The Sex Series – Part Four: Seminal allergy

Author’s note: This series is long and covers a number of topics other than vaginally penetrating sex, including male and female orgasms, reactions of the penis, testicles and prostate, anal sex, and pelvic floor dysfunction and pelvic pain.  The first several posts are about vaginally penetrating sex because this is what I get asked the most questions about.  It is not meant to be exclusive to anyone on the basis of gender or sexual orientation.

**
It is possible to be truly allergic to semen, although this is rare.  One of the hallmarks of this condition is that it is completely preventable with condom use.

Most patients react during or after their first experience with vaginal penetration by a penis resulting in ejaculation.  Each subsequent exposure generally causes a worsening reaction. However, it is possible to develop an allergy after a number of intercourse encounters. In studies, patients with seminal allergy are allergic to semen from multiple partners, although there are anecdotes about patients reacting to semen from a single partner and not only.

This type of allergy has been linked to IgE.  The testing for this sensitivity involves skin prick tests with seminal protein that produce wheal and flare response.  Semen specific IgE is often appreciable in the blood following exposure.  Some patients have type III and type IV hypersensitivity reactions to semen and symptoms can occur days after the exposure.

Like all other forms of allergy, the range of reactions is massive.  It can range from a low level itching to anaphylaxis requiring epinephrine.  Itching, burning, redness, swelling, pain, and blistering in the vagina have all been reported. Trouble breathing, cough, wheezing, GI symptoms, generalized hives, disseminated angioedema and full anaphylaxis can occur.  Anaphylaxis has been reported in 16 cases, with one case causing loss of consciousness.

Across studies, most patients have either a personal or family history of allergic conditions.  80% of patients in one study had a family history of atopic disease.  One study found that the onset of seminal allergy often coincides with genital system conditions or procedures like hysterectomy, IUD placement or removal, pregnancy and tubal ligation.  It is hypothesized that the disruption of the normal state of immune activity in the vagina by these activities can trigger seminal allergy, but this has not been proven.

References:

Schlosser BJ. Contact dermatitis of the vulva. Dermatol Clin 2010: 28; 697-706.

Moraes PSA, Taketomi EA. Allergic vulvovaginitis. Ann Allergy Asthma Immunol 2000; 85: 253-267.

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.

Harlow BL, He W, Nguyen RHN. Allergic reactions and risk of vulvodynia. Ann Epidemiol 2009; 19: 771-777.

Liccardi G, et al. Intimate behavior and allergy: a narrative review. Annals of Allergy, Asthma & Immunology 2007; 99: 394-400.

Sonnex C. Genital allergy. Sex Transm Infect 2004; 80: 4-7.