(236) Flibanserin for Post-Orgasmic Illness Syndrome: A Case Report

Abstract

Abstract Introduction Postorgasmic illness syndrome (POIS) is a rare disorder with ~50 cases recorded in the literature over the last 10 years. POIS is characterized by symptoms of flu-like fatigue, myalgias, fevers, mood disturbance, congestion, rhinorrhea and conjunctival pruritus, that begin within seconds to hours after an orgasm for a duration of 2-7 days. The most well described pathophysiologic hypothesis to date is immunologic based hypersensitivity reaction, but other hypotheses include withdrawal from endogenous opioids, dysregulated neuroendocrine response or autonomic nervous system. These mechanisms are elucidated by patient responses to different treatments including, antihistamines, dopamine agonists, benzodiazepines, NSAIDs and SSRIs. However, no standardized treatment has yet been developed. Objective Here we describe a case of intractable POIS in a patient physician, who had a remarkable response to flibanserin nightly and gabapentin nightly for pain. Methods Patient is a 40 year old male with acquired post orgasmic illness syndrome that started 10 years prior. Symptoms include headaches, muscle pain, numbness, weakness, irritability, low energy, anhedonia, and brain fog. Symptoms start 30 minutes after every orgasm and persist for 1 week. He reports fluctuations in his libido when experiencing these symptoms. Orgasms feel good to him and do not change with POIS. Pre-ejaculate and ejaculate trigger his POIS. He reports no problems with erections. He has tension headaches with arousal which affect his day but he does not experience full POIS symptoms. He does not report issues with stress except during POIS symptoms. He is a nonsmoker and has up to two drinks per month. He denies trauma, general pain, back injuries or pain, bowel dysfunction or abnormal penile curvature. He has been able to reduce symptom duration from 1 week to 4 days with a combination of bupropion, lexapro, silodosin, ritalin, and tramadol; however, the duration and intensity of symptoms is still significant. Patient was trialed on a combination of flibanserin and gabapentin. He was advised to take 200 mg gabapentin nightly and 100 mg flibanserin nightly. Results The combination of flibanserin and gabapentin significantly improved the patient's symptom duration and intensity. He now experiences mild symptoms for one day and has stopped taking his other medications. He also reports that his libido has markedly improved, helping him and his wife restore their intimate relationship. Conclusions The use of flibanserin, a serotonin receptor 2A antagonist and serotonin receptor 1A partial agonist has not yet been described in the literature, and supports a role of serotonin in the pathogenesis of POIS. Serotonin 2A is a known inhibitor of the sexual response and has a significant impact on mood, memory and cognition. As such this neuroendocrine dysregulation could modulate many of the symptoms present in POIS including brain fog, anhedonia and low energy. The variability of medications that provide relief in different patients emphasizes the importance of taking a multidimensional and individualized approach to treating patients' distinct presentations. Disclosure No