unsure if I want to continue taking CBD oil this way because of this. I may have to try a different regime with CBD oil if I want to keep experimenting with it.

Thank you for sharing with me your experience with CBD oil!

[Kit]

@Kit: I used codeine because I had a bad experience the second time I took Tramadol (seemingly serotonin symptoms). However I don't take codeine often (I did so only two times, in fact), because I somewhat fear tolerance in the long run, and also because it causes me constipation (like all opioids) while I'm already constipated ordinarily. So most of the time I only take Paracetamol after O. (My trials with both Tramadol and codeine were with brands associating them with Paracetamol; Paracetamol alone is already rather efficient [50 to 80% symptoms reduction], but not as much as with opioids [100%].)

Hi Prospero, sorry for the very late reply. I’m glad to hear you at least found something that has given you 100% relief and it is unfortunate that is not something that could be used in the long run, but I think that was for the best. Yes I do believe that Paracetamol is pro-cannibinoid. In the past couple months, I tried Tylenol 500mg and 1,000mg within 1-2 minutes after O, and I did not feel a significant change in my POIS symptoms. I took the Tylenol a little bit before bedtime, and I woke up feeling the same as if I had not taken anything. (brain fog, foggy feeling in the head, lightheadness muscle weakness etc.) I will keep experimenting with other relief methods and report here.