Postorgasmic Illness Syndrome (POIS)

[Muon]

(Extreme) fatigue is a common symptom in POIS, namely 83% Ref.
Some individuals may never figure out they suffer from this syndrome, it's even more difficult for any health care provider to come to this conclusion.

For example:
A person may have symptoms, including fatigue, that last for at least a week. If that person has an orgasm once per week then he or she will never notice the change between a POIS and non-POIS state because they are constantly symptomatic 24/7 for this example.

There is an information and support forum for POIS called POIScenter. I will leave some key info in this thread for patients and healthcare providers.

POIScenter forum

POIS Paper Archive - a list of scientific articles about POIS

POIS paper treatment summary

Chart of POIS Types and Their Possible Relief Methods

POIS wikipedia article

POIS Doctors List

Videos

When Sex Makes You Sick: Post Orgasmic Illness Syndrome

What is Post Orgasmic Illness Syndrome (POIS)?

Post Orgasmic Illness Syndrome

The Learning Channel's (TLC) feature TV presentation on POIS

Orgasm: The Trouble with Sex (POIS part) - ABC Documentary

Other platforms

Facebook

Reddit

The Naked Scientists

Note

When registering to the POIScenter forum: Due to limited manpower and bot attacks questions have been implemented into the registration procedure. Answers can be found on the forum or one can email a moderator who will provide these: Contact

Thanks for reading.

 

[leokitten]

Wow, you learn something new all the time on these forums. I’m really sorry you have this, very interesting that many of the symptoms do resemble core ME (other than some of the allergy symptoms).

Though I guess it was possible for you to determine it wasn’t ME, since with ME most any kind of physical, mental, emotional exertion triggers PEM and worsening symptoms, though with POIS it’s from a highly specific kind of exertion.

Also with ME you feel symptoms at baseline all the time even if you aren’t exerting, the only time I don’t feel my symptoms is when I’m sleeping, but within a few second of waking up they are back. With POIS I’d you are abstinent then everything goes away?

 

[Muon]

Well I did get diagnosed with CFS. That happened before the POIS diagnosis was made, but it's not misdiagnosed after all, at least in my case. Out of POIS, when abstaining, there is still a baseline of symptoms present which can get aggrevated by other triggers just like you mentioned, exercise, stress, heat, prolonged talking etc. POIS is a highly dominant and strong 'trigger', it overwhelms everything. Some also respond to release of pre-ejaculate or arousal without having an orgasm, it induces a 1-day mini POIS episode.

There are POISers who are experiencing lighter POIS-like symptoms triggered by other elements like exercise and showers out of POIS. Yes, you are right, many do not experience symptoms while abstaining, everything goes away, they basically have to wait it out and thus can be misdiagnosed with CFS/ME while in POIS mode. That's why I have placed this thread under differential diagnoses. Abstaining can also be used as a diagnostic tool to find out whether you have it or not. There is currently, as of 2020, no marker present for POIS.

It was difficult for me to determine the major part of the fatigue intensity came from POIS. Generally, I had 2 orgasms per week, occasionally 3. The symptoms peaked at ~24h post orgasm, stayed constant up till the end of day 4 and then starting to disappear during day 5 up to day 6 or 7. So the whole circus can last for a week. Having at least 2 orgasms per week kept me in a steady state of symptoms including extreme fatigue. Took me years to find out I had it.

Some have shorter durations of symptoms like 1 or 2 days, and there are extreme cases that last up for a month (like fever up to a month!). The links in my first post contain all the info one need. My case description can be found here.

There may be a few individuals out there who are able to connect the dots when reading this thread.

 

[J.G]

Interesting. My view is that POIS is a logical comorbidity to MECFS.

You may have heard of the MECFS metabolic trap theory. If my reading of it is correct, then it predicts that serotonin will run high in trapped neurons (via TPH2) while dopamine synthesis will be impaired by elevated tryptophan. This is problematic in and of itself, and the precise links to MECFS symptomology will depend on what neurons, in what brain regions are trapped to what extent, and how exactly this influences their regulatory roles as mediated by serotonin and dopamine. These are big questions, and causality remains to be teased out.

Now, POIS. We don't understand the neurobiology of orgasm particularly well. The consensus is, however, that virtually the entire brain takes part in achieving climax, and that climax involves mass monoamine release. Serotonin and dopamine are both monoamines.

What orgasm seems to do under conditions of MECFS, then, is to exacerbate pre-existing neurotransmitter imbalances. Because neuronal serotonin stocks are unusually high, the impulse from its release on climax may be supra-physiological, too. And since tryptophanic inhibition of PAH (and 5HTP negative feedback on DDC; here) means we have trouble synthesising sufficient dopamine under baseline conditions of MECFS, it follows that a dopamine mass release event may leave us unusually depleted, after which we have difficulty returning to baseline.

