ArticlePDF Available

Case of post‐orgasmic illness syndrome associated with hypogonadism



Introduction Post‐orgasmic illness syndrome is a rare condition that occurs after ejaculation and persists for 2–7 days and is characterized by flu‐like symptoms, which can significantly reduce quality of life. Case presentation A 21‐year‐old unmarried man was referred to our hospital due to flu‐like symptoms that developed after ejaculation by masturbation and persisted for about 2 days. The patient’s free testosterone level was slightly lower than normal. Nonsteroidal anti‐inflammatory drugs were initially administered and helped relieve headache and muscle pain. Thereafter, the patient was able to ejaculate three times a week. In addition, after administering testosterone enanthate once or twice a month, his general fatigue significantly improved, and he could ejaculate every day. Conclusion The pathophysiology of post‐orgasmic illness syndrome has not been fully elucidated. The treatments for this condition must be accurately selected according to pathophysiology.
Case Report
Case of post-orgasmic illness syndrome associated with
Teppei Takeshima, Shinnosuke Kuroda and Yasushi Yumura
Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
Abbreviations & Acronyms
AMS = aging male symptom
hCG = human chorionic
NSAIDs = nonsteroidal anti-
inammatory drugs
POIS = post-orgasmic illness
QOL = quality of life
SHIM = sexual health
inventory for men
SPT = skin pick test
TRT = testosterone
replacement therapy
Correspondence: Teppei
Takeshima M.D., Ph.D.,
Department of Urology,
Reproduction Center, Yokohama
City University Medical Center,
4-57 Urafune-cho, Minami-ku,
Yokohama, Kanagawa 232-
0024, Japan. Email:
How to cite this article:
Takeshima T, Kuroda S,
Yumura Y. Case of post-
orgasmic illness syndrome
associated with hypogonadism.
IJU Case Rep. 2020;
This is an open access article
under the terms of the Creative
Commons Attribution License,
which permits use, distribution
and reproduction in any
medium, provided the original
work is properly cited.
Received 8 April 2020; accepted
2 June 2020.
Introduction: Post-orgasmic illness syndrome is a rare condition that occurs after
ejaculation and persists for 27 days and is characterized by flu-like symptoms, which
can significantly reduce quality of life.
Case presentation: A 21-year-old unmarried man was referred to our hospital due to
flu-like symptoms that developed after ejaculation by masturbation and persisted for
about 2 days. The patient’s free testosterone level was slightly lower than normal.
Nonsteroidal anti-inflammatory drugs were initially administered and helped relieve
headache and muscle pain. Thereafter, the patient was able to ejaculate three times a
week. In addition, after administering testosterone enanthate once or twice a month, his
general fatigue significantly improved, and he could ejaculate every day.
Conclusion: The pathophysiology of post-orgasmic illness syndrome has not been fully
elucidated. The treatments for this condition must be accurately selected according to
Key words: ejaculatory disorder, hypogonadism, post-orgasmic illness syndrome,
testosterone replacement therapy.
Keynote message
POIS is a rare condition that occurs after ejaculation and persists for 27 days and is charac-
terized by u-like symptoms. We experienced a case of POIS associated with hypogonadism.
We had successfully treated symptoms of POIS with administration of NSAIDs followed by
POIS is a rare condition that occurs after ejaculation and persists for 27 days and is charac-
terized by u-like symptoms.
In 2001, Waldinger and Schweitzer rst reported about POIS,
and proposed ve preliminary diagnostic criteria for POIS, as shown in Table 1.
The symp-
toms of POIS were classied into seven clusters, which can impair a patients motivation to
ejaculate and QOL. However, the actual pathophysiologies of POIS have not been fully eluci-
dated; therefore, effective treatments have not been established thus far. They also have
reported about two patients treated with subcutaneous immunotherapy with autologous semen,
which decreased the symptoms.
However, randomized controlled trials of immunotherapy
have not been performed; thus, the efcacy of this treatment has not been validated. By con-
trast, Ashby et al. have hypothesized that the production of inammatory cytokines is the
mechanism associated with POIS and that the administration of NSAIDs is effective.
we report a case of POIS associated with hypogonadism that was successfully treated with
TRT combined with NSAIDs.
