Background

Postorgasmic illness syndrome (POIS) is a poorly defined clinical condition that presents primarily in men with a host of flu-like, somatic, and cognitive symptoms shortly after ejaculation. These symptoms may last for up to a week after ejaculation, significantly impacting quality of life and potentially deterring people from wanting to have sex.

POIS was originally described in 2002 by Waldinger et. al., who also defined seven symptom clusters:

• General: fatigue, exhaustion, heart palpitations, difficulty finding words/incoherent speech, migraine symptoms, and depressed mood.
• Flu-like: feverish feeling, perspiration, shivering, and cold sweats.
• Head: severe headaches and foggy/heavy sensation
• Eyes: red or bloodshot, burning, blurred vision, dryness, watering, itching, and pain or pressure.
• Nose: congestion, sneezing, and watery or runny.
• Throat: dirty taste in mouth, dry mouth, sore throat, tickling cough, hoarse voice.
• Muscle: tension (back or neck), muscle weakness, muscle pain, and stiff or heavy legs.

Study Objective

• This case series reports on 11 consecutive male patients fulfilling diagnostic criteria for POIS, managed in accordance with CARE (CAse REporting) case reporting guidelines.

Method

• 11 patients were identified from three multi-city sexual health clinics in India between 2023 and 2025 using Waldinger’s diagnostic criteria.
  • Average age of 20 years old.
  • Reported consistent, reproducible POIS symptoms in at least 2 symptom clusters within seconds to minutes of ejaculation and lasting 2-7 days.
  • No alternative diagnoses that could explain symptoms (ex. chronic fatigue, latex allergy, etc.)
• Google Forms were used to collect demographics, symptom onset, duration, severity, as well as any sexual dysfunction, psychiatric or medical comorbidities, treatment history, and follow-up outcomes.
• Labs were completed to determine the potential etiology of POIS:
  • Hemoglobin
  • Erythrocyte sedimentation rate
  • C-reactive protein
  • No semen analysis based on Waldinger criteria.
• Treatment protocols:
  • Four patients were not treated with anything.
  • Five patients treated with only selective serotonin reuptake inhibitors (SSRIs; Sertraline 25- 50 mg or Paroxetine 12.5 mg),
    • One did not start treatment.
  • One patient treated with phosphodiesterase-5 inhibitors (PDE5-i) and SSRI (Tadalafil 2.5 mg and Paroxetine 37.5 mg), and
  • One patient treated with antihistamine and SSRI (Levocetirizine 5 mg+ and Paroxetine 12.5 mg).

Key Results/Analysis

• No lab results had significant results, meaning there is likely no structural etiology.
  • Researchers say this may point to immunogenic or functional etiology.
• Of the 6 patients who started treatment, three were lost to follow-up and two discontinued treatment early.
  • Those prescribed SSRIs reported no adverse effects.
  • Four reported moderate to marked improvement in symptoms.
  • Those treated with a combination of SSRI and PDE5-i or antihistamine reported no improvement.
• Symptoms resolved in 2-7 days.
• Researchers say results emphasize the clinical consistency of POIS.
  • Clinicians should be aware of these factors to avoid misdiagnosis.
• Researchers emphasize the significant difference between Dhat syndrome and POIS
  • Dhat syndrome is characterized by anxiety surrounding semen loss and is more often observed in South Asian cultural settings.
  • POIS is distinctly clinical with identifiable symptom clusters, timely symptom onset, and possible immune-related etiologies.

Key Takeaways

• POIS is underrecognized or underreported.
  • A distinct clinical syndrome that affects quality of life in men.
• While small, this case series reinforces previous conclusions about POIS diagnostic features and calls out the ambiguity of symptom management.
• Researchers found that early identification and supportive management may provide relief from symptoms.
• Further research is needed to confirm existing mechanisms behind POIS.

Resources

• Gokani, N. S., Jacob, N., & Deshpande, S. M. (2026). Postorgasmic illness syndrome: A clinical case series of 11 patients. The Journal of Sexual Medicine, 23(5). https://doi.org/10.1093/jsxmed/qdag102