Post-orgasmic illness syndrome: possible role of mast cells, immunoglobulins, and multi-organ system inflammatory response.

INTRODUCTION: Post-orgasmic Illness Syndrome (POIS) is an incapacitating reaction that erupts following ejaculation/orgasm. The reaction occurs in different clusters, with general fatigue or flu-like symptoms, headache, brain fog, itchy rash, irritated eyes, congested nose, sore throat, and/or muscle tension. Symptoms typically last several hours to days. Although sensitized immune and autoimmune responses are implicated, it is not yet known how the symptoms are initiated or progress into fully-blown POIS. The objective of this narrative review is to assess the potential role played by mast cells, immunoglobulins, and sensitized systemic histamine responses in the etiology of symptoms related to POIS. METHODS: A narrative review of current literature on mast cell and histamine physiology, pathophysiology, studies suggesting that POIS is due to a potential sensitization of mast cells to proteins in semen or other mast cell triggers, stress and conditioned immune responses, and the role of immunoglobulin Es and other immune targets gleaned from successful treatments. Searches for current literature were conducted in PubMed, Web of Science, SCOPUS, and EBSCOhost. RESULTS: The symptoms of POIS resemble those of a systemic cytokine storm and multi-system inflammatory responses to the orgasm trigger more than a simple acute histamine intolerance. Longer duration of symptoms and the mood and neuropsychiatric symptoms are particular to POIS. In some cases of POIS, this may begin with a sensitized immune reaction to constituents in semen in mail POIS patients, while in other cases ejaculation/orgasm may activate mast cells and overwhelm several systems of the body with inflammatory mediators. Many sufferers have a history of allergies, atopic disorders, or known mast cell associated conditions. DISCUSSION: More basic and clinical research is needed to determine both basal and provoked immune and related endocrine and physiological responses at ejaculation/orgasm in individuals with POIS relative to matched controls that do not have POIS.