Postorgasmic illness syndrome: one or several entities? A retrospective cohort study

Abstract

Background: Postorgasmic illness syndrome (POIS) is a rare syndrome in which patients experience various physical and cognitive symptoms after ejaculation, and its pathophysiology remains unknown.

Aim: The aim of this study was to characterize the clinical presentations, disease course, and treatment outcomes in outpatients, as well as to examine the validity of the preliminary criteria and symptom clusters of POIS.

Methods: This retrospective monocentric study was conducted in a neurourology department, with patients included from 2010 to 2023. The diagnostic criteria and symptom cluster descriptions were based on previous studies.

Outcomes: The study focused on the clinical features of POIS, the complementary tests performed, the treatments tried, and their effectiveness.

Results: Thirty-seven men were included in the study, with symptom onset occurring at a mean ± SD age of 23.6 ± 7.4 years. The mean time from ejaculation to symptom onset was 1 hour 22 minutes ± 3 hours 42 minutes. The mean duration of symptoms was 4.7 ± 3.4 days. Seventeen patients (46%) developed the symptoms primarily, whereas in 20 (54%) they appeared secondarily. All preliminary criteria were met in 19 patients (51%). The most common symptom clusters were "general" in all 37 patients (100%; eg, asthenia and concentration difficulties) and "head" in 35 patients (95%; mostly headache and a foggy feeling). In terms of treatments, antihistamines and nonsteroidal anti-inflammatory drugs were tried and partially improved symptoms for some patients.

Clinical implications: This study helps to further characterize POIS by specifying the most frequent symptoms and comparing them with the initial criteria.

Strengths and limitations: To our knowledge, this is one of the largest cohorts of patients consulting for symptoms suggestive of POIS. There are limitations due to the retrospective nature of the data collection, such as missing data and imprecision of treatment efficacy.

Conclusion: The majority of participants met at least 3 of the preliminary diagnostic criteria, with a majority of symptoms in the general and head clusters. However, the determination of predictive factors for treatment response based on the typology of the disorders remains to be established.

Keywords: ejaculation; orgasm; postorgasmic illness syndrome; sexual disorders.