Are You Allergic to Sex?

Many people experience discomfort after sex. The symptoms are broad, and range from itching, hives, burning, and skin rashes, to pain or other symptoms in the genital region, either within the vagina or on the penis. More severe allergic reactions from sex can result in systemic symptoms, resulting in difficulty breathing, dizziness and/or facial swelling. Although the prevalence of allergies during or after sex is unknown, it has the potential to significantly impact the quality of life for both an individual and relationship.^[1] There are a variety of causes for allergies when it comes to sex. While the possibilities are vast, some are more common and easier to identify, while others are rare, but crucial to identify early.

Defining Allergy

An allergy results from a very specific immunological reaction in the body. A person’s immune system identifies something as bad or “foreign”, in this case, an allergen, and produces immune cells to combat the allergen.^[2] Specific cells, called B lymphocytes, produce antibodies to attack the allergen in some reactions. The antibody most commonly involved in allergies is called IgE (immunoglobulin E).

In other reactions, T lymphocytes produce inflammatory proteins that signal more immune cells and changes in the local environment.^[2] This is the strict definition of allergy. Various conditions can mimic local allergies, but few can mimic systemic symptoms, such as hives, facial swelling, and trouble breathing. 

Lubricant and Spermicide Allergy

Tree nuts in lubricants

Those with allergies to tree nuts should check the labels on their personal lubricant prior to purchase. Some lubricants contain almond and/or coconut oil, which can cause an allergic reaction in someone known to be allergic to tree nuts. This is called a cross-reactant. If a lubricant is not involved in sex, the partner’s dietary habits may be the culprit. Kissing and saliva may carry the allergens responsible for food allergies, including tree nuts.^[1] It's important for an individual to keep this in mind if they know that they have an allergy and may engage in sex with someone who recently consumed almonds, cashews or any tree nut.

Nonoxynol-9 in spermicide

Spermicides contain numerous chemicals with the potential to cause irritation. These chemicals are necessary for spermicides to do the job of killing sperm. Spermicides have long been associated with allergy.^[3,4] Nonoxynol-9 (N-9) is the most commonly discussed chemical in spermicides, as it often causes problems in users. In a safety study with the vaginal use of nonoxynol-9, 50% of women experienced irritation. 70% of those women were found to have inflammation with an increased number of CD8+ T lymphocytes in the vaginal tissue when biopsied.^[5] Although the biopsy findings might indicate an allergy, it could also be the result of inflammation, in the absence of allergy. For example, an in vitro study using vaginal lining cells outside the body, showed that N-9 resulted in an increase in the production of inflammatory enzymes and proteins, specifically COX-2 and PGE2.^[6] This is not an allergy, but due to an inflammatory reaction, leading to vaginal irritation.

Spermicides contain additional chemicals that may cause discomfort in both men and women. If an individual suspects that spermicides might be causing their symptoms, the should discontinue use and ensure that they are using a different form of birth control. They should also be aware that some condoms have spermicides within, so they should check the condoms too!

Condom Allergy

Latex

Latex allergies are very common; consequently, some individuals may first experience a latex allergy with the use of latex condoms. Condom irritation can develop for a number of reasons, and a reaction to latex is only one reaction people can develop with the use of condoms. Of people with a latex condom allergy, around 84% of individuals experienced itching and swelling of their genitals, while 25% experienced systemic symptoms including hives, facial swelling, or problems breathing.^[7] An older study showed 24% of people with a known latex allergy experienced local symptoms.^[8] However, this study also looked into 16 different condom brands and found that only 4 were very allergenic, meaning it would most likely cause a reaction. The remainder were either mildly allergenic or not allergenic at all.^[8] Overall, not all individuals with a latex allergy will react to latex condoms, and not all latex condoms cause a reaction. Nevertheless, if a reaction does occur, a switch to a completely different condom, like polyurethane condoms may be called for.

Dairy or cow milk

Dairy allergies are due to a reaction to a milk protein called casein. Casein can also be found in condoms. A milk allergy is very different from lactose intolerance. A milk allergy is an immune reaction to caseins in the milk where B and T lymphocytes will either produce IgE or local inflammation.^[9] Lactose intolerance is the lack of an enzyme inside the intestines and does not involve the immune system. If an individual is lactose intolerant, the casein in condoms is safe. However, for those with a milk allergy (usually detected as an infant), they should steer clear of condoms containing casein, as the casein may cause a systemic reaction within minutes of exposure, leading to swelling, hives, and problems breathing.^[9] Patients with a milk allergy should look for casein-free condoms before engaging in sex, as the allergic reaction can be severe.

Finding the right condom

If someone is experiencing systemic symptoms, it is important to identify the cause as this can be life-threatening. If an individual thinks that they may be allergic to certain types of condoms, polyurethane condoms are a good alternative and easy to find. For more alternatives and further information on different types of condoms and choosing the right one, read this article.

Sex toy reactions

Sex toys are a common topic for discussion when it comes to allergies or reactions during and after sex. While sex toys are made out of a vast number of compounds, true allergies to sex toys are uncommon. One allergic reaction that may develop from sex toys is a latex allergy. If the latex toy causes discomfort, switching to a latex-free toy is easy and the best course of action.

