Postorgasmic illness syndrome

Last updated
Postorgasmic illness syndrome
Other namesPOIS
Specialty Andrology, allergy, endocrinology neurology

Postorgasmic illness syndrome (POIS) is a syndrome in which human males have chronic physical and cognitive symptoms following ejaculation. [1] The symptoms usually onset within seconds, minutes, or hours, and last for up to a week. [1] The cause and prevalence are unknown; [2] it is considered a rare disease. [3]

Contents

Signs and symptoms

The distinguishing characteristics of POIS are:

  1. the rapid onset of symptoms after ejaculation;
  2. the presence of an overwhelming systemic reaction. [1]

POIS symptoms, which are called a "POIS attack", [1] can include some combination of the following: cognitive dysfunction, aphasia, severe muscle pain throughout the body, severe fatigue, weakness, and flu-like or allergy-like symptoms, [4] such as sneezing, itchy eyes, and nasal irritation. [5] [2] [6] Additional symptoms include headache, dizziness, lightheadedness, extreme hunger, sensory and motor problems, intense discomfort, irritability, anxiety, gastrointestinal disturbances, craving for relief, susceptibility to nervous system stresses, depressed mood, and difficulty communicating, remembering words, reading and retaining information, concentrating, and socializing. [5] [7] Affected individuals may also experience intense warmth or cold. [4] An online anonymous self-report study found that 80% of respondents always experienced the symptom cluster involving fatigue, insomnia, irritation, and concentration difficulties. [8]

The symptoms usually begin within 30 minutes of ejaculation, [5] and can last for several days, sometimes up to a week. [4] In some cases, symptoms may be delayed by 2 to 3 days or may last up to 2 weeks. [9]

In some men, the onset of POIS is in puberty, while in others, the onset is later in life. [10] POIS that is manifest from the first ejaculations in adolescence is called primary type; POIS that starts later in life is called secondary type. [1]

Many individuals with POIS report lifelong premature ejaculation, with intravaginal ejaculation latency time (IELT) of less than one minute. [1] [6]

The 7 clusters of symptoms of criterion 1: [10]

  1. General: Extreme fatigue, exhaustion, palpitations, problems finding words, incoherent speech, dysarthria, concentration difficulties, quickly irritated, cannot stand noise, photophobia, depressed mood
  2. Flu-like: Feverish, extreme warmth, perspiration, shivery, ill with flu, feeling sick, feeling cold
  3. Head: Headache, foggy feeling in the head, heavy feeling in the head
  4. Eyes: Burning, red injected eyes, blurred vision, watery, irritating, itching eyes, painful eyes
  5. Nose: Congested nose, watery/runny nose, sneezing
  6. Throat: Dirty taste in mouth, dry mouth, sore throat, tickling cough, hoarse voice
  7. Muscle: Muscle tension behind neck, muscle weakness, pain in muscles, heavy legs, stiff muscles

POIS has been called by a number of other names, including "postejaculatory syndrome", [4] "postorgasm illness syndrome", [11] "post ejaculation sickness", [12] and "post orgasmic sick syndrome". [3]

Dhat syndrome is a condition , N. N. Wig first coined the term and described in 1960 in India, [13] with symptoms similar to POIS. [11] Dhat syndrome is thought to be a culture-bound psychiatric condition and is treated with cognitive behavioral therapy along with anti-anxiety and antidepressant drugs. [14]

Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts anywhere from five minutes to two hours. PCT, which affects both men and women, occurs only after sexual intercourse and does not require an orgasm to occur, and in that its effects are primarily emotional rather than physiological. By contrast, POIS affects only men, consists primarily of physiological symptoms that are triggered by ejaculation and that can last, in some people, for up to a week. While PCT and POIS are distinct conditions, some doctors speculate that they could be related. [11]

An array of more subtle and lingering symptoms after orgasm, which do not constitute POIS, may contribute to habituation between mates. They may show up as restlessness, irritability, increased sexual frustration, apathy, sluggishness, neediness, dissatisfaction with a mate, or weepiness [15] over the days or weeks after intense sexual stimulation. Such phenomena may be part of human mating physiology itself.

Sexual headache is a distinct condition characterized by headaches that usually begin before or during orgasm. [16]

Mechanism

The cause of POIS is unknown. Some doctors hypothesize that POIS is caused by an auto-immune reaction. [17] Other doctors suspect a hormone imbalance as the cause. Different causes have also been proposed. None of the proposed causes fully explain the disease.