Case presentation
A 21-year-old unmarried man was referred to the mens health clinic of our hospital due to
u-like symptoms that developed after ejaculation by masturbation and that persisted for
about 2 days. He had his rst masturbation with hand thrust at the age of 19 years. Since
then, he experienced general fatigue, chills, headache, nasal congestion, and muscle pain
©2020 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association 1
IJU Case Reports (2020) doi: 10.1002/iju5.12184
almost every after ejaculation. The symptoms lasted for about
2 days and spontaneously disappeared. Moreover, the fre-
quency of his morning erection signicantly decreased. The
patients symptoms met the POIS criteria; therefore, he was
diagnosed with POIS.
The growth of his pubic hair and penis was normal (each
with a Tanners grade of 5). On physical examination, his
testicular volume was a little atrophic on the left side
(12 mL).
His total testosterone level (4.75 ng/mL), gonadotropic
level (luteinizing hormone: 3.5 mIU/mL and follicle stimulat-
ing hormone: 8.7 mIU/mL) was normal, and free testosterone
level (10.3 pg/mL) was mildly low.
The patients AMS score was 45 (psychological: 10,
somatic: 19, and sexual: 16), and his SHIM score was 3.
Antihistamine drugs were administered for allergic symp-
toms. However, the treatment was not effective. For headache
and muscle pain, celecoxib 200 mg, which is an NSAID, was
administered daily just after ejaculation. Immediately after the
intake of the drug, headache and muscle pain were relieved,
and the patient was able to ejaculate 3 days per week. How-
ever, general fatigue did not improve.
Thereafter, in addition to NSAIDs, 250 mg of testosterone
enanthate was administered as a TRT every 2 weeks because
the patients serum free testosterone level was lower than
70% of the average value in young adult men.
His general
fatigue signicantly improved, and morning erection has been
achieved every day. Therefore, he can ejaculate everyday by
masturbation. The patients AMS score decreased to 21 and
SHIM score increased to 7. The interval of drug administra-
tion was changed from 2 to 4 weeks. However, no recurrence
of symptoms was observed.
TRT was switched to testosterone ointment (Glowmin®;
Daito Pharma, Tokyo, Japan), and his symptoms continually
POIS is a rare condition that occurs after ejaculation and per-
sists for 27 days and is characterized by u-like symptoms.
Waldinger et al. have proposed ve preliminary diagnostic
criteria for POIS, as shown in Table 1.
POIS is classied in
two types: primary type (from the rst ejaculation during
puberty or adolescence) and secondary type (from ejaculation
later in life).
POIS develops within 30 min after ejaculation
in 87% of men and persists for an average of 4.6 2.8 days.
Moreover, the average frequency of sexual intercourse in
73% of patients is 1.04 1.00 times per week, and 17.8%
engage in sexual intercourse once in 26 months. However,
6.7% of patients abstain from intercourse.
Therefore, this
syndrome can be a psychological burden on patients, which
can lead to decreased ejaculation frequency, avoidance of
sexual activities and romantic relationships, schedule prob-
lems, and struggles in preventing eroticism.
Therefore, POIS
could signicantly reduce a patients QOL.
However, the pathophysiology of POIS has not been
fully elucidated. Waldinger et al. hypothesized that POIS is
an autoimmune or allergic disorder caused by an inamma-
tory response of the urethral mucosal epithelium to antigens
in a patients own seminal uid. A total of 33 patients
with POIS underwent SPT; 88% had a positive reaction to
their own semen.
Two patients had hyposensitization ther-
apy with autologous semen, and both were successfully
treated, with 60% and 90% improvement in POIS com-
plaints at 31 and 15 months.
However, the efcacy of this
therapy was not assessed in a randomized placebo-con-
trolled study. Alternatively, Ashby and Goldmeier hypothe-
sized that POIS is caused by a disorder in the cytokine
and neuroendocrine response.
In this study, the administra-
tion of NSAIDs (diclofenac) was effective in alleviating
symptoms (up to 80% improvement), and the patient expe-
rienced increased sexual frequency from 2 to 4 times a
In our case, the patients non-specic IgE level
did not increase, as previously reported,
and SPT was not
performed. Alternatively, NSAID was administered and had
a partial efcacy.
