Seminal plasma hypersensitivity (SPH) is an “underrecognized women’s health issue,” which can be defined as “a variety of systemic and/or localized clinical symptoms after exposure to specific protein compounds in seminal fluid.”1 

While the prevalence and incidence of SPH is unknown,1 it is possible that as many as 20,000 to 40,000 American women could potentially have this condition.2,3 Prostate-specific antigen (PSA) is believed to be the major allergen, but other seminal proteins may be involved, as well.1

Jonathan A. Bernstein, MD, Professor of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, and Director of Clinical Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, a leading expert in research and management of SPH, discusses a case of a patient with this condition.

Ms. C, a 29-year-old woman, presents to her physician with severe pain, redness, and burning after first-time unprotected intercourse with her husband. The symptoms occurred within minutes of intercourse and have continued for several days. The couple had been using condoms since the onset of their relationship five years ago, but discontinued because they wanted to conceive.

Dr. Bernstein’s Comments:

Ms. C’s age is noteworthy, as the onset of SPH usually begins between the ages of 20 and 30 years. And, like Ms. C, many patients with localized SPH experience symptoms after the first unprotected intercourse. The patient’s localized symptom pattern is one of two potential presentations of SPH. 

The other is a systemic reaction, which can involve diffuse urticaria, facial, tongue, lip and throat angioedema, wheezing with severe dyspnea, nausea, vomiting, diarrhea, general malaise, and even life-threatening hypotension, loss of consciousness, and complete circulatory failure. These reactions occur within 30 minutes of exposure to seminal fluid and may or may not include localized pelvic or vaginal pain.

Ms. C’s physician assumes that she has contracted a sexually transmitted disease (STD). Ms. C and her husband are upset, as both have been monogamous and each had been tested for STDs before they started dating.

Dr. Bernstein’s Comments:

It is important to note that most patients with SPH are not promiscuous and are mystified when an erroneous conclusion is reached that they have an STD. Certainly, it is important to rule out STDs, but other conditions should also be considered in the differential diagnosis.

For both localized and systemic symptoms, SPH can be considered a “diagnosis of exclusion.” Diagnosing SPH involves conducting a thorough medical history and ruling out chronic conditions, such as recurrent vulvovaginal yeast infections, allergic vulvovaginitis, latex sensitivity, contact dermatitis, exercise- or vibratory-associated urticaria, transmission of food or drug protein and metabolites through body fluids to a sexual partner sensitized to these proteins or metabolites, and physical factors, such as a small introitus.

To confirm the diagnosis, the clinician should obtain a fresh ejaculate from the spouse or sexual partner, liquefy it at room temperature for 30 minutes, and remove the spermatozoa. The whole seminal fluid is used to perform a skin prick test. 

It is also possible to conduct a serologic assay by collecting blood from the husband and wife and measuring specific IgE responses to the whole seminal plasma protein. But if the SPH reaction is localized, patients do not always have specific IgE antibodies, so the test isn’t conclusive. The mechanism of localized SPH is still not entirely elucidated.

Ultimately, the gold standard for diagnosing SPH is the prevention of symptoms with the use of condoms. If condoms prevent symptoms, it can be concluded that the patient is likely suffering from SPH.