For me personally, orgasm is a PEM-trigger. Additionally, it makes my brain feel absolutely wretched, as though someone were squeezing it, and it dulls my perception and cognitive abilities. Information processing is a constant struggle with MECFS - my brain is slow, and it "poops out" very quickly. Achieving orgasm makes all this worse. More so, in the days after a climax, I get cranky and irritable, and I become more prone to colds. As for the sensation in my brain, the closest comparison I can think of is to how your muscles feel after an intense workout that's taken you to the absolute limit of your endurance. It brings on the urge to shake and massage my head, like you would loosen up a leg filled with lactate. (I was an endurance athlete before MECFS!)

Anyhow, that's my two cents. I've had MECFS for about a decade a now, and comorbid POIS has become more noticeable and prominent as the disease has progressed from moderate to severe. There could well be a primary MECFS with secondary POIS, versus a primary POIS that shares part of MECFS pathophysiology.

It would be interesting to know whether the POIS community identifies viral or bacterial triggers at illness onset

Tagging @Muon

 

[Pyrrhus]

I couldn't find anything that exactly mimics what you're going through, but here are two related threads that might be helpful:
https://forums.phoenixrising.me/threads/post-sex-exhaustion.80438/#post-2280453
https://forums.phoenixrising.me/threads/choking-after-ejaculation.80131/#post-2275321

 

[Muon]

@ J.G:

Yes I see these CFS comorbities in POIS patients. Wasn't sure to place this thread in the comorbidity section or under differential diagnoses. I've heard about the metabolic trap theory but haven't studied it. About the squeezing you mentioned...some say they get the impression that there is vasoconstriction going on in the brain or abnormal vasomotor responses.

I have seen patients who have primary POIS and developed CFS, and vice versa. I have seen someone who had major improvement in his POIS but still got stuck with CFS. Also people who fixed their POIS and are 100% fine. Yes there are some that developed POIS by infectious triggers.

Some examples from old threads, these are women (less than 10% is female):
https://www.thenakedscientists.com/forum/index.php?topic=6576.msg416323#msg416323
https://www.thenakedscientists.com/forum/index.php?topic=14697.msg210404#msg210404
https://www.thenakedscientists.com/forum/index.php?topic=14697.msg344849#msg344849

Sex researchers having a hard time finding funds to cover sex research. Two researchers are going to challenge the current model or orgasm which is quite dated. They will use POIS patients for their research and will compare the measurements between healthy controls and POISers. Orgasm might be exciting systems that are affected in ME/CFS. So in case of a (partially) shared pathophysiology, POIS research could potentially provide pieces of the ME/CFS puzzle. I expect some answers within 3 years, whether it's related to orgasm itself or POIS.

 

[J.G]

It's worth noting that observations regarding POIS in / and / or MECFS go back (at least) some 25 years. Noted ME specialist Dr. Jay Goldstein in his 1996 Betrayal by the Brain:

"Several of my male patients have complained that they feel exhausted for several days after ejaculating. Although little is known about the central neurochemistry of orgasm, it appears that NE [norepinephrine] facilitates it, and that NE is depleted after ejaculation. If a male neurosomatic patient were deficient in NE prior to sexual activity, ejaculation could thereby worsen his symptoms" (Goldstein 1996: 63).

Norepinephrine is synthesised from dopamine. Goldstein postulates a "dopaminergic hypofunction" in MECFS.

 

[Muon]

That's certainly noteworthy. I know of at least one POISer who developed POIS in the early 70's and wonder how far the reports are going. Seeing how diverse the symptomatology and treatment is, I don't think there is one root cause.

Yes norepi rises in healthy people during O. I can see how dopaminergic hypofunction could potentially be a problem. J.G, you feel better during exposure to lower temperatures right? Do you also get some relief when melatonin rises at night? And do you suffer from premature ejaculation?

 

[Pyrrhus]

I couldn't find anything that exactly mimics what you're going through, but here are two related threads that might be helpful:
https://forums.phoenixrising.me/threads/post-sex-exhaustion.80438/#post-2280453
https://forums.phoenixrising.me/threads/choking-after-ejaculation.80131/#post-2275321

In addition, the sympathetic autonomic response, which inhibits erection but promotes ejaculation, uses adrenergic receptors that respond to norepinephrine. On the other hand, the parasympathetic autonomic response, which promotes arousal and erection, uses cholinergic receptors that respond to acetylcholine.