Maybe Not an Allergy

What many people may think is an allergy may, in fact, be mechanical irritation from the toy or an infection from the bacteria that can multiply on certain toys. Although specific studies on sex toys do not exist, indirect studies show a possible correlation between toys and infection. Women who have sex with women are more at risk for developing bacterial vaginosis (BV), a condition caused by an imbalance in pH and bacteria in the vagina.^[10,11]

Two studies identified the use of unclean sex toys as potential causes for BV in women who have sex with women.^[10,11] The use of sex toys among men who have sex with men also increases the risk of HIV and HCV transmission.^[12] Heterosexual couples using sex toys are also at risk when using unclean sex toys.

Cleaning sex toys and choosing silicone products are two major ways to avoid symptoms. One study detected the amount of human papilloma virus (HPV) on 2 different vibrators (silicone and non-silicone) immediately after use with HPV positive women.^[13] The non-silicone vibrator samples had higher numbers of HPV positive vibrators immediately after sex. Twenty-four hours after proper cleansing, the non-silicone vibrators showed fewer numbers of HPV positive vibrators, while the silicone vibrators had no HPV positive samples.^[13] These studies support the fact that sex toys can harbor bad infections. Choosing the right sex toy (preferably silicone), cleaning it regularly and using a condom during sex is important to prevent the spread of infections.

What Sex Toy is the Safest?

The best sex toys are pure silicone and have no holes or high ridges. It should be smooth and easy to clean. Silicone has not been shown to be a significant allergy when applied to the skin; therefore, pure silicone sex toys are the least likely to cause a reaction, meaning they are hypo-allergenic. Consumers should look for that phrase when purchasing a toy. Sex toys should also be covered with a condom if used on different parts of the body during sex or is not cleaned properly.^[14] When using the sex toy, ensure individuals should have enough lubricant so as not to cause mechanical irritation from dryness. If a silicone sex toy is being used, only use water or oil-based lubricants as silicone lubricants will destroy the toy.

Semen Allergy: Seminal Plasma Hypersensitivity

Although not commonly reported, people can develop a seminal fluid allergy.^[15] This condition is called seminal plasma hypersensitivity (SPH). The reaction occurs following mucosal exposure (oral, vaginal or anal exposure) to seminal fluid. There are 2 types of SPH: local and systemic. Local SPH presents with itching, burning, pain, or swelling. It occurs up to a few hours after exposure to semen and can last a few days. Systemic SPH is more dangerous with facial swelling, wheezing and chest tightness, and dizziness. The systemic effects can progress to life-threatening anaphylaxis. It will present immediately after semen exposure and lasts less than 24 hours.^[15]

The cause of seminal plasma hypersensitivity and who might be at risk

The definitive cause of SPH is still undergoing research, but we know there are different pathways to developing localized versus systemic SPH. Localized SPH seems to be a reaction to enzymes or proteases in semen. The cells of the vaginal lining detect the enzymes and create inflammation just in the genital areas since they do not produce antibodies frequently.^[16] Systemic SPH is caused by an antibody (IgE) reaction to a prostatic specific antigen or other seminal plasma proteins found in semen.^[16]

Patients with a personal or family history of asthma, allergic rhinitis, eczema, and/or food or drug allergies are at an increased risk of developing SPH.^[15]

Fertility concerns in women with SPH

A common concern for women who experience SPH is infertility, as they are unable to have unprotected sex for conception. Women with systemic SPH may undergo treatment to desensitize themselves to their partner’s semen.^[17] Once the desensitization process is complete, women with SPH will have the same chance of getting pregnant as women without SPH.^[17]

Allergy vs Something Else

Symptoms only occurring on the skin or genitals like itching, redness, pain, or swelling, may very well be an allergy, called allergic contact dermatitis, but it could be a variety of other causes. Conditions like vaginal yeast infections or bacterial vaginosis may present with all of these same symptoms. Sexually transmitted infections, like trichomonas or herpes, may also present with similar symptoms. Aside from infection, there are other common allergens that may cause a reaction, which has little to do with sex. Body washes, certain underwear fabrics or pads can produce an allergic contact dermatitis that may seem related to sex but is not.

What to do when you think you may be allergic to sex

The first thing to do is to ensure that an individual is having an allergic reaction. A visit with a dermatologist can help to determine if it is another condition that is causing the reaction. Contact dermatitis, folliculitis, and other conditions are known to cause vaginal or penile bumps. 

If someone is experiencing a systemic reaction resulting in trouble breathing, swelling of the lips or tongue, or sudden dizziness, they should immediately seek medical attention and determine what caused the reaction before they engage in sex again.

If an individual is experiencing a true localized allergic response, they should look at what they used during sex: toys, condoms, lubricant. Once they identify a possible source, eliminate it the next time that they have sex. Continuing to try to eliminate elements that might have caused the reaction until the culprit is found.^[1] If they continue to experience a reaction despite efforts to eliminate a cause, they should see a healthcare professional who can properly evaluate and identify the possible causes for the reaction. Sex shouldn’t be bothersome or painful. Getting to the root cause of an allergic reaction can help allow an individual to eliminate the culprit so that they can begin to enjoy sex again.