Seminal Plasma Hypersensitivity: An Uncommon Allergy and Its Impact on Medically Complex Zebras

For individuals with medically complex conditions such as Ehlers-Danlos Syndrome (EDS), life can be filled with unusual and perplexing symptoms. These patients often experience challenges pinpointing their symptoms’ causes, sometimes perplexing medical professionals. A lesser-known allergy called seminal plasma hypersensitivity (SPH) can be an unexpected and distressing for some EDS patients. This blog will delve into seminal plasma hypersensitivity (SPH), its diagnosis, and its impact on relationships, providing insight and understanding for those affected.

Human seminal plasma (HSP) refers to the components of semen other than spermatozoa. When you have an immunological reaction to human semen, it is caused by proteins in HSP with a molecular weight of twelve to seventy-five kd (Nishihara, 2015). Reactions typically occur during or shortly after intercourse and can present as either localized vaginal reactions or systemic reactions. These reactions are called seminal plasma hypersensitivity (SPH). Symptoms of localized SPH reactions may include vaginal and vulvar swelling and/or itching, as well as severe vaginal pain and burning. Systemic reactions are much more invasive. Symptoms may include vaginal and vulvar swelling and/or itching, hypotension, headaches, dizziness, gastrointestinal symptoms, wheezing, urticaria, itchy eyes, nasal obstruction, and angioedema involving the face, lips, tongue, and throat.

Seminal plasma hypersensitivity (SPH) is exclusively seen in female patients. Over 60 percent of females presenting with human seminal plasma (HSP) allergies are between 20 and 30 (Nishihara, 2015). While SPH is more prominent at child-bearing age, new-onset symptoms have been reported after age 50 in pre-and post-menopausal females (Nishihara, 2015). Eighty percent of females with SPH have a history of other allergic disorders (Nishihara, 2015). After following up on case reports, SPH has been associated with surgical procedures or reproductive events. Examples include hysterectomy, long-intercourses free periods, child-bearing, insertion of an intrauterine device, and menopause. Due to the development of SPH with a first intercourse event, the clinical relevance of these procedures is unclear.

According to the Journal of Allergy and Clinical Immunology, the cause of local SPH reactions is unknown. Alternatively, systemic SPH reactions are often mediated by type-I immunoglobulin (Ig)E hypersensitivity reactions. The diagnostic evaluation for seminal plasma hypersensitivity (SPH) is a history of localized and/or systemic allergic symptoms following exposure to ejaculate. These reactions must be prevented by using condoms and not explained by any other disorder, such as an allergy to condoms or another substance. Suppose the female has known medication or food allergies. In that case, a detailed history should be completed to rule out the male’s ingestion of those substances within two to three hours before intercourse. Once referred to an allergist, the female may undergo skin-prick testing with human seminal plasma. However, skin-prick testing is often inconclusive if the female suffers from localized reactions. A consistent history of SPH and resolution of symptoms with a condom is the gold standard for diagnosis.

Seminal plasma hypersensitivity (SPH) carries a heavy emotional impact and can significantly strain relationships. Both males and females often have to learn how to cope with the guilt of the allergy and how to work around it. Condoms must be donned before initiating intercourse to prevent a reaction. If condoms are donned just before ejaculation, symptoms may not be precluded as exposure can occur to some degree before full ejaculation.

Seminal plasma hypersensitivity (SPH) is an uncommon allergy that can profoundly impact individuals with medically complex conditions like Ehlers-Danlos Syndrome or Mast Cell Activation Syndrome. Diagnosis and management of SPH can be challenging, but with proper understanding and support, those affected can navigate the emotional and physical hurdles to maintain healthy relationships.