Allergy hypothesis

According to one hypothesis, "POIS is caused by Type-I and Type-IV allergy to the males' own semen". [1] [18] [19] This was conditioned by another study stating "IgE-mediated semen allergy in men may not be the potential mechanism of POIS". [6]

Alternatively, POIS could be caused by an auto-immune reaction not to semen, but to a different substance released during ejaculation, such as cytokines. [11]

Hormone hypothesis

According to another hypothesis, POIS is caused by a hormone imbalance, such as low progesterone,[ medical citation needed ] low cortisol, low testosterone, elevated prolactin, hypothyroidism, or low DHEA. [20]

POIS could be caused by a defect in neurosteroid precursor synthesis. If so, the same treatment may not be effective for all individuals. Different individuals could have different missing precursors leading to a deficiency of the same neurosteroid, causing similar symptoms.[ medical citation needed ]

Withdrawal hypothesis

The majority of POIS symptoms like fatigue, muscle pains, sweating, mood disturbances, irritability, and poor concentration are also caused by withdrawal from different drug classes [21] and natural reinforcers. [22] It is unknown whether there is a relationship between hypersexuality, pornography addiction, compulsive sexual behavior and POIS. Some evidence indicates that POIS patients have a history of excessive masturbation, suggesting that POIS could be a consequence of sex addiction. There is anecdotal evidence on porn addiction internet forums, that many men experience POIS like symptoms after ejaculation. [23]

Other possibilities

POIS could be caused by hyperglycemia [20] or by chemical imbalances in the brain. [24]

Sexual activity for the first time may set the stage for an associated asthma attack or may aggravate pre-existing asthma. Intense emotional stimuli during sexual intercourse can lead to autonomic imbalance with parasympathetic over-reactivity, releasing mast cell mediators that can provoke postcoital asthma and / or rhinitis in these patients. [25]

It is also possible that the causes of POIS are different in different individuals. POIS could represent "a spectrum of syndromes of differing" causes. [11]

None of the proposed causes for POIS fully explain the connection between POIS and lifelong premature ejaculation. [26]

Diagnosis

There is no generally agreed upon diagnostic criteria for POIS. One group has developed five preliminary criteria for diagnosing POIS. These are:

  1. one or more of the following symptoms: sensation of a flu-like state, extreme fatigue or exhaustion, weakness of musculature, experiences of feverishness or perspiration, mood disturbances and / or irritability, memory difficulties, concentration problems, incoherent speech, congestion of nose or watery nose, itching eyes;
  2. all symptoms occur immediately (e.g., seconds), soon (e.g., minutes), or within a few hours after ejaculation that is initiated by coitus, and / or masturbation, and / or spontaneously (e.g., during sleep);
  3. symptoms occur always or nearly always, e.g., in more than 90% of ejaculation events;
  4. most of these symptoms last for about 2–7 days; and
  5. disappear spontaneously. [1]

POIS is prone to being erroneously ascribed to psychological factors such as hypochondriasis or somatic symptom disorder. [4]

An online survey study suggested that only a small number of self-reported POIS fulfill entirely the five criteria. This study proposed to change the Criterion 3 with “In at least one ejaculatory setting (sex, masturbation, or nocturnal emission), symptoms occur after all or almost all ejaculations.” [8]

Management

There is no standard method of treating or managing POIS. Patients need to be thoroughly examined in an attempt to find the causes of their POIS symptoms, which are often difficult to determine, and which vary across patients. Once a cause is hypothesized, an appropriate treatment can be attempted. At times, more than one treatment is attempted, until one that works is found.[ citation needed ]

Affected individuals typically avoid sexual activity, [4] especially ejaculation, [1] or schedule it for times when they can rest and recover for several days afterwards. [5] In case post-coital tristesse (PCT) is suspected, patients could be treated with selective serotonin reuptake inhibitors. [11] [24]

In one patient, the POIS symptoms were so severe, that he decided to undergo removal of the testicles, prostate, and seminal vesicles in order to relieve them. The POIS symptoms were cured by this. [27]

Another patient, in whom POIS was suspected to be caused by cytokine release, was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs) just prior to and for a day or two after ejaculation. The patient took diclofenac 75 mg 1 to 2 hours prior to sexual activity with orgasm, and continued twice daily for 24 to 48 hours. [11]

One POIS patient with erectile dysfunction and premature ejaculation had much lower severity of symptoms on those occasions when he was able to maintain penile erection long enough to achieve vaginal penetration and ejaculate inside his partner. The patient took tadalafil to treat his erectile dysfunction and premature ejaculation. This increased the number of occasions on which he was able to ejaculate inside his partner, and decreased the number of occasions on which he experienced POIS symptoms. This patient is thought to have Dhat syndrome rather than true POIS. [11]

