POIS - Postorgasmic Illness Syndrome (Marta Galleana)

Author: marta galleana
Date: 15/02/2013



Orgasm is characterized by a symphony of neurobiological and psychological interactive processes, of which most parts are still unknown. It is possible that subtle changes in these processes are responsible for a number of disorders and discomforts pertaining to sexuality. In addition, there may be biological syndromes, whose symptoms are erroneously ascribed to psychological factors, somatization, or hypochondria.

Postorgasmic illness syndrome (POIS) is a combination of local allergic symptoms and transient flu-like illness. It has recently been further characterized as a specific immunological reaction by Professor Waldinger and collaborators through a study on 45 caucasian males.


Symptoms appears immediately after the ejaculation and can last from a few days up to some weeks.
Symptoms can be both mental and physical:

  • Common mental symptoms include:
    • Cognitive dysfunction
    • Intense discomfort
    • Irritability
    • Anxiety
    • Craving for relief
    • Susceptibility to nervous system stresses (e.g. cold)
    • Depressed mood
    • Difficulty communicating
    • Remembering words
    • Reading and retaining information
    • Concentrating
    • Socializing
  • Physical symptoms include:
    • Severe fatigue
    • Mild to severe headache
    • Flu-like and allergy-like symptoms
      • Sneezing
      • Ichy eyes9
      • Nasal irritation and muscle pain
  • Intense warmth


Waldinger says this condition is prone to being erroneously ascribed to psychological factors or hypochondria. In a 2010 British Medical Journal case study, Dexter links a form of coital headaches with POIS, and references a science forum in which hundreds of sufferers (a number which is rapidly growing) have detailed their condition. Dexter's patient was found to have low progesterone. Others on the referenced forum have tested low in testosterone, high in cortisol, and a contrast enhanced dedicated pituitary MRI has found pituitary abnormalities in three cases: a pituitary micro adenoma was found in two, and a partially empty sella in the other.

Pathogenesis-Current Theories

Immunogenic Pathogenesis

This is the latest theory developed by Dr. Marcel Waldinger in 2011. His findings indicate POIS is the result of a strong immune response to autologous semen

Orgasm Induced Catecholamine Imbalance via Pituitary Dysfunction

Norepinephrine and epinephrine levels peak upon orgasm and then return to basal levels. The synthesis of these catecholamines is accelerated by ACTH (secreted by the anterior lobe of the pituitary). ACTH also stimulates the release of cortisol to enhance epinephrine synthesis.
Several POIS sufferers have reported having high ACTH levels.
The potential overproduction or prolonged secretion of ACTH induced by orgasm may result in abnormally elevated levels of norepinephrine, epinephrine, and cortisol that could all give rise to the physiological symptoms. Furthermore, under ACTH stimulation, dopamine is converted into norepinephrine at accelerated rates, which could potentially deplete this neurotransmitter and cause the psychological symptoms.

Testosterone Deficiency

Low testosterone levels can cause psychological symptoms that are extremely similar to those of POIS. Several have reported having slightly low testosterone levels, and could be potentially aggravating this condition via orgasm. There is currently no theory explaining how testosterone deficiency symptoms would be aggravated by orgasm.


The psychiatric symptoms may be attributed to an abnormal response to the release of oxytocin immediately after orgasm. Oxytocin has been suggested to negatively interfere with cognition


Affected individuals typically avoid sexual activity, especially orgasm, or schedule it for times when they can rest and recover for several days afterwards.
As reported in a study by Marcel D. Waldinger Marcus M.H.M. Meinardi and Dave H. Schweitzer, POIS can be treated by hyposensitization with autologous semen, which, by all means, support immunogenic/allergic etiology and underscores the clinical implication for immunological sexual medicine.2

This is a list of remedies found on a portal of an online community, whose member are affected by POIS, identified as possible factors in reducing POIS symptoms, even if the actual reason for the improvement could be the listed method , an unknown factor or placebo3