Most studies about the physiological involvement of
testosterone in an ejaculatory disorder used animal-based
and human-based studies of the relationship
between serum testosterone level and ejaculatory function
are extremely limited. Several studies have reported that
ejaculatory disorders during sexual intercourse are associated
with decreased serum testosterone levels.
However, few
previous studies has shown that POIS is associated with
In our case, though decline of his free testos-
terone level was modest, POIS associated with hypogo-
nadism was suspected. Because the patient in our case was
not married and did not have any desire to have babies, he
chose TRT once or twice a month though we proposed self-
injection of hCG to avoid possible testicular atrophy due to
the negative feedback of gonadotropin. TRT was markedly
effective. After switching the treatment to testosterone ointment,
his symptoms continually improved. Bolanos and Morgentaler
also reported a case of POIS associated with hypogonadism,
which was successfully treated with administration of hCG.
Herein, we report a case of POIS associated with hypogo-
nadism, which was different from allergy-associated condition,
thereby treatments must be accurately selected according to
Table 1 Five preliminary diagnostic criteria for POIS
Criterion Description
11 of the following symptoms: sensation of flu-like state,
extreme fatigue or exhaustion, weakness of musculature,
experiences of feverishness or perspiration, mood
disturbances and/or irritability, memory difficulties,
concentration problems, incoherent speech, congestion of
nose, or watery nose, itchy eyes
2 All symptoms occur immediately (e.g. seconds), soon (e.g.
minutes), or within a few hours after ejaculation that is
initiated by coitus and/or masturbation and/or spontaneously
(e.g. during sleep)
3 Symptoms occur always or nearly always (i.e. >90% of
ejaculation events)
4 Most of these symptoms last for 27 days
5 Symptoms disappear spontaneously
2©2020 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association
The authors thank Dr Takeshi Tomoda for initial examina-
tions of this case.
Conflict of interest
The authors declare no conict of interest.
1 Nguyen HM, Bala A, Gabrielson AT, Hellstrom WJ. Post-orgasmic illness
syndrome: a review. Sex. Med. Rev. 2018; 6:115.
2 Waldinger MD, Schweitzer DH. Postorgasmic illness syndrome: two cases.
J. Sex. Marital Ther. 2002; 28: 2515.
3 Waldinger MD, Meinardi MM, Schweitzer DH. Hyposensitization therapy
with autologous semen in two Dutch caucasian males: benecial effects in
postorgasmic illness syndrome (POIS; part 2). J. Sex. Med. 2011; 8: 11716.
4 Ashby J, Goldmeier D. Postorgasm illness syndromea spectrum of illnesses.
J. Sex. Med. 2010; 7: 197681.
5 Iwamoto T, Yanase T, Horie H, Namiki M, Okuyama A. Late-onset hypogo-
nadism (LOH) and androgens: validity of the measurement of free testos-
terone levels in the diagnostic criteria in Japan. Int. J. Urol. 2009; 6: 168
6 Waldinger MD. Post orgasmic illness syndrome (POIS). Transl. Androl.
Urol. 2016; 5: 6026.
7 Waldinger MD, Meinardi MM, Zwinderman AH, Schweitzer DH. Postorgas-
mic illness syndrome (POIS) in 45 Dutch caucasian males: clinical character-
istics and evidence for an immunogenic pathogenesis (part 1). J. Sex. Med.
2011; 8: 116470.
8 Jiang N, Xi G, Li H, Yin J. Postorgasmic illness syndrome (POIS) in a Chi-
nese man: no proof for IgE-mediated allergy to semen. J. Sex. Med. 2015;
12: 8405.
9 Corona G, Jannini EA, Vignozzi L, Rastrelli G, Maggi M. The hormonal
control of ejaculation. Nat. Rev. Urol. 2012; 9: 50819.
10 Rastrelli G, Corona G, Maggi M. Testosterone and sexual function in men.
Maturitas 2018; 112:4652.
11 Bolanos J, Morgentaler A. Successful treatment of Post-orgasmic illness syn-
drome with human chorionic gonadotropin. Urol. Case Rep. 2020; 29:
©2020 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association 3
Case of POIS associated with hypogonadism
... POIS can be classified into two types: primary and secondary. 2,6 In primary POIS, symptoms appear after the first ejaculations during puberty or adolescence. In secondary POIS, symptoms manifest later in life. ...