Two patients, in whom POIS was suspected to be caused by auto-immune reaction to their own semen, were successfully treated by allergen immunotherapy with their own autologous semen. They were given multiple subcutaneous injections of their own semen for three years. [1] Treatment with autologous semen "might take 3 to 5 years before any clinically relevant symptom reduction would become manifest". [1]

Treatments are not always successful, especially when the cause of POIS in a particular patient has not been determined. In one patient, all of whose routine laboratory tests were normal, the following were attempted, all without success: ibuprofen, 400 mg on demand; tramadol 50 mg one hour pre-coitally; and escitalopram 10 mg daily at bedtime for 3 months. [20]

Epidemiology

The prevalence of POIS is unknown. [2] POIS is listed as a rare disease by the American National Institutes of Health [3] and the European Orphanet. [28] It is thought to be underdiagnosed and underreported. [7] POIS seems to affect mostly men from around the world, of various ages and relationship statuses. [8]

Women

It is possible that a similar disease exists in women, though, as of 2016, there is only one documented female patient. [1]

Related Research Articles

<span class="mw-page-title-main">Orgasm</span> Intense physical sensation of sexual release

Orgasm or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region characterized by sexual pleasure. Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are usually associated with involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation, and, frequently, body movements and vocalizations. The period after orgasm is typically a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins.

<span class="mw-page-title-main">Prostate</span> Gland of the male reproductive system in most mammals

The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue, as well as connective tissue.

<span class="mw-page-title-main">Myalgia</span> Muscle pain

Myalgia is the medical term for muscle pain. Myalgia is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likely cause is viral infection, especially when there has been no trauma.

Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation. Anorgasmia is far more common in females than in males and is especially rare in younger men. The problem is greater in women who are post-menopausal. In males, it is most closely associated with delayed ejaculation. Anorgasmia can often cause sexual frustration.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Retrograde ejaculation</span> Redirection of ejaculated semen into the urinary bladder

Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the release of urine also prevents a reflux of seminal fluids into the male bladder during ejaculation. The semen is forced to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur. It can also be induced deliberately by a male as a primitive form of male birth control or as part of certain alternative medicine practices. The retrograde-ejaculated semen, which goes into the bladder, is excreted with the next urination.

Persistent genital arousal disorder (PGAD), originally called persistent sexual arousal syndrome (PSAS), is spontaneous, persistent, unwanted and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, and is typically not relieved by orgasm. Instead, multiple orgasms over hours or days may be required for relief.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

Dhat syndrome is a condition found in the cultures of South Asia in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine. The condition has no known organic cause.

Sexual headache is a type of headache that occurs in the skull and neck during sexual activity, including masturbation or orgasm. These headaches are usually benign, but occasionally are caused by intracranial hemorrhage and cerebral infarction, especially if the pain is sudden and severe. They may be caused by general exertion, sexual excitement, or contraction of the neck and facial muscles. Most cases can be successfully treated with medication.

Anejaculation is the pathological inability to ejaculate despite an erection in males, with (orgasmic) or without (anorgasmic) orgasm.

La petite mort is an expression that refers to a brief loss or weakening of consciousness, and in modern usage refers specifically to a post-orgasm sensation as likened to death.

<span class="mw-page-title-main">Silodosin</span> Chemical compound

Silodosin, sold under the brand name Urief among others, is a medication for the symptomatic treatment of benign prostatic hyperplasia. It acts as an alpha-1 adrenergic receptor antagonist.

Odynorgasmia, or painful ejaculation, also referred to as dysejaculation, dysorgasmia, and orgasmalgia, is a physical syndrome described by pain or burning sensation of the urethra or perineum during or following ejaculation. Causes include: infections associated with urethritis, prostatitis, epididymitis; use of anti-depressants; cancer of the prostate or of other related structures; calculi or cysts obstructing related structures; trauma to the region.

<span class="mw-page-title-main">Chronic prostatitis/chronic pelvic pain syndrome</span> Medical condition

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection. It affects about 2–6% of men. Together with IC/BPS, it makes up urologic chronic pelvic pain syndrome (UCPPS).