  • Anthistamines(various brand and dosage): Histamine is a hormone/chemical transmitter and important protein that is involved in local immune responses, regulates stomach acid production and acts as a mediator in allergic reactions.
    During an orgasm, histamine is released, and has been connected to the sex flush among women. However, men with high histamine levels may suffer from premature ejaculations.
    People reporting relief using Anthistamines before and after the orgasm
    seems consistent with Dr. Waldinger’s theory of immune response to autologous semen and suggests that histamine could potentially be a major factor in causing this syndrome.
  • Niacin(Vitamin B3 or nicotinic acid): has produced a range of results from ineffectiveness to moderate success to fully alleviating POIS symptoms.
  • Saw palmetto (is an extract of the fruit of Serenoa repens): Traditionally used to treat urinary and reproductive system problems, this extract has consistently yielded moderate relief of physical symptoms for various members.
  • Castration and Prostate Gland Size Reduction: One member underwent castration and surgically reduced the size of the prostate gland under the premise that reducing semen production would cure POIS. As a result, only dry ejaculation can be achieved where orgasm is reached without the production of seminal fluid and spermatozoa. This member claims that he no longer suffers from any POIS symptoms whatsoever. However, mild symptoms do recur when taken off medication that reduces prostate size, namely Avodart and Saw Palmetto. Symptoms last roughly 1 to 2 days.
  • Relora: Some have found Relora, a herbal supplement, to immensely improve symptoms and, in one case, completely resolve POIS. The mechanism of action is not known. However, the manufacturers claim that Relora reduces cortisol and thereby relieves stress. Based on the theoretical role of cortisol in POIS, the potential reduction of cortisol may be what leads to the relieving effects.
  • Phosphatidylserine: (PS) is a phospholipid that naturally occurs in our cells. Interestingly, this supplement has relieved POIS symptoms to a small degree in terms of restoring concentration and clearing brain-fog in various sufferers. Manufacturers of PS openly claim it enhances communication between brain cells by increasing the number of receptor sites.
  • Fenugreek: a popularly used herb and spice. There is currently no scientific research that can directly link this compound to POIS as there is little active research on fenugreek. Strangely, some have found symptomatic relief by taking fenugreek supplements.
  • Garlic: Some have claimed that swallowing whole crushed garlic cloves has yielded some success at reducing symptoms. There is currently no scientific explanation.
  • Masturbation without ejaculation(Edging): This technique has been found to greatly reduce symptoms in terms of clearing brain fog, regaining mental and physical energy, and lifting one’s mood. It involves maintaining sexual stimulation until just before achieving orgasm; upon which time all stimulation is promptly ceased. This technique raises dopamine to high levels. However, since orgasm is not achieved, these levels theoretically remain high or gradually decline in which time psychological symptoms are greatly improved
  • Exercise and enhanced diet: High intensity workouts trigger the release of endorphins and other essential secretions within our bodies. Although short-term exercise has been found to aggravate physical exhaustion caused by POIS, long term exercise over a period of months has immensely helped a number of sufferers. In addition to regular, intense exercise, these sufferers also refined their diets to avoid sugar, significantly reduce fatty and greasy foods, and reduce the amount of processed foods. The combination of increased exercise and improved diet is the most common factor in those who have significantly improved their symptoms.
  • Low Sugar Diet: A low sugar diet alone has been found to improve symptoms.
  • Subsequent Ejaculation: While symptomatic, a subsequent ejaculation has occasionally provided complete relief from symptoms, for several sufferers.
  • Testosterone Patches: The strongest theory is connected to Dr. Marcel Wandinger’s recent Immunogenic Pathogensis theory. Testosterone supplementation in hypogonadal males was found to suppress cytokines, which is a signal carrier that activates the immune system. It may be conceivable that testosterone is indirectly suppressing the immune system and thus reducing symptoms as reported by the aforementioned six members
  • 5-HTP (5-Hydroxytryptophan): This supplement is a naturally occurring precursor to serotonin and is marketed to boost levels of serotonin. It is used as an antidepressant, appetite suppressant, and sleep aid. It seems to help with the mental symptoms.


