Hiding errant boners during surprise Game of Thrones sex scenes is a familiar scenario for many men; for David,* though, the consequences of arousal are more consequential than embarrassment.
David, an Ohio resident, suffers from post-orgasmic illness syndrome, or POIS, a rare disorder in which orgasm leads to debilitating symptoms — including fatigue, brain fog, fever and reduced cognitive functioning — that can last for days. While watching the HBO show famous for gratuitous fucking probably wouldn't give David, who's otherwise abstinent, an automatic orgasm, it could lead him to have a wet dream later, which would be dangerous for his psychological state the morning after.
"Imagine going to work and you suddenly feel like you have dementia. You can't remember where you put things, your boss is yelling at you and you don't know why," is how he describes his post-orgasm state. "But the worst part is in school, you almost flunk the test because you had a wet dream. I had that happen a lot."
The association between orgasms and this most unorgasmic state of mind imaginable was first discovered by a Dutch neuroscientist named Marcel Waldinger in 2002; his patient zero was a man who experienced warmth in his abdomen and extreme fatigue after ejaculation. Waldinger suspects that POIS may be more common than doctors think, but shame and confusion prevent sufferers from coming forward. So far, he's been able to identify just a couple hundred men with the syndrome worldwide. (It is possible that a similar disease afflicts women but, as of 2016, only one female patient has been identified.)
A recent study of 45 men with the syndrome led Waldinger to theorize that POIS was an autoimmune reaction to one's own seminal plasma; this corroborates a previous study of his that indicates sufferers could be desensitized to the condition via regular injections of their own diluted semen. (So far, this course of treatment has only been performed on two men.) However, even he's not sure what causes the disorder; on his website, he floats a few other theories, including pituitary dysfunction and testosterone deficiency
He also notes that while mental symptoms like brain fog, fatigue and shortened attention span are common, some people suffer physical symptoms including muscle aches, diarrhea, constipation, cold spells, fatigue and restlessness, making the multi-tentacled beast of an illness even more difficult to treat.
To counteract the potentially devastating effects of POIS, David told me he attempts to control his waking thoughts, ensuring he doesn't encounter anything in his daily life that could give his subconscious a lusty romp after his head hits the pillow. So far, the self-enforced vow of celibacy has been somewhat successful: he told me he now averages around 10 orgasms a year, give or take.
If you log into POIS Center, a forum for those with the condition, you'll find many others taking similar, seemingly extreme steps to ensure they don't have to deal with the psychological nightmare that is their post-orgasm condition.
In the forum, members swear by post-orgasm treatments as varied as Ambien, Niacin (a vitamin), testosterone patches, and removing all cheese, grains and, dairy and specific junk foods from their diet — including Lays potato chips and Skittles. David said he's guinea-pigged nearly every treatment in the book, even ordering Alzheimer's medication from Switzerland that gave him terrible stomach cramps. He's finally discovered a few medications — including the sleep aid, Ambien; a supplement called GABA , the fibromyalgia medication Lyrica; and Phenibut, a sedative — that seem to help, though they don't completely diminish all the nasty psychological effects of orgasming.
Barry Komisaruk, the director of the Biomedical Research Support Program at Rutgers University-Newark and an expert on brain responses to sexual stimulation, has begun his own investigation into the causes of POIS. He believes the vagus nerve — a cranial nerve tasked with communicating impulses to nearly every organ in the body — could be functioning improperly in those who suffer from POS.
"A lot of the symptoms of internal stress [that POIS sufferers have] are mediated by the vagus nerve," he explained. "We're looking at vagal activity to see if that's being affected in people with the symptoms, but it's too early to give any information about our outcomes."
He notes that POIS was only recognized by the National Association for Rare Disorders fairly recently. "It's the kind of thing that people aren't even aware of. People may be suffering from the condition without even thinking they have it," he said. "Not knowing that it's a problem, you might think that it's just the way things are."
Jeremy* remembers feeling fluish after masturbating for the first time in puberty; at the time he chalked it up to a passing virus.
"Since few people have it and it's not recognized by much of current medicine, it usually takes a lot of time to finally establish that ejaculating can make you sick for days," he said in an email. "Then, when you finally figure it out, it's very hard to accept that what is meant to be the most natural and rewarding experience for a human being is, for yourself, the source for this debilitating state."
After Jeremy orgasms, he told me, he becomes a "totally different person — tired, groggy, phased out, aggressive, with no social skills, no wit and even cognitively challenged." As one might imagine, the condition wreaks havoc on relationships. "You can't have regular sex with a partner without them noticing something wrong unless you disappear for three to seven days a few minutes after making love."
After decades suffering alone, he discovered the POIS Center forum in 2015 and has since become one of its most active members. The message board includes lifestyle diaries from those in the thick of new experimental treatments, a poll center for querying fellow sufferers, as well as an investigation area to catalyze members into supporting new research.
Florian*, another user on the site, told me it took him a while to realize that feelings of pleasure being followed by several days of complete exhaustion wasn't normal. He says he's found the forum helpful, although half of the men seem to have "given up" on modern medicine and now "swear by homeopathic treatments that are basically placebos." He notes that the other half have tried so many different medicines and supplements, "we could open a pharmacy."
"The hardest part for me is the irritability," he added. "I get angry at my friends and family for the littlest reasons and I feel horrible about it every time, but I can't help how I react. One day I'm grateful and happy and the next day I'm critical and negative," he said.
He believes POIS diagnoses need to reach a critical mass in order for doctors to begin taking it seriously. "We need as many people to talk to their doctors as possible. The more well-known this condition is, the better chance we can see treatment in the near future," he said.
Steven Blum is a freelance writer in Los Angeles. His work has appeared in Broadly, The Stranger, Blackbook Magazine and The Daily Dot.