Erectile dysfunction

Postorgasmic Illness Syndrome and Premature Ejaculation [+ Video]

Did you know that some men are seriously ill for up to a week every time they ejaculate? We kid you not. The condition is called postorgasmic illness syndrome, or POIS. If you’re one of the unfortunate men who suffers from POIS, you already know it’s no joke. What you may not know is that researchers are gaining a better understanding of this disease, finding that it’s not as rare as once thought and that men with POIS have treatment options. 

The Five Criteria of Postorgasmic Illness Syndrome

1One or more of the following: sensation of a flu-like state, extreme fatigue or exhaustion, weakness of musculature, experiences of feverishness or perspiration, mood disturbances and/or irritability, memory difficulties, concentration problems, incoherent speech, congestion of nose or watery nose, itching eyes
2All symptoms occur immediately within seconds, minutes, or within a few hours after ejaculation that is initiated by coitus, and/or masturbation, and/or spontaneously (e.g. during sleep).
3Symptoms occur always or nearly always, e.g., in more than 90% of ejaculation events.
4Most symptoms last for about 2 to 7 days.
5Symptoms disappear spontaneously.
Source: Paulos. Postorgasmic illness syndrome. Fertil Steril 2019.

What is Postorgasmic Illness Syndrome (POIS)?

POIS is a cluster of symptoms that causes debilitating illness after ejaculation. Severe flu-like symptoms last for two to seven days, making men sick enough to have orgasm anxiety and to avoid sexual activity. Premature ejaculation is a component of the condition in over half of known cases.

How Common is Postorgasmic Illness Syndrome?

Until recently, POIS was thought to be extremely rare; before 2019, there were only 60 cases documented in the research. However, an anonymous survey done in October 2019 shows the condition to be underdiagnosed, in part because of the wide variety of symptoms it can cause.

The survey found that, of the 180 who responded, 76 percent said they experienced POIS symptoms with 90-100 percent of ejaculations. All of the men reported significant distress because of their POIS. Those who sought medical attention were often told their symptoms were psychological.

The fact that many doctors have never heard of this orgasmic disorder is another reason that POIS might be more common than currently known.  Another possible contributor is that many men feel uncomfortable talking about sensitive sexual issues, even with their doctors.

Lately, however, researchers have discovered common symptoms that suggest a POIS diagnosis once a man seeks treatment.

How is Postorgasmic Illness Syndrome Diagnosed?

The table above shows the five criteria used to diagnose POIS. Premature ejaculation (PE) is not a diagnostic criterion, and it’s not always present. But there is some evidence that lifelong PE and POIS often go hand-in-hand: 56 percent of men with POIS, according to one study, ejaculate after less than one minute of vaginal penetration and 33 percent of those in less than thirty seconds.

What are the Symptoms of Postorgasmic Illness Syndrome?

One man takes desperate measures to cure his POIS 

POIS symptoms begin in seconds to hours following ejaculation, with the average being between one and thirty minutes. They typically last from two to seven days. Many men who suffer from the condition find the symptoms so debilitating that they avoid masturbation and partnered sexual activity. Most men have symptoms even with spontaneous ejaculation, e.g., nocturnal emissions.

POIS symptoms vary from one man to another, but they are typically consistent for each individual. Symptoms appear to cluster into seven groups. Some men will have symptoms from only one cluster, others more than one. The clusters break down as follows:

The Seven Clusters of Criterion 1, Postorgasmic Illness Syndrome

GeneralExtreme fatigue, exhaustion, palpitations, problems finding words, incoherent speech, dysarthria, concentration difficulties, quickly irritated, cannot stand noise, photophobia, depressed mood
Flu-likeFeverish, extreme warmth, perspiration, shivery, ill with flu, feeling sick, feeling cold
HeadHeadache, foggy feeling in the head, heavy feeling in the head
EyesBurning, red, injected eyes, blurred vision, watery, irritating, itching eyes, painful eyes
NoseCongestion nose, watery/runny nose, sneezing
ThroatDirty taste in mouth, dry mouth, sore throat, tickling cough, hoarse voice
MuscleMuscle tension behind neck, muscle weakness, pain in muscles, heavy legs, stiff muscles
Source: Paulos. Postorgasmic illness syndrome. Fertil Steril 20OIS

According to a 2011 study of 45 Dutchmen with POIS, the most common symptoms reported were:

  • Concentration difficulties (87 percent)
  • Severe fatigue and exhaustion (80 percent)
  • Fever and flu-like symptoms (78 percent)
  • Irritability (78 percent)
  • Headache (55 percent)

A 2020 study involving 302 men had similar findings with the addition of muscle weakness (70 percent). The researchers discovered that men with symptoms in the head and throat clusters tended to have the most severe disease.