<span class="mw-page-title-main">Ejaculation</span> Euphoric stimulative semen discharge of the male reproductive tract

Ejaculation is the discharge of semen from the male reproductive tract. It is normally linked with orgasm, which involves involuntary contractions of the pelvic floor. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. Ejaculation can occur spontaneously during sleep, and is a normal part of human sexual development. In rare cases, ejaculation occurs because of prostatic disease. Anejaculation is the condition of being unable to ejaculate. Ejaculation is normally intensely pleasurable for men; dysejaculation is an ejaculation that is painful or uncomfortable. Retrograde ejaculation is the condition where semen travels backwards into the bladder rather than out of the urethra.

<span class="mw-page-title-main">Myalgic encephalomyelitis/chronic fatigue syndrome</span> Chronic medical condition

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience delayed worsening of the illness after minor physical or mental activity, which is the hallmark symptom of the illness. Other core symptoms are a greatly reduced ability to do tasks that were previously routine, severe fatigue that does not improve much with rest, and sleep disturbances. Further common symptoms include dizziness or nausea when sitting or standing, along with memory and concentration issues and pain.

Sexual anhedonia, also known as pleasure dissociative orgasmic disorder, is a condition in which an individual cannot feel pleasure from an orgasm. It is thought to be a variant of hypoactive sexual desire disorder.

Shenkui is a traditional Chinese medicinal term in which the individual suffers withdrawal like symptoms including chills, nausea, and even flu-like symptoms with anxiety, believed to be caused by an orgasm and loss of semen. The symptoms can last weeks to months after a single orgasm. In Traditional Chinese Medicine, shen (kidney) is the reservoir of vital essence in semen (ching) and k’uei signifies deficiency.

