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Generally speaking, orgasms are pretty wonderful, but for some, they can be literally sickening.  People with a chronic condition called post-orgasmic illness syndrome, or POIS, develop a range of debilitating symptoms within minutes of climaxing.  We're talking nasty things like pain, fatigue, itching, weakness, cognitive difficulties, even a flu-like state, and this can last anywhere from two to seven days, which obviously has a serious negative impact on their lives.

Unfortunately, doctors aren't 100% sure what's going on or how best to treat it, but by studying POIS, they hope to figure that out and they'll learn more about what happens to the body before, during, and after orgasm while they're at it.  Right now, POIS is considered a rare disorder, though its true prevalence is unknown.  Some doctors think it's under-reported and under-diagnosed which may be because people are apprehensive about talking to their doctor about what they're experiencing.  

Also, the condition wasn't described in the medical literature until 2002 and the next study on it didn't come out for another nine years.  That's how long it took for doctors to find enough people with similar symptoms to put together a formal description of the syndrome.  For a person to be diagnosed with POIS, they have to have experienced awful symptoms during or shortly after orgasm for most, if not all, orgasms.  These symptoms last for multiple days, then they just go away.  

For about half of the study patients in the 2011 study, this started right at puberty, for the rest, onset occurred in their 20s or later, and the researchers have come up with a few possible explanations for what might be happening.  The first hypothesis is that POIS is a really rare autoimmune condition. 

The vast majority of known cases are in people with testes and a penis, so some researchers think POIS is an allergic response of sorts that's set off by semen as it travels through a person's internal plumbing during ejaculation and there's some evidence to support this idea, like for one person with POIS, drugs known as NSAIDs helped prevent the worst symptoms.  These drugs counteract inflammation, the general response the immune system has to things that upset it, so that could suggest an immune overreaction was the cause of their symptoms.  

Also the doctors that formally described POIS in 2011 tested this idea by performing what's known as an allergy skin prick test on 33 of the study's patients.  Basically, they took the person's semen and diluted it 1:40,000 in saline, then injected a tiny amount of it under the skin to see if they would have an allergic reaction to it, and 29 of them did, but there was a pretty big flaw in the methods.  They didn't try the allergy test on people without POIS.  A small study published in 2015 did just that with three subjects and all of them also had a reaction to their own semen.  Turns out, maybe we're all allergic to our own semen.

So other researchers have proposed other mechanisms like that POIS has more to do with the brain than the gonads.  Though there's limited data on the neuroscience of orgasms, it's believed that the feelings of intense pleasure that often accompany climax come from the brain releasing opioids and the doctors who reported the first case from China in 2015 think that might be what's causing the condition rather than anything immunological.

Their patient didn't have an allergic reaction to their semen, but the researchers noticed that the symptoms the person experienced did closely resemble opioid withdrawal.  So they thought there might be something amiss with the opiod receptors in the patient's brain. Ultimately though, both team immunology and team brain chemistry only have hypotheses right now, and a 2019 review of the literature on POIS pointed out that it's possible that neither or both of them are right.

See, what's being thought of as one syndrome with one ultimate cause could actually be a whole spectrum of disorders with a different set of causes in each person and that means to figure out the best treatment option, every patient would need to get a detailed work up of all of the body systems involved in orgasm, but doctors don't necessarily know what those are because we still don't have a whole lot of clarity about what happens in the body during orgasm.  

We do know that the autonomic nervous system plays an important role.  That's the part of your nervous system that regulates unconscious actions like breathing and your heart rate, so it could be involved in POIS, too.  There's also a lot happening psychologically when it comes to orgasms, so anxiety, emotions, and other psychological elements could be a factor, too, and there's probably more important stuff happening in the body that we don't know about yet, because we haven't studied the physiology of orgasms that thoroughly, though that's where the internet might help.

There are an increasing number of self-reported POIS cases on internet forums and researchers think these forums could yield valuable data to identify potential causes.  The good news is, wherever the data comes from, further research on POIS will help lots of people, including those who don't have the condition.  After all, to understand POIS, doctors are gonna have to learn more about what happens in the body during orgasm in general and that could provide insights into other disorders, too, so that more people can experience the joys of a healthy sex life.

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