The authors dedicate this article to thank Professor Alexander Gudkov, a prominent Russian urologist. Professor Gudkov did much to attract doctors of different medical communities to the immune system of men, particularly to the dependence of the favorable course of the postoperative period on a healthy immune system, and the need to be attentive to secondary immune-compromised and allergic conditions in the male reproductive system. In addition, he provided important insights into the analysis of this study.
Coyle PK. Introduction to neuroimmunology. In: Rizvi SA, Cahil JF, Coyle PK, editors. Clinical Neuroimmunology. New York: Humana Press; 2019. pp. 3–15.
Gong J, Zeng Q, Yu D, Duan Y. T Lymphocytes and Testicular Immunity: A New Insight into Immune Regulation in Testes.Int J Mol Sci. 2020;22:57. [DOI] [PubMed] [PMC]
Ye L, Huang W, Liu S, Cai S, Hong L, Xiao W, et al. Impacts of Immunometabolism on Male Reproduction.Front Immunol. 2021;12:658432. [DOI] [PubMed] [PMC]
Chen CS, Barnoud C, Scheiermann C. Peripheral neurotransmitters in the immune system.Curr Opin Physiol. 2021;19:73–9. [DOI]
Yadav P, Mali PC. Testicular inflammation in male reproductive system.Explor Immunol. 2024;4:446–64. [DOI]
Tortorec AL, Matusali G, Mahé D, Aubry F, Mazaud-Guittot S, Houzet L, et al. From Ancient to Emerging Infections: The Odyssey of Viruses in the Male Genital Tract.Physiol Rev. 2020;100:1349–414. [DOI] [PubMed]
Freud S. Three essays on the theory of sexuality. New York: Basic Books; 1963. p. 130.
Kinsey AC, Pomeroy WR, Martin CE. Sexual behavior in the human male. 1948.Am J Public Health. 2003;93:894–8. [DOI] [PubMed] [PMC]
Selye H. Stress and the general adaptation syndrome.Br Med J. 1950;1:1383–92. [DOI] [PubMed] [PMC]
Sennepin A, Real F, Duvivier M, Ganor Y, Henry S, Damotte D, et al. The Human Penis Is a Genuine Immunological Effector Site.Front Immunol. 2017;8:1732. [DOI] [PubMed] [PMC]
Wadhwa V, Hamid AS, Kumar Y, Scott KM, Chhabra A. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation.Acta Radiol. 2017;58:726–33. [DOI] [PubMed]
Klimov VV. Functional Organization of the Immune System.In: From Basic to Clinical Immunology. Cham: Springer; 2019.
Bhushan S, Theas MS, Guazzone VA, Jacobo P, Wang M, Fijak M, et al. Immune Cell Subtypes and Their Function in the Testis.Front Immunol. 2020;11:583304. [DOI] [PubMed] [PMC]
Voisin A, Saez F, Drevet JR, Guiton R. The epididymal immune balance: a key to preserving male fertility.Asian J Androl. 2019;21:531–9. [DOI] [PubMed] [PMC]
Wang C, Xie Y, Liu J, Xie Q, Kang Y, Dong X, et al. Recent advances in the study of the structure and function of the epididymis.Explor Immunol. 2024;4:309–24. [DOI]
Tung KSK, Han D, Duan Y. Editorial: The immunology of the male genital tract.Front Immunol. 2022;13:1042468. [DOI] [PubMed] [PMC]
Mendelsohn AC, Sanmarco LM, Spallanzani RG, Brown D, Quintana FJ, Breton S, et al. From initial segment to cauda: a regional characterization of mouse epididymal CD11c+ mononuclear phagocytes based on immune phenotype and function.Am J Physiol Cell Physiol. 2020;319:C997–1010. [DOI] [PubMed] [PMC]
Klimov VV. Textbook of Allergen Tolerance. Cham: Springer; 2022. p. 326.
