I was finally able to access and read five articles on Postorgasmic illness syndrome (for more information about this syndrome, its Diagnosis Description can be found here), and their content was disappointing—nothing new, nothing studied in more comprehensive detail or larger cohorts. Rosetti et. al’s readily available 2023 study on six subjects with Postorgasmic illness syndrome is still the best recent resource I’ve found to date.
For this last post on Postorgasmic illness syndrome, I want to explore the auto-inflammatory treatments that have been sparsely described in very few patients. Waldinger et. al theorized that Postorgasmic illness syndrome was the result of a combined Type I and Type IV allergic reaction, and treated two patients with Hyposensitivity therapy (more on that below). Kim et. al later theorized a Type IV reaction, and treated one patient successfully with Intralymphatic Immunotherapy (more on that below, too). First, a brief explanation of “wheal & flare.” Next, I’ll touch on Types I and IV hypersensitivity (not necessarily allergic) reactions. Then, we’ll get to the two treatments.
Wheal & Flare
A “wheal” is a bubble-like protrusion on the skin’s surface that’s deeper under the skin’s layers than a blister, and indicates increased permeability of blood vessels related to an immediate immune reaction. The increased permeability of blood vessels leads to seepage of fluid out of blood vessels and into the surrounding tissue, causing the characteristic “wheal.” The picture above is a little more bulbous than your typical wheal, but it gets the idea across. The “flare” is the circular red area surrounding the wheal, represented by the closely spaced ripples immediately surrounding the “wheal” in the photo above. Measuring the “wheal & flare” after an injection of an allergen just under the skin’s surface is part of the typical allergic assessment. It was used in skin prick testing and hyposensitivity therapy in Postorgasmic illness syndrome.
The Four Types of Hypersensitivity Reactions
Yikes! I’m pretty sure I could spend a year on the science behind separating “hypersensitivity” reactions into four distinct types. Just to date myself, my 2008 pathophysiology (how disease works) textbook notes that splitting hypersensitivity reactions into four distinct types is a useful tool to conceptualize these reactions, but is rarely, if ever, so simply divided in an actual human. Usually, several types are involved in any reaction, and they can be both allergic and autoimmune. The basic, four-part split happens in this way:
Type I
Mediated by Immunoglobulin E (IgE), an immune protein that reacts to an antigen, traditionally considered “allergic,” but there are exceptions to this rule (of course there are exceptions! poison ivy is one of the notable ones (not IgE mediated))
Type II
Tissue-specific, roughly meaning antibodies that react against antigens on the membranes of particular types of cells
Type III
Immune Complex, roughly meaning antibodies that react against antigens that have been dissolved in the bloodstream
Type IV
Cell Mediated, specifically mediated by a type of white blood cell called a T lymphocyte, which recruits and activates other immune reactions
(Heuther & McCance, 2008)
Some studies have found limited evidence of an IgE-mediated reaction in Postorgasmic illness syndrome, and some studies have found no evidence of an IgE-mediated reaction. Given how complex immune reactions can be, and that autoimmunity can change which immune system players are at work at any given time, these contradictory findings don’t reveal whether Postorgasmic illness syndrome is autoimmune or not.
Hyposensitivity Therapy
Where there’s hypersensitivity, the remedy is hyposensitivity. Hyper- (fast) is the opposite of Hypo- (slow). The binary simplicity of medical terminology always make me happy, even if it obscures some serious gray areas in actual disease mechanisms and treatments. Waldinger used under-the-skin injections of a participants own semen to gradually reduce symptoms of Postorgasmic illness syndrome. Multiple, small exposures over time are a way to reduce reactivity, and is a method used to desensitize patients to a number of different allergens. In Waldinger’s study of two patients, injections were administered every two weeks in the first year, then spaced to every four weeks in the second and third year. The results are so limited by the study size, and design, that it’s hard to draw very many conclusions from his result. Waldinger did find a slow reduction of complaints, with 60% improvement in symptoms after 31 months of injections in one participant, and 90% improvement in symptoms after 15 months of injections in the second participant. The patient experience in all of this was likely to be difficult. To get the semen, the participants would have to expose themselves to the potential for Postorgasmic illness syndrome symptoms every two weeks for a year, then every four weeks for subsequent years. There is the minor pain and inconvenience of the injections, the long time frame, and the incomplete symptom improvement to consider. Not ideal.
(Waldinger et. al, 2011)
Intralymphatic Immunotherapy
To address the problems with Hyposensitivity therapy, outlined above, Kim et. al tried Intralymphatic Immunotherapy on one patient. They injected the patient’s own semen into an inguinal (groin) lymph node on a monthly basis, for a total of 5 injections. Interestingly, this patient had semen-specific IgE (immune protein E). They note a marked improvement in the patient’s symptoms, and some lab values, although the treatment resulted in flu-like symptoms following the third and fourth injections that persisted for weeks. At 8- and 15-month follow up, after the first injection, sore throat and urinary symptoms were still present, but their duration was shortened. All other Postorgasmic illness syndrome symptoms had resolved.
(Kim et. al, 2018)
Why It Matters
I have always thought that it take a special sauce of utilitarian compassion and necessary psychopathy to be a medical worker of any kind. The treatments outlined above did nothing to dissuade me from this idea. Don’t get me wrong, this is not an indictment of the researchers: I see this special sauce in myself, too. If I were a patient or a study participant, I would definitely want to weigh my disease severity against the cons of the intervention. On the plus side, if Postorgasmic illness syndrome is on the autoimmune-autoinflammatory spectrum, there are two treatment protocols outlined in the literature for a larger research study to examine.
This post concludes my look at Postorgasmic illness syndrome. Next week’s post will be a roundup of recent autoimmune disease research news. There’s been some groundbreaking changes in the past month that I just have to pause and recognize. After that, I’ll be reviewing the research on Palindromic rheumatism. For those who are new to AutoimmuneDx, I am working my way through reader-requests for more information and analysis on particular autoimmune diagnoses. If you would like me to take a closer look at a particular diagnosis, please leave a comment below. If you don’t feel comfortable commenting publicly, email me at autoimmunedx@gmail.com
References
Huether, S. E., & Mccance, K. L. (2008). Understanding pathophysiology. Mosby.
Kim TB, Shim YS, Lee SM, Son ES, Shim JW, Lee SP. Intralymphatic Immunotherapy With Autologous Semen in a Korean Man With Post-Orgasmic Illness Syndrome. Sex Med. 2018 Jun;6(2):174-179. doi: 10.1016/j.esxm.2017.12.004. Epub 2018 Mar 15. PMID: 29550252; PMCID: PMC5960017.
Waldinger MD, Meinardi MM, Schweitzer DH. Hyposensitization therapy with autologous semen in two Dutch caucasian males: beneficial effects in Postorgasmic Illness Syndrome (POIS; Part 2). J Sex Med. 2011 Apr;8(4):1171-6. doi: 10.1111/j.1743-6109.2010.02167.x. Epub 2011 Jan 17. PMID: 21241454.