... 6,13 POIS caused by this condition was successfully treated with the administration of human chorionic gonadotropin 13 or testosterone enanthate. 6 However, in our case, the patient's total testosterone level was 10.4 nmol l −1 , luteinizing hormone level was 2.97 mIU ml −1 , and follicle-stimulating hormone level was 7.85 mIU ml −1 , all of which were within the normal range. Therefore, our case of POIS was different from that associated with hypogonadism. ...
... Takeshima et al. (23) administraron antihistamínicos para los síntomas alérgicos del SEP presentados por un varón de 21 años, pero no resultaron eficaces. A fin de tratar el dolor de cabeza y dolor muscular se le administró Celecoxib 200 mg de forma diaria justo después de la eyaculación, reduciendo considerablemente la sintomatología. ...
Full-text available
RESUMEN Introducción: El Síndrome de Enfermedad Postorgásmica (SEP) es una condición médica descubierta recientemente y que ha sido poco estudiada. El primer reporte de este síndrome incluía síntomas parecidos a la gripe, fatiga, irritabilidad o síntomas de alergia, que se manifiestan después del orgasmo y duran entre 2 a 7 días, remitiendo de forma espontánea. Se han revisado los criterios diagnósticos, síntomas, hipótesis etiológicas y tratamientos. Como etiología se proponen la hipersensibilidad al semen, la desregulación transitoria del sistema nervioso autónomo, una respuesta neuroendocrina exagerada o la falta de progeste-rona. Se han descrito casos de buena respuesta a la hiposensibilización, el Diclofenaco y la Silodosina, entre otros. Sin embargo, se requiere más investigación para conceptualizar mejor este síndrome. Se reporta el caso de un paciente de 77 años con SEP y recuperación total con Silodosina. Palabras Clave: Síndrome de Enfermedad Postorgásmica, semen autólogo. ABSTRACT Introduction : Post Orgasmic Illness Syndrome is a recently discovered medical condition that has been little studied. The first report of this syndrome included flu-like symptoms, fatigue, irritability, or allergy symptoms, which manifest after orgasm and last between 2 to 7 days, remitting spontaneously. Diagnostic criteria, symptoms, etiological hypotheses, and treatments have been reviewed. Hypersensitivity to semen, transient dysregulation of the autonomic nervous system, an exaggerated neuroendocrine response or lack of progesterone are proposed as aetiology. Cases of good response to hypo sensitization, Diclofenac and Silodosin, among others, have been described. However, more research is needed to better conceptualize this syndrome. We report the case of a 77-year-old patient with SEP and total recovery with Silodosin.
Post-Orgasmic Illness Syndrome is a rare disorder causing a debilitating cluster of flu-like and allergic-type symptoms that occur immediately or within minutes or hours after ejaculation. Symptoms occur after partnered sex, solo masturbation, or spontaneous ejaculation and can last from 2 to 7 days. The condition is chronic and the onset pattern can be lifelong, occurring in adolescence, or acquired, with onset later in life. Prevalence and incidence are unknown as the condition is likely under-reported and under-diagnosed. The pattern of symptoms suggests an allergic or auto-immune aetiology; however, the exact pathophysiology is unknown, and there is no effective treatment. Men suffering from post-orgasmic illness syndrome describe emotional trauma and significant impairment of their quality of life. They may feel embarrassed and ashamed to report his symptoms preventing them from discussing it with their physician or partner. Furthermore, physicians may be unaware of the diagnosis as it is uncommon.
Full-text available
Post-orgasmic illness syndrome (POIS) is an uncommon condition in which men experience debilitating symptoms following orgasm, including anxiety, weakness, and lassitude. The etiology is unknown, and treatment challenging. We present a 25y man with POIS since puberty. He dreaded ejaculation due to his subsequent symptoms. Multiple prior treatments had failed. Blood tests revealed testosterone (T) deficiency. hCG was prescribed. At 6 weeks T levels normalized with near-complete resolution of symptoms. This successful result argues for hormonal investigation in men with POIS, and a trial of hCG or T therapy if total or free T is low or borderline.