 

[Muon]

About the norepi:
Specificity of the neuroendocrine response to orgasm during sexual arousal in men

In addition to that Pyrrhus. We see POIS patients with exercised induced POIS or exercise intolerance.
"For example, during exercise there is a progressive decrease in PNS tone and a parallel increase in SNS tone. There are unique situations in which the autonomic response is characterized by either dual activation or dual inhibition. For example, in human adults, sexual arousal is characterized by a dual excitation."
Vagal tone: A physiologic marker of stress vulnerability

I have seen some members here on the Phoenix Rising forum having succes with Pyridostigmine for PEM, if you combine it with the above story it makes sense:
List of ME/CFS Recovery and Improvement Stories

Premature ejaculation is the most commonly reported comorbid condition in POIS, 47% Ref. Even the women with POIS will orgasm within 1 minute of stimulation. Some ideas can be found here if you scroll all the way down to the premature ejaculation header.

"The present study found the balance between the sympathetic and the parasympathetic system was changed in favor of the sympathetic action in patients with lifelong PE. This imbalance might trigger lifelong PE."

"A converse viewpoint is that overactivation of a1-adrenoreceptors via the SNS might lead to PE"

Autonomic Nervous System Dysfunction in Lifelong Premature Ejaculation: Analysis of Heart Rate Variability

I just received some answers from one of the researchers who is involved in the upcoming study funded by POIScenter. I'm posting it here as well:

Muon:

1) Should anal contractions always happen during orgasm?

2) What does it mean if anal contractions are absent during orgasm?

Dr. Nicole Prause:

Hi,

1) Contractions are the main way we define orgasm physiologically, but contractions do not need to be present to experience pleasure and have fulfilling sexuality.

2) We don't know. I'm working on it.

Nicole Prause, Ph.D.

 

[Pyrrhus]

About the norepi:
Specificity of the neuroendocrine response to orgasm during sexual arousal in men

That's a good point: We must consider hormones in addition to neurological stimulation.

I have seen some members here on the Phoenix Rising forum having succes with Pyridostigmine

I would think that Atomoxetine would be better as it is specifically a norepinephrine reuptake inhibitor, without any other mechanisms of action.

It is also important to note that the sympathetic autonomic response and the parasympathetic autonomic response were the first two autonomic responses to be well understood. Although there are many many more types of autonomic responses that are unrelated to either the sympathetic response or the parasympathetic response, people still try to explain autonomic responses in terms of "sympathetic" and "parasympathetic"...

 

[Muon]

Although there are many many more types of autonomic responses that are unrelated to either the sympathetic response or the parasympathetic response, people still try to explain autonomic responses in terms of "sympathetic" and "parasympathetic"...

What do you mean Pyrrhus, could you give some examples?

 

[Pyrrhus]

What do you mean Pyrrhus, could you give some examples?

I was just remarking that the attempt to characterize arousal, erection, and orgasm in terms of "sympathetic" or "parasympathetic" may be oversimplistic.

If you're looking for examples of autonomic responses that are not "sympathetic" or "parasympathetic", I would mention the body's response to cold, the body's response to heat, the body's response to standing/lying down, or the body's response to insufficient food/water.

 

[Muon]

I was just remarking that the attempt to characterize arousal, erection, and orgasm in terms of "sympathetic" or "parasympathetic" may be oversimplistic.

Ah ok in that way, yes I agree.

 

[J.G]

J.G, you feel better during exposure to lower temperatures right? Do you also get some relief when melatonin rises at night? And do you suffer from premature ejaculation?

I'm guessing you read my posts about beneficial cold For about 12 months, continuous overexertion put me into a state of chronic PEM where I constantly felt like I'd been run over by a lorry. I was extremely heat-sensitive during this time, and only cold exposure could bring transient relief.

Icy showers are still a mild PEM-buster for me. I do okay at room temperature now (provided I stay within my very modest exertion limits), and I think the more accurate characterisation for me currently is that I don't handle temperature swings / extremes too well, hot nor cold.

People with ME generally feel better at night. Our day-night cycles are inverted, for whatever reason. Prof Davis talks about it here @30:20, drawing a gene expression comparison to African sleeping sickness.

My POIS onset after orgasm is - from what I understand - also somewhat atypical, in that it's not immediate (ie. within minutes or hours, as is often reported), but delayed by 24-48hrs much like typical exertion PEM. Sadly it's not the act of sex / self-help that causes the PEM; I've investigated this...

Fast, but not premature. Not by consensus classification, and not by personal opinion. In general I think of human orgasmic latency as a bell curve. It seems to me that societal expectations of male sexual stamina give the curve a far fatter "perception" PE tail than is biologically warranted. You could even argue that - historically - PE (or fast ejaculation, perhaps more accurately) bestows an evolutionary advantage where passing on one's genes is imperative. But I digress...

