From the Guidelines
Allergic reactions to seminal plasma are rare but potentially serious conditions where individuals experience hypersensitivity reactions to proteins in semen, and the most effective management strategy is desensitization therapy, which involves gradual exposure to seminal fluid under medical supervision over several months, as supported by the most recent and highest quality study 1.
Causes of Human Seminal Plasma Hypersensitivity
The causes of human seminal plasma hypersensitivity include:
- IgE-mediated sensitization to human seminal plasma proteins with molecular weights ranging from 12 to 75 kd, as reported in the study 1
- Spermatozoa have been identified as the source of allergens inducing a cell-mediated reaction in rare cases, as noted in the study 1
- Coital anaphylaxis has also been attributed to exposure to exogenous allergens transferred through semen during sexual intercourse, such as food or drug allergens, as described in the study 1
Symptoms of Human Seminal Plasma Hypersensitivity
The symptoms of human seminal plasma hypersensitivity include:
- Diffuse pruritus and urticaria
- Pelvic pain associated with uterine contractions
- Nasal symptoms, including rhinorrhea and sneezing
- Wheezing, dyspnea, and/or laryngeal edema
- Hypotension and syncope in rare cases, as reported in the study 1
Diagnosis and Management
The diagnosis of human seminal plasma hypersensitivity is confirmed by means of demonstration of sensitization to seminal fluid proteins through in vivo and/or in vitro immunologic methods, as stated in the study 1. The use of condoms is a common feature in preventing reactions, and desensitization therapy has been universally successful in preventing anaphylaxis to seminal fluid, provided the sensitizing seminal fluid fractions are used as immunogens, as supported by the study 1. Proper diagnosis through allergy testing is important before initiating treatment, and patients should always carry emergency medication if they have experienced severe reactions previously, as noted in the study 1.
Risk Factors
The most significant risk for seminal plasma protein anaphylaxis is in patients with a history of allergic asthma or atopic dermatitis, as reported in the study 1. Anecdotal case reports of seminal fluid–induced anaphylaxis have occurred postpartum, after gynecologic surgery, and after injection of anti-Rh immune globulin, as described in the study 1. Reactions have also been observed in women whose male partners have recently undergone prostatectomy or vasectomy, as noted in the study 1.
Quality of Life
Human seminal plasma hypersensitivity can significantly impact a person's quality of life, causing anxiety and stress related to sexual activity, as well as potentially leading to infertility, although localized and/or systemic seminal plasma hypersensitivity is not associated with infertility, as stated in the study 1. Therefore, proper diagnosis and management of human seminal plasma hypersensitivity are crucial to improving the quality of life for affected individuals, and desensitization therapy is the most effective management strategy, as supported by the most recent and highest quality study 1.
From the Research
Causes of Human Seminal Plasma Hypersensitivity
- The exact causes of human seminal plasma hypersensitivity are not fully understood, but it is believed to be an IgE-mediated allergic reaction to specific components of the seminal plasma 2, 3, 4.
- Prostate-specific antigen is thought to be a major allergen involved in the disorder, but other proteins are likely involved as well 2, 4.
- Women with systemic reactions are frequently atopic, suggesting a possible link between atopy and human seminal plasma hypersensitivity 2, 4.
Symptoms of Human Seminal Plasma Hypersensitivity
- Local reactions include itching, burning, erythema, and edema in the vulvar region or other sperm contact sites 2, 4.
- Systemic reactions can be experienced as dyspnea, dysphagia, rhinoconjunctival complaints, generalized urticaria, angioedema, gastrointestinal symptoms, exacerbation of existing atopic eczema, or anaphylactic shock 2, 3, 4.
- Symptoms can occur immediately or within 1 hour after contact with seminal plasma, and can range from mild to severe 2, 3, 4.
- In some cases, human seminal plasma anaphylaxis may present as 'vulvar vestibulitis syndrome' or 'burning semen syndrome' 2.
Diagnosis and Treatment
- Diagnosis is based on clinical history, demonstration of specific IgE antibodies in the serum, and skin tests 2, 4.
- Treatment options include allergen avoidance by use of condoms, attempts at desensitization, and prophylactic use of antihistamines or local cromolyn cream 5, 2, 4, 6.
- Local desensitization, such as intravaginal administration of serial dilutions of the partner's seminal plasma, can be an effective treatment option 6.
- Subcutaneous desensitization to relevant fractionated seminal plasma proteins obtained from the woman's sexual partner is also a possible treatment approach 4.