Full-text available
Introduction: Post-orgasmic illness syndrome (POIS) is a rare but debilitating cluster of postejaculatory symptoms affecting men. It is a chronic disorder manifesting as a constellation of flulike and allergic symptoms within seconds, minutes, or hours after ejaculation. POIS can be followed by mental sequelae such as diminished concentration and irritability. POIS negatively affects the life of patients by limiting sexual encounters, dampening romantic prospects, creating internal struggles to avoid eroticism, and affecting patients' schedules. First described in 2002, the prevalence and incidence of POIS are still unknown owing to a paucity of studies but is likely under-reported. There are approximately 50 cases of POIS in the literature. Despite the debilitating effects of POIS, the pathophysiology of POIS is still not well elucidated. Aim: To provide an update on the current literature on POIS, provide updated information on the pathophysiology of POIS, and discuss potential management options. Methods: Comprehensive review of literature pertaining to POIS. Main outcome measures: The symptoms, classification, pathophysiology, diagnostic considerations, and management of POIS were reviewed. Results: There are 5 preliminary diagnostic criteria for diagnosing this condition. POIS is categorized as primary or secondary. The autoimmune-allergy hypothesis is the most accepted hypothesis explaining the pathogenesis of POIS. A competing hypothesis involves a disorder involving endogenous μ-opioid receptors. Another hypothesis invokes impairment of the cytokine and neuroendocrine responses. There are no known treatment modalities for POIS; patients have been symptomatically treated with antihistamines, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful. A trial of non-steroidal anti-inflammatory medication helped 1 patient described in a single case report, but failed to successfully treat other patients. Conclusions: POIS is a rare condition that is underdiagnosed and under-reported. Further studies are warranted to investigate the prevalence, pathophysiology, and treatment of this debilitating condition. Nguyen HMT, Bala A, Gabrielson AT, Hellstrom WJG. Post-Orgasmic Illness Syndrome: A Review. Sex Med Rev 2017;X:XXX-XXX.
Testosterone (T) is deeply involved in every step of the male sexual response. However, the occurrence of sexual disorders cannot be automatically related to a decline in T levels. In fact, this relationship is complicated by organic, relational and psychological factors, which can independently impair sexual function. For example, it is recognized that erectile dysfunction (ED) can result from vascular damage as well as from low levels of T. T therapy (TTh) can improve sexual function but meta-analyses show that it improves erectile function only in men with ED and overt hypogonadism. Similarly, impaired sexual desire can result from a wide range of organic, relational and psychological factors, although it is recognized as one of the most specific symptoms of hypogonadism. Accordingly, low desire is improved by TTh in men with overt hypogonadism. The association between low T levels and delayed ejaculation has not been well studied and needs further confirmation, as does the role of TTh in such cases. Meta-analyses have found that TTh can improve orgasmic function in hypogonadal men. Clinicians should bear in mind that sexual dysfunctions have multifactorial causes and hypogonadism represents only one of these. Only hypogonadal men are likely to improve their sexual symptoms when treated with TTh. The assessment of serum T levels is mandatory before patients are prescribed TTh, as are the assessment and possible treatment of other concomitant conditions.
Men with post orgasmic illness syndrome (POIS) become ill rather immediately after ejaculation, whether spontaneously at night, during sexual intercourse or masturbation. Two subtypes are distinguished: Primary and secondary POIS. It also occurs before or after a man has been sterilized. POIS is an invalidating most probably auto-immune disease leading to much distress in males and their partners. It is characterized by five criteria. Its symptoms are described by seven clusters. However, the manifestation of these symptoms varies from one male to the other but is relatively constant in the person himself. Among men the symptoms vary in intensity, durations and sort of symptoms. POIS is a chronic disorder that manifests itself in POIS "attacks" that occur within a few minutes to a few hours after ejaculation, and disappear spontaneously after 3 to 7 days. POIS is not associated with increased total serum IgE concentrations. On the contrary, there are indications that POIS is triggered by specific cytokines that are released by an auto-immune reaction to the man's seminal fluid. Indirect clinical evidence suggests that the antigen (Ag) triggering the POIS systemic reaction is not bound to spermatozoa but to seminal fluid produced by prostatic tissue. In addition, POIS may also occur-although rarely-in females. In those cases, it is hypothesized that the Ag is associated with female prostatic tissue around the vagina.
