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NASHVILLE -- Extreme fatigue, heart palpitations, muscle aches, incoherent speech, and problems concentrating were among the most common symptoms reported in an online survey of men with a poorly understood condition known as post-orgasmic illness syndrome (POIS).

Among the 180 men who responded to the survey, 18.2% reported that their symptoms occurred almost immediately (within 1 minute) after ejaculation, while 56.7% and 85%, respectively, reported symptoms beginning within 30 minutes and 6 hours, post-ejaculation, according to medical student Caleb Natale, of Tulane University in New Orleans, and colleagues.

Also, 76.2% of responders reported symptoms after 90% to 100% of ejaculations, and 61.9% reported that their symptoms persisted for 2 to 7 days, they said in a presentation at the Sexual Medicine Society of North America fall meeting.

First described in the early 21st century, POIS refers to several different clusters of symptoms that occur within minutes or hours after ejaculation.

Only about 50 cases of the disorder , but the recent appearance of internet forums devoted to the subject suggest that it is widely under-reported, Natale told MedPage Today.

"The men reported a great deal of distress related to their POIS, and when they did seek treatment, physicians often assumed their symptoms were psychiatric in nature or they attributed them to something else," he explained.

Although the mechanism driving the disorder is not known, one hypothesis is that it an autoimmune or allergic disorder triggered by an inflammatory reaction to a man's own seminal fluid.

In, Marcel Waldinger, MD, PhD, then of HagaZiekenuis in The Hague, the Netherlands, and colleagues hypothesized that "POIS is caused by Type-1 and Type IV allergy to the males' own semen, as soon as it is triggered by ejaculation." Waldinger, who was among the first to describe the disorder, .

Other theories suggest the cause to be related to chemical imbalances in the brain, neuroendocrine response, or disordered cytokines.

Symptoms may be generalized or they may be localized to a specific area of the body. Flu-like symptoms -- including feeling feverish, perspiring heavily, shivering -- are reported by some men.

When asked if they abstained from sex to avoid triggering a post-ejaculatory reaction, 44% of the men who completed the survey said they did so frequently and 20% said they did so "sometimes."

Also, 73% said they frequently or sometimes abstained from masturbation to avoid triggering the reaction, and 77% said their romantic life was frequently or sometimes impacted.

POIS was reported most often after masturbation with ejaculation (76.7% of responders), intercourse with ejaculation (76.7%), and nocturnal emission (58.3%).

The most commonly reported comorbidities were premature ejaculation (45%), depression (35%), and generalized anxiety disorder (18.3%). Erectile dysfunction was reported by 13.3% of respondents.

Well over half of the respondents (55.6%) sought medical help for the condition, with 86% consulting a generalist and 61% eventually consulting a urologist. Antihistamines were prescribed to a third of the men who saw clinicians (33.3%) and selective serotonin reuptake inhibitors (SSRIs) were prescribed to 16.7%.

Urologist Daniel Shoskes, MD, of the Cleveland Clinic, told MedPage Today that it is not clear which specialist a man with POIS symptoms should consult, given the uncertainty about what is driving the condition.

"Clearly we don't really understand anything about the mechanism at this point," said Shoskes, who was not involved in the study. "Because of this, I wonder whether ultimately it is best addressed by urologists. When someone has a seizure triggered by a flashing light, they don't seen an ophthalmologist. They see a neurologist. We need to know a lot more about this disorder before we will know how to best treat it."

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