Introduction. Postorgasmic illness syndrome (POIS) is a pathological condition that occurs after ejaculation and is manifested mainly by flulike symptoms. The exact prevalence and incidence of the syndrome are unknown. The National Institute of Health (NIH) of the United States classifies this syndrome as a genetic and rare disease. Few episodes of post-orgasmic malaise have been described in the literature, and they are mainly represented by clinical cases. This problem is not reflected in the domestic literature and only one work was found in the scientific electronic library eLibrary.ru. The aim of the work: to present a literature review devoted to POIS and a rare clinical case of a patient suffering from POIS.
Materials and methods. When writing the article, data on POIS posted in the PubMed and Scientific Electronic Library eLibrary.ru databases were used. The following keywords were used when searching the databases: «postorgasmic ilness syndrome», «Waldinger's preliminary diagnostic criteria», «autologous sperm», «sexual disorders». A total of 21 publications were selected and included in this review. The description of the manifestations and drug therapy of this syndrome is presented using a clinical case as an example.
Results. The study of POIS was started in 2002. Criteria for diagnosing POIS were developed, the symptoms of the disease were described in detail, and several theories of etiopathogenesis were proposed: impaired cytokine and neuroendocrine regulation, autoimmune reaction, autonomic nervous system disorder, androgen deficiency, and peripheral axonopathy. Various drugs are used to treat this condition: desensitizing therapy, immunotherapy, antihistamines, anti-inflammatory drugs, etc. Many other drugs and dietary supplements have been proposed to alleviate the symptoms of POIS.
Clinical case. The article presents data on a 23-year-old man complaining of worsening health after sexual activity (sexual arousal with or without subsequent ejaculation): a feeling of pressure in the frontal and occipital regions, fatigue, increased fatigability, attention deficit, memory impairment, pain in the calf muscles, and a feeling of heat. The examination revealed a moderate decrease in the level of free testosterone and recommended taking an extract of the herb Tribulus terrestris (Tribulus) 1000 mg per day. While taking Tribulus, the symptoms after sexual arousal (regardless of the presence of orgasm) became less pronounced. During a control study of the hormonal status, the level of free testosterone was within normal values. Subsequently, due to the return of the level of free testosterone to the original value, accompanied by an increase in symptoms, the patient was prescribed intramuscular injections of chorionic gonadotropin at 1500 IU 2 times a week.
Conclusion. Given the diversity of symptoms of POIS, one can think of the polyetiology of the disease or that several pathological conditions are hidden under the mask of MOD. Regardless of the main cause of POIS, the role of the central nervous system in the development of its manifestations is obvious. Therefore, when examining these patients, a neurologist consultation is necessary to exclude vegetative disorders and other functional and organic disorders. Patients with symptoms of POIS need an interdisciplinary approach with the participation of an andrologist/urologist and a therapist (general practitioner), and, if indicated, an endocrinologist, immunologist/allergist and psychiatrist.