IntroductionPostorgasmic illness syndrome (POIS) is a rarely described syndrome characterized by transient flu-like symptoms and cognition disorders. Recent studies suggest that immunogenic reactivity to autologous semen is the underlying mechanism in POIS. However, there are no data published on immunoglobulin E (IgE)-mediated allergy to autologous semen in men without POIS.AimThe purpose of the current work was to characterize the first diagnosed POIS patient in China and to study the allergic response of autologous semen in the affected patient and in three healthy males.Methods Specific IgE was tested with seminal fluid and common perennial aeroallergens in vitro. Skin prick tests and intracutaneous tests with autologous diluted semen were performed in the patient and three healthy donors. The pattern of IgE reactivity to patient's semen was identified using immunoblotting and ELISA.Main Outcome MeasureClinical features of POIS, skin reactions with autologous diluted seminal fluid, and the IgE reactivity patterns of immunoblotting and ELISA in vitro.ResultsA patient was diagnosed with POIS. The patient complained of lifelong premature ejaculation symptoms and allergic rhinitis. Routine laboratory and hormonal assessments were generally within normal range. The patient had a positive skin test with his own semen. Three healthy donors also showed positive skin tests. No semen-specific IgE to autologous semen was detected in the serum of the affected patient or healthy males.Conclusions This is the first report of a man with POIS in China. He had positive skin reactions after injection of autologous seminal fluid but no detectable serum concentrations of specific IgE antibodies. IgE-mediated semen allergy in men may not be the potential mechanism of POIS. Jiang N, Xi G, Li H, and Yin J. Postorgasmic illness syndrome (POIS) in a Chinese man: No proof for IgE-mediated allergy to semen. J Sex Med **;**:**–**.
Hormones regulate all aspects of male reproduction, from sperm production to sexual drive. Although emerging evidence from animal models and small clinical studies in humans clearly point to a role for several hormones in controlling the ejaculatory process, the exact endocrine mechanisms are unclear. Evidence shows that oxytocin is actively involved in regulating orgasm and ejaculation via peripheral, central and spinal mechanisms. Associations between delayed and premature ejaculation with hypothyroidism and hyperthyroidism, respectively, have also been extensively documented. Some models suggest that glucocorticoids are involved in the regulation of the ejaculatory reflex, but corresponding data from human studies are scant. Oestrogens regulate epididymal motility, whereas testosterone can affect the central and peripheral aspects of the ejaculatory process. Overall, the data of the endocrine system in regulating the ejaculatory reflex suggest that widely available endocrine therapies might be effective in treating sexual disorders in these men. Indeed, substantial evidence has documented that treatments of thyroid diseases are able to improve some ejaculatory difficulties.
Postorgasmic illness syndrome (POIS) is a post-ejaculatory complex of local and/or systemic symptoms that nearly always occurs within seconds, minutes, or hours post-masturbation, coitus, or spontaneous ejaculation. Recent data suggest an autoimmunogenic/allergic underlying mechanism. To treat males with POIS by hyposensitization with their own semen (autologous semen). Two males suffering from POIS, of which one male with coincidental lifelong premature ejaculation (PE) were investigated. Based on their local and systemic symptoms including a positive dermatologic reaction after skin-prick testing with autologous semen, auto-allergy to semen was likely an underlying mechanism. A hyposensitization program was initiated, including multiple subcutaneous (SC) injections with autologous semen, initially at 2 weeks intervals in the first year and gradually at 4 weeks intervals in the second and third year. From initial semen dilutions of 1 on 40,000 and 1 on 20,000, the titers were gradually increased to 1 on 20 and 1 to 280, respectively. Evaluation with a dedicated questionnaire about severity of POIS symptoms and specialized interviews on self-perceived intravaginal ejaculation latency times (IELT) before and during the desensitization program. POIS was confirmed in both subjects, PE was confirmed in one male, and skin-prick tests with autologous semen in both subjects were positive. During the program, gradual reduction of complaints resulted in 60% and 90% amelioration of POIS complaints at 31 and 15 months, respectively, which coincided in one male with a delay of the IELT from 20 seconds at baseline to 10 minutes after 3 years of treatment. The cause of this association with IELT is unknown and remains to be elucidated. Two males with POIS were successfully treated by hyposensitization with autologous semen, which supports an immunogenic/allergic etiology and underscores the clinical implication for immunological sexual medicine.
