The Sex Series – Part Five: Seminal allergy, post-orgasmic illness syndrome and burning semen syndrome

Allergy to semen has only been well documented and studied in cisgender (non-transgender) women. Some papers go so far as to state that this problem is exclusive to (cisgender) women.  Despite this, there is evidence that (cisgender) males can have allergy to semen, including their own.  Furthermore, semen allergy is not restricted to vaginal intercourse and can be seen in anal and oral sex, as well as local reactions when semen contacts skin outside of the vaginal area.

Semen contains a number of inflammatory molecules, including TGFb1, MCP-1, IL-13 and IL-17.  MCP-1 has a well described role in mast cell activation in which it draws mast cells toward an inflammatory site and directly induces histamine release.  The physical effects of orgasm use opioids made in the body.  Some patients experience a days-long reaction to orgasm.

Termed “postorgasmic illness syndrome”, allergic symptoms affecting the genitals and general flu-like symptoms present 2-8 hours after ejaculation. These symptoms can persist for up to a week, with the day after ejaculation often being the worst.  Postorgasmic illness syndrome causes excessive sweating, rhinitis, anxiety, depression and difficulty concentrating.  This condition is recognized as a rare disorder by the NIH.  It has been hypothesized that these patients are in fact suffering from opioid withdrawal caused by the rapid depletion of opioids by orgasm.

Semen allergy has been associated with serum IgE to prostate-specific antigen (PSA), a molecule involved in the kallikrein-kinin system.  Autologous semen allergy, or allergy to one’s own semen, can be confirmed by reaction to semen in skin prick allergy testing or by specific IgE in the blood. One study found that 88% of patients who experienced burning and pain after ejaculation were positive for allergy to their own semen.

The phenomenon of burning after ejaculation is called “Burning semen syndrome”. In these patients, burning, pain and swelling of the UG tract occurs following ejaculation.  This study also evaluated partners of these patients receiving vaginal sex.  In many instances, both members of the couples evaluated were positive for allergy to semen. 89% of these couples had at least one member who exhibited allergic reaction to semen.

 

References:

Van Dijk F, et al. Non-oncological and non-infectious diseases of the penis (penile lesions). EAU-EBU Update series 4 2006; 13-19.

Ghosh D, Bernstein J. Systemic and localized seminal plasma hypersensitivity patients exhibit divergent immunologic characteristics. J Allergy Clin Immunol 2014: 134 (4): 969-972.

Jiang N, et al. Postorgasmic illness syndrome (POIS) in a Chinese man: No proof for IgE-mediated allergy to semen. J Sex Med 2015; 12: 840-845.

Bernstein JA, et al. Is burning semen syndrome a variant form of seminal plasma hypersensitivity? Obstetrics & Gynecology 2003; 101 (1): 93-102.

Chen WW, Baskin M. A 33-year-old woman with burning and blistering of perivaginal tissue following sexual intercourse. Annals of Allergy, Asthma & Immunology 2004; 93: 126-130.