Reacting
to Semen: An Intimate Allergy
By:
Christine Haran
When it comes to relationships, we've all reacted badly
to our partner at some point or another. But some people
are actually allergic to their partners—to their partner's
semen, that is. Semen allergy is a rare but often-misdiagnosed
condition that can masquerade as a common yeast infection
or herpes infection. Not surprisingly, the associated pain,
redness, burning and swelling can wreak havoc on some relationships,
especially if the woman in the couple is trying to become
pregnant.
Once accurately diagnosed, however, couples can be treated
successfully. Dr. Jonathan Bernstein, an associate professor
of clinical medicine of the University of Cincinnati College
of Medicine is one of the few researchers who has studied
semen allergy and now treats people with this condition.
Below, Dr. Bernstein explains what causes semen allergy
and how to cope with it.
What kinds of allergic reactions can people have to semen?
People can have localized problems after immediate contact
with semen. They can have burning, pain and swelling that
can occur for long periods of time. Typically it affects
the outer vaginal vault area, though it can also affect
the inner vault. Some women describe severe burning and
pain, where it feels like 1,000 needles have been injected
in them at one time.
Some people can have a systemic response that involves trouble
with breathing, hives and soft tissue swelling. In rare
cases, people have had what we call vascular collapse or
anaphylaxis where they can pass out. But we haven't had
any fatalities that we're aware of with this condition;
deaths are more likely to occur as the result of a classic
anaphylactic response. And some people can have both localized
and systemic responses.
Symptoms can last from hours to days. They typically occur
within 20 to 30 minutes, most often within five minutes.
What in semen are people allergic to?
People are allergic to proteins in semen. We don't really
know which proteins are responsible at this point. Many
of the proteins associated with the semen allergy are believed
to be common proteins found in all semen, but it's also
possible for people to be allergic to a protein that is
unique to an individual.
The systemic reaction is believed to be linked to a specific
IgE antibody that is triggered by the protein; this antibody
response is similar to what occurs in people who have seasonal
allergies. There are probably multiple causes of the localized
reaction. A delayed type of hypersensitivity response similar
to what occurs with poison ivy may be involved.
Is this allergy often misdiagnosed or under-diagnosed?
Most women typically visit urologists and their gynecologist
for localized symptoms. Unless the doctor is astute and
takes a thorough history, it can be overlooked.
Semen allergy is sometime confused with recurrent vaginal
candidiasis and sexually transmitted
diseases such as herpes
simplex virus type 2.
Some people have been told that their vaginal vault is not
large enough for their partner's penis, so they have a surgical
procedure to enlarge the vaginal vault. That hasn't typically
helped. Sometimes women have actually been told that they
just have dryness and need to lubricate.
Many times patients get frustrated because they've been
through the gamut, or they haven't been acknowledged in
a serious manner by their physicians. Women then go on the
Internet and can usually stumble across something about
this type of allergy that will allow them to figure out
what might be going on.
Are these women more likely to have other allergies?
We haven't demonstrated that being allergic to common seasonal
and perennial allergens is a risk factor for this disorder.
There's been some suggestion that some existing food allergies
or a family history of food allergies might be related,
but that requires further verification.
Is it possible to have an oral reaction?
Yes, it's a possibility. But interestingly we haven't seen
this very often. Women have reported developing acneiform
lesions on their face after contact with semen. But we've
not had many women experience anaphylaxis or have localized
vaginal symptoms after oral contact typically. It may be
that many of these proteins are neutralized by something
in the gastrointestinal tract.
Can men have semen allergy?
It mostly affects women, but we did some work on the burning
semen syndrome in men who, after coming back from the Gulf
War, were complaining of burning and pain after ejaculation
or after contact with their own semen. But most of the complaints
were from their female sexual partners, who never previously
had trouble until their Gulf War partners came back.
We've not treated any men who have sex with men for this
allergy, however, they are at risk, theoretically.
Is there any relationship between semen allergy and infertility?
That's never been demonstrated. All of the women we have
treated have been able to go on and get pregnant. Because
condoms are used as a treatment, semen allergy can prevent
women from having unprotected intercourse naturally. But
in vitro fertilization has been successful in these women.
What problems can it cause?
We haven't seen fatality, although it's certainly possible
for these women to experience systemic anaphylaxis. It can
be disruptive to interpersonal relationships. I have seen
people who have gone on to find different partners because
the allergy was unique to the individual that they were
with.
How is this allergy diagnosed and treated?
Condoms are obviously the best in terms of avoidance. The
couple should don them before they start having intercourse,
since there's usually semen leakage during the act and that
could lead to some symptoms. If condom use isn't helpful
then you have to be concerned about whether semen allergy
is really the right diagnosis.
At the University of Cincinnati, we treat semen allergy
by desensitizing women to their sexual partner's semen with
injections similar to regular allergy shots. We take ejaculate
from the woman's sexual partner and separate the large and
small proteins. The woman is skin tested to these proteins
to determine which ones she react to. She is then desensitized
over several hours to the proteins she reacted to in the
skin test. The injections are given every 10 to 15 minutes
at increasing concentrations. After the desensitization
has been completed, ejaculate is instilled into the woman's
vagina. If she has no symptoms, then the treatment has been
successful.
It is believed that desensitization induces tolerance to
one or more proteins, similar to how standard allergy injections
work. We've had over 95 percent success with this treatment,
but it's a laborious and costly process and it's hard to
get insurance to cover it.
Some clinicians have tried to desensitize women using whole
seminal fluid. They dilute the semen and gradually instill
increasing concentrations of seminal fluid in the woman's
vagina over time. There are several reports of this treatment
being successful, but we have not found this treatment to
be uniformly successful. Treatments used to treat seasonal
allergies, such cromolyn sodium and oral antihistamines,
have not been helpful, either.
What advice would have for a couple with this problem?
First of all, it's important to make sure that women don't
have any other kind of underlying sexually transmitted diseases
that could be a problem, and that they've ruled out any
potential structural issues. The man should stay hydrated
before and during intercourse because dehydration can cause
a concentration of semen and more acidity. If there is a
problem, the couple should try using condoms and see if
that prevents the symptoms from occurring. If all those
things have been done and they still have a problem, then
I think that the couple needs to contact a board-certified
allergist who might be able to help them at least get started.
©
2005 Healthology,
Inc.
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