Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that primarily affects women, but also a handful of men. Of the roughly 6 million Americans affected, around 80-85% of them are women of childbearing age. POTS is a type of dysautonomia, which is a group of neurologic disorders that affect the system that regulates the processes related to blood flow, heart rate, sexual arousal, and digestion. Specifically, when someone with POTS stands up, the body will release more adrenaline than normal to account for an above normal amount of blood pooling below the heart, which for an unknown reason, their blood vessels do not respond to very well. However, the heart still responds the same as a non-POTS person, leading to an increase in heartbeat without the right amount of blood flow. Due to this imbalance, lightheadedness, dizziness, and sometimes fainting can occur.

POTS can occur on its own, or as the result of another condition, and is usually triggered upon standing up after either lying down or sitting. POTS also comes with a myriad of other symptoms. Namely, fatigue, brain fog, chest pain, shortness of breath, anxiety, gastrointestinal issues, frequent urination and bowel movements, and shakiness.

Because POTS is often a result of another condition, there are several conditions that may occur at the same time (comorbidities). These include pregnancy, chronic migraines, COVID-19 or long COVID, and Ehlers-Danlos Syndrome (EDS), all of which currently have more research surrounding them, and can lend further insight into the effects of POTS on sexual health.

In regard to men’s sexual health, POTS (and EDS) are most known for causing erectile dysfunction (ED), which is what occurs when an erection cannot be sustained long enough for satisfactory sexual activity. This is mostly attributed to vascular dysfunctions and dysautonomia, which disrupts the blood flow needed to achieve and maintain an erection. However, ED has also been attributed to depression from the overall effect of coping with chronic illness.

Women’s sexual health is affected more intensely than men’s. It’s believed that estrogen plays a large role in POTS and other dysautonomia disorders, leading to worsened period symptoms as well as vaginal dryness due to hormonal fluctuations. Additionally, pregnancy puts women at-risk for developing POTS, sometimes worsening the symptoms of both conditions.

It’s important to note that these comorbidities, specifically EDS, migraines, and other autoimmune disorders, appear to be associated with sexual dysfunction on some level or another. EDS, for example, is known for high levels of reported dyspareunia and vulvodynia, conditions which cause pain during sexual activity. Additionally, chronic illnesses such as POTS and migraines tend to cause low libido (sexual desire) due to fatigue and illness-related depression.

Conclusion

Overall, POTS affects women more than men. When it comes to sexual health and sexual function, it’s important to take these factors, such as the development of POTS due to pregnancy, into consideration. Some options for treating POTS and other dysautonomia disorders include dietary changes, increasing hydration, and staying active. Between myriad comorbidities and overall effects of coping with chronic illness, it’s important to pay attention to these issues and speak with a healthcare professional about appropriate treatments specific to sexual dysfunction and chronic illness.

References:

• Bourne, K. M., Hall, J., Stiles, L. E., Sheldon, R. S., Shibao, C. A., Okamoto, L. E., Garland, E. M., Gamboa, A. C., Peltier, A., Diedrich, A., Biaggioni, I., Robertson, D., & Raj, S. R. (2021). Symptom presentation and access to medical care in patients with postural orthostatic tachycardia syndrome: Role of sex. CJC Open, 3(12). https://doi.org/10.1016/j.cjco.2021.08.014
• Blitshteyn, S., Lange, A., Corinaldi, C., Guy, P., & Brook, J. (2024). Sexual dysfunction in postural orthostatic tachycardia syndrome (POTS): A cross-sectional, case-control study. Journal of Clinical Medicine, 13(8), 2274. https://doi.org/10.3390/jcm13082274
• Dysautonomia: Malfunctions in your body’s automatic functions. Cleveland Clinic. (2023, September 11). https://my.clevelandclinic.org/health/diseases/6004-dysautonomia
• Peggs, K. J., Nguyen, H., Enayat, D., Keller, N. R., Al‐Hendy, A., & Raj, S. R. (2012). Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome. International Journal of Gynecology & Obstetrics, 118(3), 242–246. https://doi.org/10.1016/j.ijgo.2012.04.014 
• Pots: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. (2022, September 9). https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots
• Sexual dysfunction in Ehlers-Danlos Syndrome (EDS). The EDS Clinic. (2024, October). https://www.eds.clinic/articles/sexual-dysfunction-in-ehlers-danlos-syndrome-eds