Allergic Seminal Vulvovaginitis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

The human body is allergic to various foreign substances, although some are harmless. An allergic reaction is the body's way of getting rid of that foreign substance. A cascade of reactions occurs in the body by producing antibodies, leading to noticeable symptoms. During the first contact with the allergen, the body identifies and marks it as harmful. After the subsequent contacts, an inflammatory response is triggered, leading to symptoms like redness, itching, etc. Anaphylaxis is a severe form of an allergic reaction that can be life-threatening. Interestingly, the human body can be sensitive to pollen, dust, clothes, chemicals, and sometimes even sperm.

What Is Allergic Seminal Vulvovaginitis?

Allergic seminal vulvovaginitis is an allergic reaction to the sperm that causes inflammation in women's vagina and external genitalia. Once the sperm comes in contact with the vagina, a response is triggered. This response manifests as urticaria, meaning an immediate redness, swelling, and itching develop on the affected skin. Symptoms of sperm allergy may be localized, generalized, or both. Seminal allergy is also known as seminal plasma allergy or hypersensitivity and seminal fluid hypersensitivity.

What Causes Allergic Seminal Vulvovaginitis?

Generally, allergies are thought to be the body’s natural reaction to foreign substances. However, the reason why the human body identifies substances as harmful is still unknown. Likewise, the cause of semen allergy remains a question. Several researchers have put forward their hypothesis that explains genital-tract immunomodulation (changes in the body’s immune system that modify the immune response). Some of the causes of allergic seminal vulvovaginitis are as follows:

• Hormonal changes like pregnancy and menopause.

• Hereditary and genetic factors.

• Surgical procedures involving the genital tract.

Is Allergic Seminal Vulvovaginitis Common?

An accurate estimate of allergic vulvovaginitis has not been determined. Most cases go undiagnosed because of their sensitive nature. A survey conducted in the United States estimated around 8 % prevalence. The details are as follows:

• Semen contact allergy affects women, and 40 percent of them show symptoms after the first sexual intercourse.

• It affects women in their second or third decade of life, sometimes after menopause.

• Cases are significantly associated with a family history or a genetic predisposition.

• Vulvovaginal (localized) symptoms occurred in 31 percent of women.

• 28 percent of women experienced general systemic symptoms.

• 39 percent developed from both localized and systemic symptoms.

• Only one percent developed a cutaneous reaction (changes in the skin).

What Are the Symptoms of Allergic Seminal Vulvovaginitis?

The symptoms can be exclusively localized, involving only the external genitalia. The reaction can start immediately on any part of the body the semen comes in contact with. Some of the symptoms include:

1. Vulvovaginal burning, itching sensation.

2. Tingling sensation around the vaginal opening.

3. Redness and swelling in the vulvovaginal region.

4. Blistering and pain are uncommon symptoms.

5. Uterine contractions and weak lower extremities.

Symptoms may last up to several days after the exposure, and the intensity of the reactions may increase. Localized reactions are often present with systemic manifestations. The general systemic symptoms include:

1. Generalized urticaria (itching of the skin triggered by an allergen).

2. The tongue, lips, and throat may become swollen (angioedema).

3. Common respiratory symptoms are wheezing, tightness in the chest, cough, sneezing, and runny nose.

4. Nausea, vomiting, and diarrhea are gastrointestinal symptoms.

5. Anaphylaxis (severe life-threatening allergic reaction) may occur in extreme cases. But no cases of death have been reported.

How to Diagnose Allergic Seminal Vulvovaginitis?

Diagnosis can be made based on the clinical history and lab investigations.

• Physical vaginal examination to identify the symptoms.

• Swabs from the vagina can be collected to rule out sexually transmitted diseases.

• Laboratory tests include a complete blood count, kidney and liver function tests, and more.

A specific test to identify semen allergy is a skin prick test. The procedure includes:

• Freshly ejaculated sperms are liquefied for half an hour at room temperature.

• The sample is centrifuged to separate components.

• The components are used for the prick test. After the prick, if an allergic rash develops on the skin, the test is said to be positive.

How Does Allergic Seminal Vulvovaginitis Affect Pregnancy and Conception?

This condition indirectly affects pregnancy and conception because of the reduced frequency of sexual intercourse. It has a psychological impact on individuals and their relationships, resulting in anxiety and sexual dysfunction. If the condition is managed, natural conception can be achieved. Patients can also opt for artificial insemination with washed sperm, but cases of persistent allergy have been reported.

What Is the Treatment and Prevention for Allergic Seminal Vulvovaginitis?

The treatment for allergic seminal vulvovaginitis includes general and specific management.

1. General Management -

• Antihistamines: Allergy medications like antihistamines can be taken 30 to 60 minutes before intercourse as prophylaxis. This may reduce the severity of the reaction. Antihistamines are commonly prescribed for semen allergies. If planning to engage in daytime sexual activity, it is advisable to consult a doctor for non-drowsy options. Taking an antihistamine can also be considered to minimize symptoms, ensuring they are mild and tolerable.

• A handy adrenaline injection is recommended.

• Sexual education and counseling will help patients deal with psychological impact.

2. Prevention -

Preventing semen allergy involves consistently using condoms to avoid direct contact between semen and the body, particularly for individuals engaging in penetrative sex, use of contraceptives (condoms or vaginal diaphragms) is recommended to avoid the allergen. For men practicing masturbation, it is crucial to prevent contact with semen during ejaculation.

• Desensitization: It is a process that involves gradual stimulation of the immune system by increasing the doses of the allergen. This modifies the immune system, and eventually, the body stops allergic response. Desensitization of the semen can be achieved intravaginally (inside the vagina) or subcutaneously (under the skin). A sexologist administers frequent injections of highly diluted semen into the vagina, monitoring the body's response. It is an effective technique that eliminates the allergy in more than 95 % of women after two to three times of weekly exposure. Repeated injections aim to build tolerance, potentially eliminating the allergic reaction. Regular unprotected sex with a partner may also be recommended to help the body develop resistance to semen-induced allergies.

When Should One Consult a Healthcare Professional?

Scheduling an appointment with a healthcare provider is necessary when experiencing painful symptoms following contact with semen. Localized symptoms may manifest as burning, itching, or swelling. Serious and potentially life-threatening systemic symptoms can also occur. The healthcare provider can conduct tests to ascertain whether semen is the source of the allergic reaction. Given that similar symptoms can be caused by other skin irritants or vaginal infections, seeking assistance is crucial for an accurate diagnosis.

Conclusion:

Allergic seminal vulvovaginitis is a condition characterized by an allergic reaction to semen. It is an uncommon condition, often associated with local and systemic symptoms. Burning, stinging, swelling, redness, and blistering around the vaginal opening is common. Systemic symptoms include urticaria, wheezing, and anaphylaxis in extreme cases. Diagnosis is confirmed after a positive reaction to the prick test. This condition can be managed by using prophylactic anti-allergy medications and desensitization.