Why the Big O can also lead to incredible sadness

Lucy was referred to my clinic by a general practitioner. The diagnosis on her referral form read consistently sick after orgasm. Cause of illness unknown! The accompanying notes stated that Lucy always developed malaria-like symptoms after sex. Tests showed that she was not suffering from any disease or infection.

“We are in the deep end of a scientific mystery here,” her husband Andrew told me. “We hope you can help us figure it out and cure it.” Andrew was a professor of literature at one of the public universities. At 52, he was 16 years older than Lucy, who was also a lecturer at the same university, with a PhD in mathematics.

The pursuit of academic excellence had caused both of them to put their romantic lives on hold. Lucy had had no time for a social life and had never had a boyfriend. She was celibate until she met the professor. Lucy also had strict views about sex and love. In her world view, virginity was only to be shared with the man who would eventually marry her. The lucky man was the professor of literature.

They were not married yet, but they were sure about the path their relationship was taking. And so when Lucy was ready, they consummated their relationship and started having sex frequently in anticipation of marriage. For some time Lucy did not get an orgasm. The day she finally got one, she developed muscle pains, felt exhausted, had a congested nose and even developed a sore throat. “I could not leave bed,” she explained. “I blamed Andrew for infecting me with a cold although he did not have symptoms himself.”

SICK FOR OVER A WEEK

Lucy was sick for over a week and unable to go to work. Then they noticed that every time she had an orgasm, she would feel very ill. Her doctor did not have any clue about what was happening, which is why they came to me. “Sometimes I feel that it is the effect of age. Maybe if I started having sex earlier in life I would not have gotten into this mess,” Lucy lamented.

I assessed Lucy, and found that she had symptoms of flu. She also reported general tiredness. She was anxious and moody, almost bordering on depression. “Yesterday I was very healthy but immediately I had an orgasm at night, I developed these symptoms,” she explained.

I concluded that Lucy was suffering from post-orgasmic illness syndrome (POIS). POIS is a rare condition that affects men and a small percentage of women. It is caused by an abnormal release of and response to hormones that control orgasm.

During orgasm, both men and women release dopamine, one of the hormones that excites the body. It is immediately countered by release of prolactin which brings the body back to normal. Sometimes this system fails to work, leading to the body reacting abnormally and causing symptoms of POIS. Affected individuals can feel sick for up to two weeks.

Common symptoms of POIS include abnormal exhaustion following sex, sometimes accompanied by muscle pains. The affected person may have a blocked or congested nose and sore throat. There may be indigestion, bloating and tummy discomfort. Psychologically the symptoms include anxiety and sometimes depression. The person may be unable to think straight and may have a foggy mind. Insomnia may also happen.

“How can we fix this, doctor?” Lucy asked.

There is medicine to relieve the symptoms of POIS but there is no medication that will treat the condition forever. Every time the symptoms happen the affected person has to take the medicine. I prescribed it for Lucy and hoped that it would help the couple enjoy their relationship afresh.