The authors also found that a large percentage of participants made behavior changes because of their symptoms. These changes included:

  • Avoiding masturbation: 71 percent of participants
  • Making schedule changes such as planning for sex, rearranging daily schedules, or avoiding sexual intercourse: 71 percent
  • Abstaining from sex: 62 percent

What Causes POIS?

Though we now have diagnostic criteria for POIS, researchers still aren’t sure what causes it. The condition hasn’t been well studied, but researchers have theories. POIS could be an autoimmune response (when the body attacks its own systems as it would a foreign infection) triggered by inflammation or allergy to a man’s own semen. A hormonal imbalance is another possibility, and there are several others.

Some men’s symptoms begin with their first orgasm at puberty (primary POIS). Others have onset later in life (secondary POIS).

Flower pot.
Premature ejaculation and postorgasmic illness syndrome often go hand-in-hand

Postorgasmic Illness Syndrome and Premature Ejaculation

The 2020 study found that premature ejaculation was the most common co-occurring condition; 47 percent of participants reported PE, a rate much higher than in the general population. The men who had symptoms in the general, throat, or muscle clusters were more likely to suffer from PE.

In one case study, a patient with erectile dysfunction and premature ejaculation found if he was able to maintain his erection long enough to ejaculate in his partner, his post-orgasm symptoms were significantly reduced. To treat his erectile dysfunction, he took tadalafil (brand-name Cialis) and found that he could complete intercourse more often and experienced a POIS episode less often. (Note that this patient also had ethnic components of another orgasm disorder called dhat syndrome that may or may not have played a role in his symptoms and treatment success.)

More study is needed to learn how PE and POIS are connected.

Can POIS be Treated?

Because no one yet knows what causes POIS, and it affects nearly all body systems, there is no consensus on the appropriate specialist to treat it.

Of the 51 percent of men surveyed who had sought medical treatment, 83 percent went to primary care practitioners. Others saw urologists, sexual medicine specialists, neurologists, psychiatrists, endocrinologists, and allergists.

Symptomatic Treatment

In most cases, treatment thus far has been targeted at symptoms only. Study participants have tried a variety of symptomatic remedies, and a few have been effective. They include:

  • Niacin supplements (according to 76 percent of the men in the 2020 study)
  • Anti-inflammatory drugs (74 percent)
  • Antihistamines (50 percent)

These treatments have helped reduce symptoms; however, many reported their symptoms did not fully resolve, and they weren’t satisfied with the results.

Systemic Treatment

Treating the disease rather than symptoms only is the long-term goal, and several treatments have proven successful in a small number of case studies:

  • Human chorionic gonadotropin (hCG) therapy. One study successfully used hCG to raise testosterone levels in one patient with low T and eliminate his POIS. The authors concluded that direct testosterone replacement therapy is likely to be as effective as hCG in men with low to borderline total or free T.
  • Testosterone patches. According to the online forum POISCenter, some men have tried testosterone patches and have been very satisfied with the results. However, this is a controversial treatment, as many of these men have normal testosterone levels at baseline.
  • Hyposensitization therapy. Also called allergy immunotherapy, hyposensitization treats POIS as an allergy and desensitizes the immune system to the allergen by exposing the patient to a little bit at a time. At least one study has found this to be a successful treatment, but the process involves applying the patient’s own semen to the skin, which can cause discomfort or pain. What’s more, producing the semen sample will typically provoke a POIS episode.
  • Surgery. At least one man (see video above) has taken desperate measures in choosing surgical castration to cure POIS. The drawbacks here are apparent, and it may be challenging to find a surgeon who would perform the procedure, even with proof of a severe impact on quality of life.
Man talking with medical doctor.
If you have POIS symptoms, don’t wait to see your doctor

A Final Word

Postorgasmic illness syndrome is a debilitating condition that undermines the very definition of masculinity. Unfortunately, it is often mis- or undiagnosed, in part because many men find it difficult to talk about sensitive sexual issues. But awareness is increasing among medical providers, so help is available to those who seek it out.

If you or someone you love is suffering from pain or illness following orgasms, getting treatment could have life-changing benefits. A man who can’t enjoy orgasms is no laughing matter.

If you suffer from premature ejaculation, can help. Call us toll-free at 1-800-467-5146 to schedule a free consultation with one of our physicians. We can set you up with a prescription for tadalafil and a premature ejaculation kit that will help you last longer in bed. Take advantage of the convenience of online ordering and discreet shipping at no cost to you.

For more information and to interact with people living with POIS, visit the online support group POISCentral.

Disclaimer: Information given in this article is not intended to diagnose or treat any medical condition. Please speak to your doctor (or one of ours) before making any changes to your medical regimen.

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