Postorgasmic illness syndrome (POIS) is a combination of local allergic symptoms and transient flu-like illness. In this study, the investigators propose five preliminary criteria to establish the diagnosis. To describe the clinical details in 45 males being suspected of having POIS and to test an immunogenic hypothesis as the underlying mechanism of their presentations. Forty-five males were studied according to standardized protocol, including neuropsychiatric and medical sexological evaluations; their complaints were categorized using their own words, and their self-perceived intravaginal ejaculation latency time (IELT). Skin-prick testing with autologous diluted semen in 33 men were also performed. Clinical features of POIS including self-perceived IELTs and the results of skin-prick testing with autologous diluted seminal fluid. Of the 45 included men, 33 subjects consented with skin-prick testing. Of them, 29 (88%) men had a positive skin-prick test with their own (autologous) semen, and four had a negative test. In 87% of men, POIS symptoms started within 30 minutes after ejaculation. Complaints of POIS were categorized in seven clusters of symptoms, e.g., general, flu-like, head, eyes, nose, throat, and muscles. Local allergic reactions of eyes and nose were reported in 44% and 33% of subjects, a flu-like syndrome in 78% of subjects, exhaustion and concentration difficulties in 80% and 87% of subjects. Of all subjects, 58% had an atopic constitution. Lifelong premature ejaculation, defined as self-perceived IELT < 1 minute, was reported in 25 (56%) of subjects. The combination of allergic and systemic flu-like reactions post-ejaculation together with a positive skin-prick test in the majority of males underscores the hypothesis of an "immunogenic" etiology of POIS, e.g., that POIS is caused by Type-1 and Type-IV allergy to the males' own semen, as soon it is triggered by ejaculation.
We describe two men with marked symptoms following orgasm. In each case, the symptoms were consistent with those found in postorgasm illness syndrome (POIS). Further elucidation of the cause of the patients' symptoms. Both cases were investigated for causes of POIS with biochemical, hormonal, neurological, autonomic, cardiological, and psychological workup. Extensive investigation did not reveal a major organic cause for these patients' symptoms. Detailed history revealed likely differing etiologies in each case. In one case, the symptom picture suggested cytokine release, and, in fact, the patient subjectively improved by 80% on taking nonsteroidal anti-inflammatory drugs just prior to and for a day or two after orgasm. The other case appeared to have an ethnic/cultural etiology that was associated with the "Dhat" syndrome. The apparent differing etiologies/clinical associations of these cases highlight the need for careful history, examination, and investigations in patients presenting with POIS. We recommend that each case needs individual consideration and investigation, and treatment needs to be tailored to the likely cause. It seems likely that POIS represents a spectrum of syndromes of differing etiologies. Further research into the neurobiochemical sequelae of orgasm will be useful in understanding the pathological processes in these cases.
The basis of diagnosis of late-onset hypogonadism (LOH) is the measurement of androgen levels. Traditionally, total testosterone (total T) was also used as the primary indicator of gonadal function in Japan. In 1998, the International Society for the Study of the Aging Male was founded to conduct basic and clinical research on this issue internationally. As a result, it is said that bioavailable testosterone levels should be measured in the diagnosis of LOH. At present, however, there are a number of problems for bioavailable testosterone to become a routine diagnostic tool. Here, we will explain the various measurement indicators of androgens, measurement problems, standard values of total T, and free testosterone (free T) in Japan, and the diagnostic methods for LOH overseas. In Japan, the Japanese Urological Association and the Japanese Association of Men's Health recommend the measurement of free T levels in the diagnosis of LOH, for the following reasons: (i) It has been demonstrated that free T is more strongly correlated with calculated bioavailable testosterone, than total T, showing a statistically significant difference; (ii) The behavior of free T is highly consistent with that of bioavailable testosterone, with free T levels being markedly decreased due to aging; (iii) For the measurement of free T, a method that allows the measurement of free T only, without affecting the balance between free T and protein-bound testosterone in blood, is available; and 4) The mean total T by age range decreases only to 80% of the young adult mean even during presenile and senile periods, when LOH occurs most frequently, but the free T level shows a linear decrease with aging and drops to 50% of the young adult mean. For these reasons, we will describe the validity of the recommendation for the measurement of free T levels.