Sexual Hypersensitivities

 
Allergic reactions that interfere with sexual activity cause a particularly distressing condition that is not nearly as rare as is supposed. The effect on a woman of finding that she is allergic to her husband’s semen can be devastating psychologically as well as physically.

The whole area of sex- related allergies is complex and is rendered even more difficult due to the natural reticence of most patients. There are a number of true allergic reactions and also hypersensitivity reactions and straightforward irritation. Diagnosing the correct cause of trouble is crucial to managing it successfully. Even so, some cases are difficult to resolve.

With any kind of inflammatory reaction, both men and women can be affected. Women usually experience vulvo-vaginitis, that is, inflammation and irritation of the vulva and vaginal area. In males, inflammation of the tip of the penis (balanitis) occurs. The reaction can spread to other parts of the body. This is especially true of women, who have been known to have severe systemic (total body) allergic reactions following intercourse.

Sexual reaction can have a number of causes:

• Infective organisms

• The products of ejaculation

• Contraceptive substances and devices
• cosmetics
• incidental contact with unusual substances

MICROBIAL HYPERSENSITIVITY
A number of organisms in infective conditions can affect the genital area. ‘Honeymoon’ cystitis of course does not confine itself solely to the honeymoon period. Repeated attacks of painful urination and bladder irritation can frequently follow intercourse.

Bacterial vaginosis is more directly related to intercourse with an infected partner. A vaginal discharge is the usual accompaniment. Pathogens are mostly mixed, including Gardnerella vaginalis and various anaerobes (bacteria that live without oxygen). The characteristic foul smell of the discharge is produced by volatile amines such as methylamine, ethylamine and putrazine. These substances can be released by contact with seminal fluid, which is alkaline, and the sudden spread to the tissues can give rise to flushing, irritation and other symptoms that may lead the partners to assume (erroneously) that they are ‘allergic to sex’.

Candidiasis
This may not show itself on repeated vaginal swabs but can be a cause of intense vulvo-vaginal irritation made worse by intercourse. In addition, patients may show a true allergic IgG-mediated type hypersensitivity to Candida albicans.

Balanitis
De-epithelialization of the glans penis is a poorly documented condition that often affects men. Perhaps because the penile epithelium is unaccustomed to exposure, prolonged or forceful intercourse, especially if lubrication is poor, may occasionally rub and inflame it. This condition needs to be distinguished from a true inflammatory balanitis caused by hypersensitivity reactions to vaginal micro-organisms, spermicides, etc.

SEMEN
Allergy to semen was first described in 1967 by Halpern et al, who reported a case of a 29-year-old atopic woman who developed asthma after intercourse. In another case, reported in 1974, increasing hypersensitivity reactions culminated in an anaphylactic-type circulatory collapse. Since then, the condition has been widely described and this unusual diagnosis is now only missed when the attending physician is insufficiently attentive to the patient’s reported history.

Diagnosis may be made by patch testing or, as is done at our clinic, with intradermal testing of the serial titration type. For moral and ethical reasons we prefer to use the husband’s own semen, through the semen of most men appears to contain the same sensitizing agents. Apparently these agents come from the seminal vesicles.

Note: Women can also have allergic reactions to substances via their partner’s semen. One of my patients reacted to her husband’s medication. This was discovered by her having sex with and without condoms and with and without the medication; we were able to show that the allergy was not a semen allergy. Literature also contains a case of a woman who had an anaphylactic reaction to walnuts. She was highly allergic to them and, if her husband had been eating walnuts immediately prior to coitus, she would have a similarly severe reaction after intercourse. Walnut protein was demonstrated in the semen.

A woman may react to her partner’s aftershave, topical ointments, etc, by direct contact. This may be very puzzling until the true cause is deduced. The usual culprit is propylene glycol, which is also widely used as a vehicle for cosmetics, body lotions, anti-perspirants and topical medicines.

CONTRACEPTIVES
Some men (and also women) experience a hypersensitivity reaction to the rubber of contraceptive sheaths. The usual culprits are additive reagents to the rubber itself, but reactions may also be due to the ‘sensitizing’ solutions used by the condom manufacturers for enhancement purposes. Allergic hypersensitivity to K-Y Jelly and other lubricants has also been reported.

COSMETICS
A number of local applications to the genital area may cause hypersensitivity reactions, which on occasion could be aggravated during sex and appear to be caused by sex. Such applications include perfumes, hygiene sprays, soaps, bubble baths and locally applied medications containing notorious sensitizers such as amino glycocides, tetracyclines, chlorohexadine, hexachlorophane and chloroxylenol. Some women wear self-adhesive pads to contain vaginal secretions, which may contain disinfectants and scents (acetyl acetonate and derivatives). Hypersensitivity to clotrimazole, a common anti-Candida treatment, may be the cause in a woman whose vaginal irritation worsens when she receives treatment for thrush.

Taking a detailed history is very important. This may bring to light unusual sexual practices – as in the case of the woman who had  a severe inflammatory vulvo-vaginitis caused by her lover anointing his penis with a rubefacient cream, the idea being to cause both partners stimulation from the warm ‘glow’ that resulted.

INCIDENTAL ALLERGENS
Sometimes allergic reactions may occur at intercourse due to some non-obvious cause, for example, allergy to the duvet. Another reported case was allergic hypersensitivity to newsprint, which was transferred to the vulva via the husband’s fingers. He was in the habit of reading the newspaper before retiring for the night and he carried with him sufficient chemicals to cause his wife to react.

TREATMENT
The most obvious treatment is avoidance where possible, for example no spermicides, cosmetics, douches, etc. Identification is clearly important. Patch tests are not reliable.

For semen allergy, desensitization may be tried with the Miller’s low-dose technique, which is the only safe method. Anti-histamine creams or tablets, such as diphenhydramine hydrochloride, may be tried.

The use of condoms, if acceptable, may be a way of avoiding semen hypersensitivity or a reaction to a partner’s ingestants.

Genital infections need treating in the usual way and are seldom tackled vigorously enough. For example, it makes good prescribing sense to treat both partners at the same time, to prevent ‘ping-pong infections’ (backwards and forwards). Broad spectrum antibiotics such as tetracycline may be needed for chlamydia nd anaerobes, metronidazole (Flagyl) is the recognized treatment for Trichomoniasis vaginalis and chlamydia.  

ALLERGIES AND APHRODISIACS

Allergies play a part in arousal for many people, whether they know it or not. Reactions to food are often rather like intoxication, the effect on the brain being alterations in function very similar to those everyone is familiar with in  connection with alcohol. Many patients, especially women, are able to describe dramatic events of arousal following allergy challenge testing.

Certain foods since time immemorial have been ascribed the power of increasing sexual desire (aphrodisiacs). You may be aware of the reputation of some of them. But as you will see from the table below, any food may do it if the individual is maladapted to it and it produces a slightly enhanced reaction! Alcohol has always been the most potent of these foodstuffs, simply because by its nature it tends to provoke stimulatory reactions to the foods contained in the beverage. Those of you who know what ‘brewer’s droop’ is will understand that it also impairs function. Thus Shakespeare was right when he had the porter in Macbeth declare that alcohol ‘provokes the desire, but it takes away the performance’ (II, iii).

In fact allergies can both stimulate and suppress, though usually depression follows too much stimulation (exactly as with alcohol). Dr Theron Randolph  tabulated the main effects, and these are shown here. Compare this table with that given for general cerebral stimulation due to maladaptation, also by Theron Randolph (see brain allergy).

Changes in Sexuality at Various Levels of Reaction