Overcoming sperm allergy

Dear Dr. G,

My 26-year-old wife and I have been trying for a baby for two years with no luck so far.

I am 28, and we have a very healthy sexual relationship – we even plan for intercourse during my wife's fertile period every month.

However, my wife complains of pain after intercourse. She said it can be quite bad and persists for a few days. This has obviously caused some concern and strain in our relationship.

We never had this problem when we started having sex two years before getting married.

Most of the time, we used protection but now, I am puzzled why she is having this problem without condom use.

I read some articles describing something called sperm allergy, which I assumed to be an urban myth.

However, I would like to put Dr G on the spot to say if couples can truly suffer such a problem.

I am worried and keen to know why people can develop a reaction to their own and another person's bodily fluids?

How common is this? Is it life-threatening to myself and my wife?

Does that spell the end of possibility of parenthood for us?

Please help us and thank you in advance.

Allergic Alister

Sperm allergy is an actual medical condition, also called semen allergy or seminal plasma hypersensitivity.

This is caused by a woman's aversion to the proteins found in semen, not the spermatozoa itself. Sperm allergy is rare and can occur during initial intercourse or following repeated sexual contacts with the same partner. Some women may have an allergic reaction to one partner but no adversity with others. It is not uncommon to encounter a spontaneous reaction, even after having unprotected intercourse with the same partner for many years.

Typical symptoms of sperm allergy include redness, itchiness, pain and burning sensation around the genitalia shortly after ejaculation into the vagina. The reaction can persist for a few hours or even days after sexual contact. It can also affect other areas of the body that have come in contact with the semen, including the mouth and skin. In more serious responses, some may develop rashes, hives and swelling, difficulty in breathing or even anaphylactic shock.

Sperm allergy is frustrating and can cause tremendous strain in a relationship. It is particularly infuriating when the couple is attempting to conceive.

Women who encounter pain and rashes after intercourse can confirm any semen hypersensitivity by consulting an allergy specialist. The diagnostic test usually involves an intradermal injection, where a small amount of the partner's semen is injected under the skin to verify any hypersensitive reaction.

On a separate note, the self-production of immunological proteins in men is known as anti-sperm antibodies – where the body mistakes sperm for an invader and triggers an immune system to protect itself. The sperm is usually protected from normal immune reactions in men through the "blood-testis barrier". Traumatic injury or surgical intervention of the testicles can breach the barrier, resulting in sperm triggering the immune system and an inflammatory response. The presence of anti-sperm antibodies can have an effect on fertility by impacting sperm quality and sperm-egg interaction. However, such immunological response is dormant and induces no symptoms in both men or women.

Immunosuppressive therapy like the use of corticosteroids may help treat anti-sperm antibodies and semen hypersensitivity, though research is very limited. One small study of nine infertile men, immunosuppressive therapy reduced anti-sperm antibodies in three subjects and substantially increased sperm count and fertility in one. A total of three successful pregnancies occurred. Laboratory techniques such as sperm washing can also be used to reduce the impact of anti-sperm antibodies on fertility. Sperm washing with centrifuge separate sperm from seminal fluid and attached antibodies will generally enhance the chances of fertility through Artificial Reproductive Technology (ART), also avoiding the adversity of sperm allergy.

The definitive treatment of semen allergy is building tolerance by having frequent unprotected intercourse.

A New York allergy specialist, Dr David Resnick, devised a treatment regime called "intra-vaginal seminal graded challenge". In the procedure, an allergist places the partner's semen into the vagina every 20 minutes and gradually increases the concentration until the woman cannot tolerate it any more. As most semen hypersensitivity is mild in its reaction, the process of building tolerance will not induce any life-threatening problems.