POIS could affect between 0.25% and 1% of the population.
In the United States of America, POIS is recognized as a rare disorder by the National Institutes for Health (NIH), Office of Rare Diseases Research. It is also listed in the organizational database of the National Organization for Rare Disorders (NORD)


I report here the Discussion consequent the study which first described the phenomenon1:

“The common features of both men included a rapid onset of flulike symptoms after ejaculation that became most intense on the second day and lasted to 4–7 days. The intensity of the complaints led the patient to avoid masturbation and intercourse. Both men suffered from exhaustion, flulike symptoms (very warm feelings, perspiration, headache, burning eyes, sore throat, general myalgia), erythema of the skin (itching, pimples), urinary hesitation, changed stools, mental disturbances (concentration problems and agitation). Remarkably, both men suffered from spontaneous and premature ejaculation (patient 1, lifelong; patient 2, acquired), and both had lifelong hyperhydrosis on exertion. Sexual desire, arousal, and erectile function were normal. Ejaculation itself was not painful. Both couples decided to diminish their sexual activities, although with different coping strategies. Treatment with antihistamines and prednison, taken prior and after intercourse, was based on the assumption of a possible urticarial reaction but did not result in any relief of symptoms. Treatment with Benzodiazepinesand SSRIs (paroxetine and citalopram) was partly successful in the improvement of the mental state but did not result in any disappearance of the somatic features. Both men were not particularly susceptible to viral infections, such as influenza. In fact, their general health had always been excellent. For example, patient 1 had walked the Nijmeegse Vierdaagse, a yearly
4-day walk of 40 km/day, in the Netherlands. He remarked that one ejaculation made him more tired and ill than walking that many kilometers. Both men requested medication to diminish their ejaculation frequency. We decided, therefore, to titrate a very low dose of flutamide, an androgen receptor antagonist, using the gonadotrophins (LH and FSH) as parameters. To avoid hypogonadism, we titrated flutamide up to a maximum of a threefold increase of early morning LH concentrations. This strategy resulted in a substantial decrease of spontaneous ejaculations and intercourse events, although
sexual desire remained at acceptable levels. Despite these clear effects,
the intensity of somatic and mental symptoms after ejaculation were
not affected. On the basis of their experiences, both men voluntarily decided to continue flutamide on a daily basis, thereby accepting a mild diminishing of their libido. Endocrine followup revealed a threefold increase of LH during the treatment period of 3 years.
Emphasizing the severity of clinical features, we propose to call this
cluster of symptoms post-orgasmic illness syndrome (POIS). POIS typically is a postsexual disorder, suggesting that a factor associated with ejaculation or orgasm serves as a trigger for the induction of a cascade of biological reactions. A few studies in males and females have shown that during and after orgasm prolactine and oxytocin concentrations are increased (Carmichael, Warburton, Dixen, & Davidson, 1994; Exton et al., 2000). To our best knowledge, there are no reports in the literature that suggest that these hormones are related to flulike symptoms. However, oxytocine has been suggested to
negatively interfere with cognition (Geenen et al., 1988). We assume that a still-undiscovered factor or mechanism associated with ejaculation or orgasm triggers a cascade of immunological reactions that culminate in the previously described flulike symptoms.
Indeed, flulike syndromes have been described as side effects of the
medical use of cytokines (Vial and Descotes, 1995a, 1995b). Involvement of an immediate-type immune response, clinically represented by urticaria, can be excluded by the unresponsiveness of symptoms to antihistamines. The prevalence of POIS is unknown. We describe these two cases to draw attention to this syndrome and encourage colleagues and investigators to contact us regarding similar case findings. Further research is necessary to unravel the biological background of this post sexual disorder.”

Further study performed by Marcel D. Waldinger, Dave H. Schweitzer and M.H.M. Meinardi on 45 caucasian male, as stated before, characterized better this syndrome concluding that :
“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.”2


[1] "Waldinger MD, Schweitzer DH (2002). Postorgasmic illness syndrome: two cases
2 "Waldinger MD, Meinardi M, Zwinderman A, Schweitzer, D. (April 2011). Postorgasmic Illness Syndrome (POIS) in 45 Dutch Caucasian Males: Clinical Characteristics and Evidence for an Immunogenic Pathogenesis (Part 1). The Journal of Sexual Medicine.
3 POIS Site

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