POIS treatment must consider symptoms, outcomes: study

Examining the symptoms experienced by patients with postorgasmic illness syndrome (POIS) can help improve treatment and resolve these symptoms, suggests a study.

“Based on our results, we believe symptom clusters experienced by the patient may be predictive of their response to treatment,” the investigators said.

In June 2024, the databases of PubMed, Embase, and Scopus were searched for relevant clinical studies, randomized controlled trials, and case reports analysing treatment modalities of patients diagnosed with POIS. Fifty-eight studies were identified, of which 14 met the eligibility criteria.

The systematic review included one cross-sectional study, one cohort study, and 12 case reports. Most studies included only male patients, and only two papers involved female patients. [J Sex Med 2025;22:1236-1243]

Pharmacologic treatment modalities were evaluated in 11 papers. These therapies included ibuprofen, antihistamines, steroids, triptans, NSAIDs, SSRIs, alpha-blockers, beta-blockers, calcium channel blockers, and hormone replacement therapy.

Two papers discussed immune treatment, namely intracutaneous injection of autologous semen and intralymphatic immunotherapy with the injection of allergen-specific immunotherapy. Finally, one paper reported surgical treatment with bilateral epididymectomy and bilateral vasoligation.

“Amongst the trialled therapies, it is important to consider the different outcomes between the use of pharmacologic treatment vs procedural treatment,” the investigators said. 

“As previously mentioned, many patients’ symptoms improved with both pharmacologic and procedural treatment, [but] a complete resolution of POIS was only achieved in one reported case via bilateral epididymectomy and bilateral vasoligation,” they added. [Asian J Androl 2022;24:332-334]

However, this procedure resulted in patient infertility. This irreversible consequence must be considered in shared clinical decision-making between physicians and patients, according to the investigators. POIS treatment, therefore, should include patient preferences to ensure satisfaction.

Pathophysiology

Current literature is focused on POIS being caused by a hypersensitive immunologic response, but the exact pathophysiology behind this condition remains a mystery. Thus, several treatments have been studied to examine benefits for this patient population. [J Sex Med 2011;8:1164-1170]

"Through our systematic review, a pattern was noted that treatment is frequently based on presenting POIS symptoms rather than a proposed aetiology and pathophysiology,” the investigators said. 

“A variety of treatments were demonstrated in the literature, including the use of antihistamines, analgesics, hormone modulators and hormone replacement therapy, serotonin-receptor modulators, immunomodulators, calcium channel blockers, adrenergic antagonists, and surgical or procedural treatments,” they added. 

Many of these treatments achieved clinical success in individual cases, but a gap remains in the treatment protocol for patients with POIS.

“The largest limitation to continued research is related to the rarity and low recognizability of POIS,” the investigators said. 

“Scientists across the world are collaborating to better understand the pathophysiology behind this condition and investigate treatment modalities to address the associated symptoms,” they added.

POIS is a rare condition characterized by feeling ill following orgasm. Only 18 percent of sexual medicine experts report an improvement in symptoms in >30 percent of patients, according to the investigators.

“Given the lack of standardized therapeutic approaches, there is a critical need to document and evaluate various treatments tried for POIS management,” they noted.