 

[Pyrrhus]

My POIS onset after orgasm is - from what I understand - also somewhat atypical, in that it's not immediate (ie. within minutes or hours, as is often reported), but delayed by 24-48hrs much like typical exertion PEM.

Many ME patients report standard delayed PEM from orgasm, so that may just be your ME. However, these patients report that the PEM is not related to any exertion prior to the orgasm, it appears to be due entirely to the orgasm itself...

 

[J.G]

Many ME patients report standard delayed PEM from orgasm, so that may just be your ME. However, these patients report that the PEM is not related to any exertion prior to the orgasm, it appears to be due entirely to the orgasm itself...

Yup! That is also my thinking. I meant to say that my MECFS comorbid POIS is atypical compared to reports I've read of primary POIS, which appears to be characterised by rapid / immediate onset of symptoms following orgasm.

 

[Muon]

https://poiscenter.com/forums/index.php?topic=3551.msg38085#msg38085

Many do improve with TRT or hCG therapy. I wonder whether they respond to Nitroglycerin.

 

[Muon]

https://poiscenter.com/forums/index.php?topic=2219.msg38315#msg38315

Mr Raba:

"Hi,

I actually flew to LA to see Dr. Jay Goldstein circa 1990. Such a nice guy. I had read his book. Maybe it was not fully published then.

He tried sequentially many of the meds in his list. I could not tell what did what because of the short time they were all administered while in his office. Eventually and due to the literature of the time I tried oxytocin shots. That went badly. DHEA went far worse. It gave me a bad case of OCD that took more than a decade to finally go away. It worked some first, but then I caught chicken pox while on it and what a horrible experience, also and when I tried to go back on it. Like going insane. What I learned with the decades and trials is to very careful taking active hormones that put a forcing function on my tenuous hormonal equilibrium.

Goldstein told me that he knew of several men with just POIS symptoms that had sought his help. So my combo case (POIS and CFS which are labels describing symptoms) was nothing new to him. He did not have a cure for either but it was so nice to talk to great Dr. that got our suffering and dedicated his life to the neuroscience of these conditions. Of course CFS has come far ahead since then.

Although Goldstein knew the conditions were related somehow more than 25 years ago, I am just starting to see greater interest from some POISERs and CFSers on looking at what light one condition might share on the other.

His book is very interesting history. The new science on CFS that helps me as a combo sufferer on both fronts is light years ahead and is well described and published in this site."

https://www.healthrising.org/

 

[Reading_Steiner]

mine has a delay of around 1 hour to 4 hours before the 'PEM' sets in, I would be interested to know how this contrasts with POIS. Is it possible to be on a scale of POIS I wonder ? Having read through the threads I see people whose experiences seem to differ wildly.

In my case, as far as I can tell ' finishing ' vs not seems to make a minor difference, with most of the 'damage' being done during the sexual activity, and scaling up with duration. Physical movement is a factor but its not the main one. Seems to vary a lot over time, sometimes it can only take a small amount of activity to make myself feel noticeably more ill, sometimes can be active for hours with minimal effect, much like other experiences of the illness e.g. walking ability.

The PEM I get from that is different to exercise, if I started intense weightlifting all of a sudden I would feel light headed and dizzy and sometimes a sort of disorientated and a dulling of perception and consciousness, I would get heat issues later on and insomnia.

With sexual activity its more like ... a dull ache low in the stomach at first, then a heavy feeling all over, but different from a crash ( which feels more horrible ), I will also feel overworked in the sort of chest area ( heart maybe ? ), and a bit fuzzy in the brain which makes it hard to start doing some work ( might have to sleep it off first ). The next day I feel generally more depressed and a bit irritable and less motivated, theres an unpleasant feeling all over which is a bit like a dull burning ache that can last days.
I have found a good rule is to not do more sexual activity while still feeling that way, especially if feeling 'rough' and sleeping multiple times a day ( 'rough' = less common feeling that feels kind of like acid stomach ( same feeling as when you don't sleep for long enough at night or stay up all night ) or a viral infection feeling ).

I start to feel energetic stress sometimes just by looking at images, I feel tense and a bit unwell as if I were actually stressed about something, its the physiological reaction which prepares people for sexual activity, its something to do with changes in blood pressure, nerve activation, hormone production etc etc, so I can only guess that is the aspect that causes the most PEM for me. Other things too can have a similar affect like
listening to loud aggressive music when I'm not up to it, or video games that have aspects of conflict or surprise or something, it can help to turn the sound down or off.