Suspected hypersensitivity to cervicovaginal fluid - what can we learn from the seminal plasma allergy story?

Abstract

After the first report of seminal plasma hypersensitivity (SPH) in 1958, it took more than 40 years to identify the allergen responsible for these reactions.1, 2 Even in the middle of the 70s, women suffering from allergic reactions against the ejaculate of their partners received the recommendation, ‘that she avoids this gentleman’.3 The first publication about SPH is written in Dutch language.1 The authors used the term ‘merkwaardig’ to describe the reaction of their female patient against seminal plasma. It is worth mentioning that ‘merkwaardig’ may mean ‘remarkable’, ‘strange’, but also ‘funny’ implicating some uncertainty concerning the severity of this reaction. The manuscript by Jankowski et al. reminds one very much of the situation in 1958. Nothing is known about hypersensitivity to cervicovaginal fluid (CVFH). The characterization of this potentially new disease is based on subjective reports from patients and the personal opinion of dermatologists. However, prick tests or determination of specific IgE are not available. This is not surprising, as the allergen(s), that may be responsible for CVFH, have not yet been identified. The fact that CVF contains a variety of components and is mixed with secretions of genital accessory glands does not necessarily mean that isolation of the allergen is not possible. Seminal plasma is also composed of proteins and substances from different anatomical structures such as testicles, epididymis, prostate gland and seminal vesicles (and more!). Suspected CVFH and SPH have one common problem. Genital or general discomfort after sexual intercourse may be caused by organic or psychogenic factors. However, the most important difference is that the composition of CVF differs according to the female cycle and is also influenced by the microbiological microflora.4, 5 Considering these aspects, the Internet-based questionnaire by Jankowski et al. is an important step to draw attention to a problem we do not have enough knowledge about, but we need more data ‘to characterize the population of men with suspected hypersensitivity to cervicovaginal fluid’ and to calculate the prevalence of CVFH. Do men with suspected CVFH notice differences in their complaints, when they have sexual intercourse at different times of their partner's cycle? Do oral contraceptives show effects on the reaction against CVF? Do men with suspected CVFH react differently to different sexual partners? If these data are available, it would be interesting to present them. As several studies have focussed on components of the vaginal or cervical–vaginal fluid,4, 5 it should be technically possible, to gain enough material for allergological tests. In addition, men with suspected CVFH need to be evaluated by physicians trained in sexual medicine. It is likely that some men have really IgE-mediated allergies against CVF. Witkin et al. 6 demonstrated that some men (without symptoms) have IgE antibodies in their seminal plasma that reacted with components of the vaginal fluid of their partners or (in one case) also with that of another woman. The allergens involved were not further characterized. In principle, it seems to be possible that men react specifically to their partners CVF. The consequence of the manuscript by Jankowski et al. will be that more reports about suspected CVFH will be published in the future. This will enable the allergological workup of these patients and their problems. It is hoped that it will not take 50 years to clarify this interesting problem!