Migraines and toe twitches: Weird things happen when we orgasm, researchers find (and that’s okay)

Not long ago, and for reasons he couldn’t fully explain, Dr. James Simon saw a number of women within a short period of time with a remarkably similar complaint — orgasmic cephalgia, or a sudden, severe explosive headache upon orgasm.

When the George Washington University obstetrician-gynecologist and his then-senior resident started looking into post-coital, orgasmic migraines, they discovered “a bunch of these cases” of other bizarre things that can occur to some people just before, at the moment of, or soon after orgasm, including post-orgasmic cataplexy (an abrupt and total loss of muscle tone), altered status of consciousness, hallucinations and flu-like attacks researchers theorize are due to allergic reactions to one’s own sperm.

Their recently published paper — “’Did you Climax or Are You Just Laughing at Me?’ Rare Phenomena Associated With Orgasm” — appears in the journal, Sexual Medicine Reviews.

Simon doesn’t consider himself an expert in orgasms. Nor does he want to be seen as pathologizing peri-orgasmic syndromes, or the people who experience them. “I don’t want to trivialize the fact these syndromes exist,” he said in an interview. “I want to make sure the scientific community knows that they exist, and understands basically why we believe they exist (so) they can tell patients, ‘Well, this has been reported before, you’re not alone and it really doesn’t portend something horrible in your life.’”

Orgasm is a primitive reaction that occurs in animals of all kinds, Simon said. However, many of the phenomena he and his co-author found in their review of the medical literature can be thought of as almost epileptic-like syndromes, where the “neurological discharge” that occurs during orgasms, as Simon explains, becomes more generalized.

For example, “status orgasmus,” also known as expanded sexual response, a kind of tantric sex-like state of sustained, long lasting or multiple orgasms. In one Turkish study of 47 women claiming to have some form of expanded sexual response, almost all noted a flying experience, or “sensation of flight.” Half said they had a surreal, out-of-body experience. A not insignificant proportion saw cartoon characters.

Simon and co-author Dr. Anna Reinert, of the department of obstetrics, gynaecology and reproductive sciences at the University of Maryland, also found case reports of panic attacks, as well as face or foot pain with orgasm. One study describes a woman who developed spontaneous orgasmic sensations in her left foot whenever she experienced an orgasm, due, the researchers hypothesized, to partial regeneration of damaged nerve fibres in her foot. According to Simon, “we believe, and I would say we know in mapping the human brain, whether it’s a male or female, that the genitals are located very near where the great toe is mapped,” which, he allowed, might explain foot fetishes.

The researchers also unearthed reports of crying after sex (post-coital dysphoria) uncontrollable fits of post-orgasmic sneezing dating back to the 1900s, a woman who complained to a romance advice columnist her partner always laughed after sex, and post-orgasmic cataplexy or catatonia, a rare occurrence usually, though not exclusively reported in people with narcolepsy or other sleep disorders.

“Imagine that you and your partner have had this passionate lovemaking session, it’s your first one together, and you become catatonic for the new few hours,” Simon said. “I mean, that’s why I thought, ‘oh my goodness, this should be something we figure out.’”

HSAs — headaches that occur with sexual activity — are thought to affect roughly one per cent of the population, but are three to four times more common in men, according to the British Journal of Medical Practitioners. “The typical story is that the headache occurs during sexual activity, is bilateral and stops or is less severe if sexual activity stops prior to orgasm,” otherwise the pain can last up to four hours, according to the BJMP, which adds that the most intense coital headaches are likely due to “increased intracranial pressure secondary to a Valsalva maneuver (attempting to exhale against a closed airway, like weight-lifters’ blackouts) during orgasm.” Pot can make things worse.

One of the newest syndromes to emerge in the literature is POIS, or post-orgasmic illness syndrome, in which men become seriously ill within a few minutes to a few hours after ejaculation. In 2002, Dutch researchers published a case report of two men who experienced astonishingly similar flu-like symptoms — fever, foggy head, aching muscles, burning eyes, irritated mood — post ejaculation. The symptoms disappeared spontaneously after three to seven days, but recurred as soon as they again ejaculated. The investigators postulated POIS was caused by an allergic reaction of the male against his own semen. To prove it, they performed a skin prick test in a larger sample of men with suspected POIS, injecting samples of the men’s own semen (mixed with saline) into their left forearm; 29 of the 33 men (79 per cent) tested positive.

Doctors aren’t exactly sure which part of the ejaculate contains the antigen responsible for triggering the allergic response. However, they have reportedly successfully treated several men using “hyposensitization therapy,” injecting them with gradually higher concentrations of their diluted sperm, like allergy shots for people allergic to cats, or ragweed. (POIS is rare, but not unheard of, in women.)

“The human sexual response is complex and diverse,” Simon and Reinert conclude in their peri-orgasmic phenomena paper which, “despite anecdotal reports to the contrary,” yielded no published literature for drooling, swearing, cursing or other search terms they used along with “orgasm” and “post-coital.” Still, they say, “the diversity of the phenomena presented is notable.” The goal in the end, Simon says, is “to try to normalize them, if we can, so that people don’t feel like they’re weirdos, or their partners don’t feel like they’re weirdos.”