Complementary role of Benson’s relaxation technique in post orgasmic illness syndrome

Dear editor,

A rare following-ejaculation disorder that affects men is the definition of post-orgasmic illness syndrome (POIS). The affected man with POIS usually reports physical (myalgia, flu-like condition, generalized malaise, extreme fatigue and muscle weakness, concentration and/or speaking difficulties, fever with dry mouth/sore throat, runny nose, and ocular itching/burning) and psychological (irritability, anxiety, depressed mood, and stress) symptoms [1]. These symptoms usually last from 2–7 days to be spontaneously resolved at the end [2]. To avoid the recurrence of the above-mentioned symptoms, POIS men usually avoid any future sexual intercourse or masturbation as possible [3–7].

According to the published literature, no data confirmed the prevalence, etiology, or pathophysiology of POIS. Also, there is no standardized treatment for this rare condition [8].

The common by-physician prescriptions for POIS are selective serotonin reuptake inhibitors, alpha-blocker agents, antihistaminic drugs, desensitization therapy, benzodiazepines, immunotherapy, and non-steroidal anti-inflammatory agents according to the reported signs and symptoms [9].

Due to the lack of physicians’ awareness of POIS, they refer the cases to mental health specialists who are also unfamiliar with POIS, so the POIS-related psychological complaints aggravate [8].

The non-medical complementary therapies (mental distraction techniques, breathing exercises, music therapy, and muscle relaxation techniques) are used to improve the physiological status, pain, physical complaints, and mental/psychological discomfort. One of the popular complementary interventions that involve the previously mentioned non-medical complementary therapies is Benson’s relaxation technique (BRT, a combination of deep breathing exercise with progressive muscle relaxation). The application of BRT synchronizes the activity of sympathetic and parasympathetic systems. This synchronization improves the physiological status (respiration, pulse, and blood pressure), muscle tension, pain, physical discomfort, and sleeping quality, hence psychological complaints (irritability, anxiety, depressed mood, and stress) improve [10]. To our knowledge, investigating the acute effect of BRT on alleviating the physical and mental symptoms during the POIS attack was not published elsewhere, so this paper focused on this aim.

This letter to editor introduces a 25-year-old Egyptian married man. He was an engineer with a normal body mass index. He had one child. At the age of 20 years old, he first noticed the development of flu-like symptoms nearly after 30 min of his spontaneous ejaculations or masturbations. These symptoms spontaneously disappeared within 2–7 days on average. He counseled many physicians from different medical disciplines, but they referred him to psychology physicians to no avail.

With the repeated impact of negative post-ejaculation symptoms on stress, mood, depression, and work regularity, there has been an avoidance of having a regular sexual relationship with his wife. This avoidance increased the rate of nocturnal spontaneous ejaculations and hence, the reoccurrence of symptoms.

On 30th December 2021, he visited the andrology outpatient clinic of a nearby general hospital reporting sore throat/extreme fatigue, muscle pain, flu-like symptomatic complaints, anxiety, sudden depressed mood, and irritability. The symptoms started to appear after 30 min from ejaculation from the last sexual relationship held for 2 days with his wife. After a complete physical examination by an andrologist, he was diagnosed as a POIS patient. This diagnosis was confirmed after excluding psychological, neurological, systemic, urologic, prostatic, genital, allergic, erectile, sex-hormone, atopy, or viral infective disorders. He was prescribed antihistamines, mucolytic agents, and non-steroidal anti-inflammatory drugs.

With his refusal to take medications for anxiety, stress, and depression during the POIS-symptomatic attack, he recommended his wife turn to centers that provide physiotherapeutic, alternative, and/or complementary treatments for these medications.

On 31th December 2021, and without a referral, he visited my private physiotherapy and complementary-therapy center in Mit Ghamr asking for alternative therapy for psychological symptoms. With his passion and his reading of complementary therapies, he administered one BRT session in the center after consenting for getting included in further investigations.

The instructions of the session were as follow: (1) lie in the supine position on the plinth, (2) after closing the eyes slowly, from foot to head, relax all muscles of your body, (3) quietly take inspiration from the nose followed by expiration from your mouth (expiration is connected with saying the word “one”), (4) Repeat breathing exercises for 20 min while maintaining deep-relaxation state and ignoring any bad/annoying thoughts, (5) finally, (after 20 min), open your eyes, the session is finished.

Blood pressure, visual-analogue-scale-related POSI symptoms, pulse and respiratory rates, serum cortisol, and the total score of the state anxiety inventory questionnaire were assessed.

Comparing the measurements immediately taken before and after the BRT session showed appreciating improvements. These measurements were systolic blood pressure (125 versus 122 mmHg), diastolic blood pressure (82 versus 80 mmHg), respiratory rate (19 versus 17 breath/min), pulse (80 versus 76 pulse/min), serum cortisol (12 versus 11 μg/dL), the total score of the state anxiety inventory questionnaire (80 versus 57), visual analogue scale (VAS) of depression severity (100 versus 80 mm), VAS of anxiety severity (100 versus 50 mm), VAS of irritability severity (100 versus 40 mm), VAS of stress severity (100 versus 30 mm), VAS of fatigue and malaise severity (100 versus 80 mm), VAS of weakness and myalgia severity (100 versus 70 mm), VAS of sore throat and runny nose severity (100 versus 70 mm), VAS severity of sputum (100 versus 80 mm), and VAS severity of ocular burning (100 versus 50 mm).

Escaping obvious physical causes, with unexplained etiology and unclear approved treatment, POIS represents a challenging clinical problem. This syndrome usually triggers psychological issues such as guilt (due to avoidance of having regular sexual relations with the partner), distress, irritability, etc. The psychological issues are usually more aggravated during the attack of symptoms). For the first time in the literature, this paper reports a POIS man who showed partial POIS-related symptomatic partial improvements immediately after one BRT session.

Reaching the state of BRT-induced full deep relaxation is an expression of parasympathetic nervous system involvement. If this system is involved, the patient’s physiological, physical, vital, and emotional responses decrease. BRT-decreased activation of the sympathetic system decreases the oxygen consumption by the patient’s body, hence his muscles become more relaxed, and consequently he overcomes mental and some physical symptoms. So, after BRT, he feels calm, less depressed, more comfortable, less stressed and anxious, and less irritable [11] may be due to the reduced activity of the stress axis or hypothalamic-pituitary-adrenal axis [12].

Application of one session of BRT can provide immediate control to some of POIS-related physical and mental symptoms in an Egyptian man suffering from an attack of POIS. Future involvements of other relaxation techniques during POIS are needed.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.