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An Intimate Allergy: Reacting to Semen

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.

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.