Idiopathic chronic fatigue (ICF) or chronic idiopathic fatigue or insufficient/idiopathic fatigue is a term used for cases of unexplained fatigue that have lasted at least six consecutive months and which do not meet the criteria for Myalgic Encephalomyelitis/chronic fatigue syndrome. Such fatigue is widely understood to have a profound effect on the lives of patients who experience it.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 Waldinger MD (2016). "Post-Orgasmic Illness Syndrome". In Levine S, Risen CB, Althof SE (eds.). Handbook of Clinical Sexuality for Mental Health Professionals (3rd ed.). Routledge. p. 380. ISBN   9781317507451.
  2. 1 2 3 Wylie KR, ed. (2015). ABC of Sexual Health. John Wiley & Sons. p. 75. ISBN   9781118665565.
  3. 1 2 3 "Postorgasmic illness syndrome". Genetic and Rare Diseases Information Center (GARD). National Institutes of Health. 2015. Archived from the original on 5 March 2016. Retrieved 30 July 2015.
  4. 1 2 3 4 5 6 Waldinger, MD; Schweitzer, DH (May 2002). "Postorgasmic illness syndrome: two cases". Journal of Sex & Marital Therapy . 28 (3): 251–5. doi:10.1080/009262302760328280. PMID   11995603. S2CID   27162173.
  5. 1 2 3 4 Balon R, Segraves RT, eds. (2005). Handbook of Sexual Dysfunction. Taylor & Francis. ISBN   9780824758264.
  6. 1 2 3 Jiang N, Xi G, Li H, Yin J (Mar 2015). "Postorgasmic illness syndrome (POIS) in a Chinese man: no proof for IgE-mediated allergy to semen". The Journal of Sexual Medicine . 12 (3): 840–5. doi:10.1111/jsm.12813. PMID   25630453.
  7. 1 2 Nguyen HM, Bala A, Gabrielson AT, Hellstrom WJ (January 6, 2018). "Post-Orgasmic Illness Syndrome: A Review". Sexual Medicine Reviews. 6 (1): 11–15. doi: 10.1016/j.sxmr.2017.08.006 . PMID   29128269.
  8. 1 2 3 Strashny, Alex (September 2019). "First assessment of the validity of the only diagnostic criteria for postorgasmic illness syndrome (POIS)". International Journal of Impotence Research. 31 (5): 369–373. doi:10.1038/s41443-019-0154-7. ISSN   1476-5489. PMID   31171851. S2CID   174814433.
  9. ↑ Bolanos J, Morgentaler A (March 2020). "Successful treatment of Post-orgasmic illness syndrome with human chorionic gonadotropin". Urol Case Rep. 29: 101078. doi:10.1016/j.eucr.2019.101078. PMC   6889685 . PMID   31832334.
  10. 1 2 Paulos, Mark R.; Avelliino, Gabriella J. (2020-01-01). "Post-orgasmic illness syndrome: history and current perspectives". Fertility and Sterility. 113 (1): 13–15. doi: 10.1016/j.fertnstert.2019.11.021 . ISSN   0015-0282. PMID   32033716. S2CID   211064753.
  11. 1 2 3 4 5 6 7 8 Ashby, J; Goldmeier, D (May 2010). "Postorgasm illness syndrome--a spectrum of illnesses". The Journal of Sexual Medicine . 7 (5): 1976–81. doi:10.1111/j.1743-6109.2010.01707.x. PMID   20214722.
  12. ↑ Goldstein A (10 Aug 2011). "Urology: Post ejaculation sickness". AllExperts. Archived from the original on 17 April 2016. Retrieved 30 July 2015.
  13. ↑ Rao, T. S. Sathyanarayana (2021). "History and mystery of Dhat syndrome: A critical look at the current understanding and future directions". Indian Journal of Psychiatry. 63 (4): 317–325. doi: 10.4103/psychiatry.IndianJPsychiatry_791_20 . ISSN   0019-5545. PMC   8363894 . PMID   34456344.
  14. ↑ Lim, Russell F. (2015). Clinical Manual of Cultural Psychiatry (2d ed.). American Psychiatric Pub. p. 521. ISBN   978-1-58562-439-3.
  15. ↑ Burri AV, Spector TD (Jun 2011). "An epidemiological survey of post-coital psychological symptoms in a UK population sample of female twins". Twin Res Hum Genet. 14 (3): 240–8. doi: 10.1375/twin.14.3.240 . PMID   21623654. S2CID   24204845.
  16. ↑ "Sexual headaches: What are they, who gets them and are they dangerous?". Global News. 28 June 2017. Retrieved 24 February 2020.
  17. ↑ Sáenz-Herrero, Margarita (2019). Psychopathology in Women: Incorporating Gender Perspective into Descriptive Psychopathology (2d ed.). Springer. p. 256. ISBN   978-3-030-15178-2.
  18. ↑ Farley SJ (March 2011). "Sexual dysfunction: Postorgasmic illness syndrome". Nature Reviews Urology . 8 (3): 121. doi: 10.1038/nrurol.2011.17 . PMID   21513019.
  19. ↑ "Dutch Doctor Identifies Post-Orgasmic Syndrome". Reuters Health. Amsterdam. Reuters. April 12, 2002. Retrieved 30 July 2015.
  20. 1 2 3 Attia AM, Yasien HA, Al-Ziny MH (2013). "Post-orgasmic illness syndrome: a case report". F1000Research . 2 (113): 113. doi: 10.12688/f1000research.2-113.v1 .
  21. ↑ West, Robert; Gossop, Michael (1994). "Overview: A comparison of withdrawal symptoms from different drug classes". Addiction. 89 (11): 1483–1489. doi:10.1111/j.1360-0443.1994.tb03747.x. ISSN   1360-0443. PMID   7841860.
  22. ↑ Olsen, Christopher M. (2011-12-01). "Natural rewards, neuroplasticity, and non-drug addictions". Neuropharmacology. Synaptic Plasticity and Addiction. 61 (7): 1109–1122. doi:10.1016/j.neuropharm.2011.03.010. ISSN   0028-3908. PMC   3139704 . PMID   21459101.
  23. ↑ Tsai, Chengchung; Li, Minyi (October 2019). "A New Exploration of the Combined Treatment of Symptoms and Social Work Psychology in Male Sexual Addiction Patients". Proceedings of the 2nd International Conference on Contemporary Education, Social Sciences and Ecological Studies (CESSES 2019). Atlantis Press. doi: 10.2991/cesses-19.2019.118 . ISBN   978-94-6252-816-1.
  24. 1 2 Friedman, Richard A. (January 19, 2009). "Sex and Depression: In the Brain, if Not the Mind". The New York Times. Retrieved 30 July 2015.
  25. ↑ Shah A (Jul 2001). "Asthma and sex" (PDF). Indian J Chest Dis Allied Sci. 43 (3): 135–7. PMID   11529431.
  26. ↑ Abdessater, Maher; Elias, Sandra; Mikhael, Elie; Alhammadi, Abdalla; Beley, Sebastien (2019-09-03). "Post orgasmic illness syndrome: what do we know till now?". Basic and Clinical Andrology. 29: 13. doi: 10.1186/s12610-019-0093-7 . ISSN   2051-4190. PMC   6721082 . PMID   31508233.
  27. ↑ "Weight For It & Desperate Measures". Strange Sex . Season 2. May 22, 2011. TLC. Archived from the original on 2021-12-15.
  28. ↑ "Postorgasmic illness syndrome". Orphanet. 2015. Retrieved 7 August 2015.
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