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Tired and sweaty after sex? A Dutch doctor said on Friday he is studying a rare new syndrome among middle-aged men who complain of flu-like symptoms for up to a week after having an orgasm.Marcel Waldinger, head of the department of psychiatry and neurosexology at Leyenburg Hospital in the Hague said he planned to publish a report on "post-orgasmic illness syndrome" in the US Journal of Sex and Marital Therapy this month. Waldinger has seen five Dutch men in as many years in his surgery complaining of a range of flu-like symptoms, including a sore throat, sweating, extreme fatigue and eye irritation after sex."Men developed influenza-like symptoms within minutes of having an orgasm. It is like having a serious flu. This happens as soon as they have an orgasm," said Waldinger. "It is a new syndrome or a syndrome which is old but has not been looked at properly." The syndrome could be a physical disorder caused by an allergic reaction or the immune system in direct response to the release of chemicals in the body after sex. The symptoms lasted between three and seven days, he said. "We know that during orgasm and ejaculation very specific compounds like hormones are released into the nervous system. One hypothesis is that they might have had an allergic reaction to one of those compounds," Waldinger said.
We describe the symptoms of a postejaculatory syndrome in two men with spontaneous ejaculations. The syndrome consists of severe fatigue, intense warmth, and a flulike state, with generalized myalgia. These symptoms occur rapidly after ejaculation and only disappear after 4 to 7 days. The symptoms are so severe that sexual activity is avoided. The cluster of symptoms is named postorgasmic illness syndrome (POIS). To date, no explanation has been offered for the etiology and pathogenesis of the symptoms, and the prevalence is unknown. Both cases are presented to draw attention to this syndrome for further research regarding etiology, pathogenesis, and treatment.
Post Orgasmic Illness SyndromeDr. Mulhall presented a case of a 48 year old man complaining of crashing upon ejaculation for 2 days. He feels flu like symptoms, extremely achy, heavy, very sluggish cognitively, and sometimes even sore throat. He avoids ejaculation. Apart from that he is cardiac free with normal testosterone and cortisol. He suffers from hypothyroidism. His libido is normal.Dr. Mulhall found nothing in literature except a single paper (case report on 2 patients) by Dr. Marcel Waldinger and hence was asking about any ideas as regards the pathophysiology and management of this problem.Dr. Kevan tried for such cases a number of analgesics including gabapentin and pregabalin as well as many of the classic treatments for 'prostatitis'. Distraction techniques and other non ejaculatory (but orgasmic) Taoist type sexual activity, he thought might be useful. He also added that for some cultures and many couples, there are a number of psychosomatic or relational factors to considered.Dr. Moser suggested success with Buproprion having anti-anxiety properties with no negative effects on sexual functioning. Dr. Ashour had success with Tramal 50mg PRN. Dr.Dave wrote about a study which tried an opioid antagonist (Naloxone ) given to a group of atheletes having similar symptoms post exercising and questioned if this syndrome could be related to endorphin deficit.Dr. Krishnamurti stated that in some countries some guys believe that loss of semen (vital fluid) causes weakness. Many of these develop post-ejaculatory symptoms to varying degrees, sometimes severe.Detailed discussionDear ISSM Members:Please read below an email from a man who seems to havepost-orgasmic illness syndrome. other than a single paper(case report on 2 patients) by marcel waldinger I have notfound any other useful literature. I would value your thoughtsas to the pathophysiology and management of this problem."My symptoms became apparent about 8 years ago. They arevery simple really. Upon ejaculation I crash. By that Imean, completely (and I mean completely) drained of energyfor about 2 days. I feel flu-ish, extremely achy, heavy,very sluggish cognitively, sometimes even sore throat.Needless to say, I avoid ejaculation. Other than that I am(according to my doctor) a normal, healthy, 48 year old malealthough I have hypothyroidism. I just had a physical and allblood tests and heart are normal. I have had testosteroneand cortisol tested and those are normal. Also, libido isnormal."I am currently seeing a client with the same syndrome. Irecommend contacting Marcel D. Waldinger, He was able to give me some insights into my case. He iscurrentlyconducting another study on this topic but his results havenot beenpublished yet.Annette Owens, MD PhDDear John & AnnetteI am currently trying to help another man with these symptoms in my andrology clinic who avoids ejaculation at all costs. To date he has tried a number of analgesics including gabapentin and pregabalin after trails of many of the classic treatments for 'prostatitis'. Other men I have treated with similar symptoms are often resistant to medical interventions.Distraction techniques and ‘prescribing’ non-ejaculatory (but orgasmic) Taoist type sexual activity may be useful but the aftermath of loss of ejaculatory control for many of these men is too overwhelming and they cannot be persuaded to become sexually active again.Of course for some cultures and many couples there are a number of psychosomatic or relational factors to consider.Kevan.Dear folks,I have had several patients like this as well. I have also noted that they are resistant to medical interventions. My best success is with buproprion XL, but patients often choose to discontinue it, even after it has “helped.”Take care,Charles Moser, PhD, MD, FACPCharleswhat is the rational for Wellbutrin??Pierre AssalianI saw this as an anxiety disorder, at least in my patient.Buproprion doeshave anti-anxiety properties (though many people do notbelieve the data)and it has no negative effects on sexual functioning. Italso tends to energize people, so I thought it might help the feelings offatigue after orgasm.The patient was seen back 2 in weeks; he took 150 mg QD fora week then 300 mg QD for a week. He felt his fatigue was less severeafter orgasm and his girlfriend thought everything was better in theirrelationship. He was seen after another month on 300 mg a day and reported that thefatigue and other symptoms were better and were still improving, but were notyet resolved. He then decided to travel for 6 months and did not want totake the pills with him. Also of note, he broke up with his girlfriend.Pt was lost to follow-up at that point. Take care, Charles MoserDear All:Is it possible to prove that this syndrome is NOT functional in etiology ? What is the scientific explanation for this symptom complex ? In this part of the world, there are millions of guys who believe that loss of semen (vital fluid) causes weakness. Many of these develop post-ejaculatory symptoms to varying degrees, sometimes severe.If there's conjecture about possible organic etiology, it has to be established unambiguously.Sudhakar KrishnamurtiIt is possible, but the patients I have seen did not seem preoccupied with semen loss or overly worried about it. They just noted this response.See reference below.Take care,Charles Moser, PhD, MD, FACPDear Annette and alli had one case of the same symptoms who failed any treatment but what found of geat help is to use Tramadol-Tramal 50 mg as PRN thrapy.Shedeed Ashour ShedeedDear colleagues,The syndrome described is reminiscent of a study I recall in which physically fit volunteers were given an opioid antagonist (Naloxone I think) and then asked to exercise. Rather than experiencing the "high" well known to exercisers after an aerobic session they experienced a response similar –it seems to me- to that described in the post-ejaculatory syndrome: fatigue, anhedonia, etc. So the question: could this be a syndrome of endorphin deficit??Dave
Post Orgasmic Illness Syndrome (Dr. Sarah Ashworth)Dr. Ashworth had a case of an 18 years old male complaining of post orgasmic illness syndrome in the form of cognitive symptoms associated with anxiety and depression. Flouxetine was prescribed which had some effect with regard reducing the amount of nocturnal emissions he experiences but has had little effect regarding his other symptoms post orgasm. Dr. Moser had tried SSRI and Bupropion with limited success. Dr. Ashour suggested the trial of cymbalta or tramal. Dr. Boul thought it might be a form of General Anxiety Disorder (GAD) with the depersonalisation experienced in Panic Attacks which might be related to a past traumatic sexual experience.I am wondering whether it would be possible to post a query on your list or if you could provide me with any further information - particularly practitioners who know something about Post-Orgasmic Illness Syndrome.I am about to conduct a mental health assessment on an 18 year old young man who has given me prior information that he believes that he suffers from POIS. Certainly the symptoms he describes seems to fit with the examples I have just read on your forum. The symptoms he lists are as follows:Lack of concentrationLack of cognitionDisorientationBrain fog <-- most importantAbsentmindednessConfusionShortened attention spanDepersonalizationDe-realizationExhaustion (physically and mentally)Word finding difficultiesTongue tiedInability to comprehend/retain what is readImpairment of speech and/or reasoning (forming thoughts into words)Inability to calculate numbersDepressionAnxiousnessAny advice I could give him about how to get help would be appreciated. He finds his symptoms so troublesome that he has abstained from sexual behavior including masturbation for some time and states, "If I did not have a single orgasm in the rest of my life I would be so happy."He tells me he has seen two GPs, neither of whom had heard of the syndrome and has subsequently been prescribed Fluoxetine 20mg which has had some effect with regard reducing the amount of nocturnal emissions he experiences but has had little effect regarding his other symptoms post orgasm.Hope you can help and best wishes, SarahSarah AshworthI do believe POIS exists, but there is no data on what the underlying problem is or how to treat it. Many of the individuals are quite disturbed about it (understandably), but it is not clear how to help them. I have used SSRI’s to help decrease sexual urges. I have had some limited success with Bupropion. I am also interested in what others have tried.Sincerely,Charles Moser, PhD, MD, FACPDear allYes it exists But the symptoms vary beteen patients. I do believe its a sort of neurotransmitters depletion??? but regarding this case it points to an AD or ADHD background of the pt. Pls check and if not; trial of Dual action anti depressants may help Cymbalta 60 mg. or Tramal 50 mg PRN in very limited range.Shedeed AshourDear SarahThe symptoms of post orgasmic illness syndrome, and the ones you describe for your young clients, sound very much like most of the symptoms of General Anxiety Disorder (GAD) with the depersonalisation experienced in Panic Attacks.My immediate thoughts, particularly with a young inexperienced client, would be around potential past traumatic sexual experiences i.e., early masturbatory trauma - being caught in the act, being ridiculed by a partner, or abused. Indeed, it could be a form of PTSD but it would appear that there haven’t been any long term studies to identify if the episodes intensify or change. The client could also have fears of such things as losing control, sexually transmitted diseases, inadequacy, and there is also a possibility of confusion over sexual identity.Medication for the physical symptoms will assist your client in engaging in therapy and exploring any underlying psychological issues.Hope this is of assistance.Lori Boul PhD