Gal-Oz ST, Maier B, Yoshida H, Seddu K, Elbaz N, Czysz C, et al. ImmGen report: sexual dimorphism in the immune system transcriptome.Nat Commun. 2019;10:4295. [DOI] [PubMed] [PMC]
Wilson C. ARE THERE SEX DIFFERENCES IN THE IMMUNE SYSTEM?New Sci. 2023;257:40. [DOI] [PubMed] [PMC]
Ozbun MA, Campos SK. The Long and Winding Road: Human Papillomavirus Entry and Subcellular Trafficking.Curr Opin Virol. 2021;50:76–86. [DOI] [PubMed] [PMC]
Lorenzo GD, Buonerba C, Ferro M, Calderoni G, Bozza G, Federico P, et al. The epidermal growth factor receptors as biological targets in penile cancer.Expert Opin Biol Ther. 2015;15:473–6. [DOI] [PubMed]
Kidd LC, Chaing S, Chipollini J, Giuliano AR, Spiess PE, Sharma P. Relationship between human papillomavirus and penile cancer-implications for prevention and treatment.Transl Androl Urol. 2017;6:791–802. [DOI] [PubMed] [PMC]
Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, et al. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers.J Low Genit Tract Dis. 2023;27:307–21. [DOI] [PubMed] [PMC]
Castellsagué X, Bosch FX, Muñoz N, Meijer CJLM, Shah KV, Sanjose Sd, et al. International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners.N Engl J Med. 2002;346:1105–12. [DOI] [PubMed]
Chadha J, Chahoud J, Spiess PE. An update on treatment of penile cancer.Ther Adv Med Oncol. 2022;14:17588359221127254. [DOI] [PubMed] [PMC]
Iorga L, Marcu RD, Diaconu CC, Stanescu AMA, Stoian AP, Mischianu DLD, et al. Penile carcinoma and HPV infection (Review).Exp Ther Med. 2020;20:91–6. [DOI] [PubMed] [PMC]
Morris BJ, Hankins CA, Lumbers ER, Mindel A, Klausner JD, Krieger JN, et al. Sex and Male Circumcision: Women’s Preferences Across Different Cultures and Countries: A Systematic Review.Sex Med. 2019;7:145–61. [DOI] [PubMed] [PMC]
Shapiro SB, Laurie C, El-Zein M, Franco EL. Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression.Clin Microbiol Infect. 2023;29:968–78. [DOI] [PubMed]
Smith JS, Backes DM, Hudgens MG, Mei W, Chakraborty H, Rohner E, et al. Male Circumcision Reduces Penile HPV Incidence and Persistence: A Randomized Controlled Trial in Kenya.Cancer Epidemiol Biomarkers Prev. 2021;30:1139–48. [DOI] [PubMed] [PMC]
Prodger JL, Galiwango RM, Tobian AAR, Park D, Liu CM, Kaul R. How Does Voluntary Medical Male Circumcision Reduce HIV Risk?Curr HIV/AIDS Rep. 2022;19:484–90. [DOI] [PubMed] [PMC]
Mielke R. Male Circumcision and Infection. In: Zaghal A, Rahman N, editors. Circumcision and the Community. IntechOpen; 2019.
Collier R. Vital or vestigial? The foreskin has its fans and foes.Can Med Ass J. 2011;183:1963–4. [DOI] [PubMed] [PMC]
Cox G. De virginibus puerisque: the function of the human foreskin considered from an evolutionary perspective.Med Hypotheses. 1995;45:617–21. [DOI] [PubMed]
Boon JA. Verging on Extra-Vagance: Anthropology, History, Religion, Literature, Arts... Showbiz. 2nd ed. Princeton University Press; 2021. p. 368.
Moodley P, Vries L. The male role in cervical cancer prevention and transmission: Representation of subject positions in South African press reports (1998–2014).PINS. 2016;52:44–7. [DOI]
Bekker L, Das M, Karim QA, Ahmed K, Batting J, Brumskine W, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women.N Engl J Med. 2024;391:1179–92. [DOI] [PubMed]
Palm NW, Zoete MRd, Flavell RA. Immune-microbiota interactions in health and disease.Clin Immunol. 2015;159:122–7. [DOI] [PubMed] [PMC]
Onywera H, Williamson A, Ponomarenko J, Meiring TL. The Penile Microbiota in Uncircumcised and Circumcised Men: Relationships With HIV and Human Papillomavirus Infections and Cervicovaginal Microbiota.Front Med (Lausanne). 2020;7:383. [DOI] [PubMed] [PMC]
Pohl HG, Groah SL, Pérez-Losada M, Ljungberg I, Sprague BM, Chandal N, et al. The Urine Microbiome of Healthy Men and Women Differs by Urine Collection Method.Int Neurourol J. 2020;24:41–51. [DOI] [PubMed] [PMC]
Zuber A, Peric A, Pluchino N, Baud D, Stojanov M. Human Male Genital Tract Microbiota.Int J Mol Sci. 2023;24:6939. [DOI] [PubMed] [PMC]
Tuddenham S, Ravel J, Marrazzo JM. Protection and Risk: Male and Female Genital Microbiota and Sexually Transmitted Infections.J Infect Dis. 2021;223:S222–5. [DOI] [PubMed] [PMC]
Mehta SD, Zhao D, Green SJ, Agingu W, Otieno F, Bhaumik R, et al. The Microbiome Composition of a Man’s Penis Predicts Incident Bacterial Vaginosis in His Female Sex Partner With High Accuracy.Front Cell Infect Microbiol. 2020;10:433. [DOI] [PubMed] [PMC]
Krzastek SC, Smith RP, Kovac JR. Future diagnostics in male infertility: genomics, epigenetics, metabolomics and proteomics.Transl Androl Urol. 2020;9:S195–205. [DOI] [PubMed] [PMC]
Chen J, Chen J, Fang Y, Shen Q, Zhao K, Liu C, et al. Microbiology and immune mechanisms associated with male infertility.Front Immunol. 2023;14:1139450. [DOI] [PubMed] [PMC]
Burnet FM. A modification of Jerne’s theory of antibody production using the concept of clonal selection.CA Cancer J Clin. 1976;26:119–21. [DOI] [PubMed]
Parish IA, Heath WR. Too dangerous to ignore: self-tolerance and the control of ignorant autoreactive T cells.Immunol Cell Biol. 2008;86:146–52. [DOI] [PubMed]
O’Donnell L, Rebourcet D, Dagley LF, Sgaier R, Infusini G, O’Shaughnessy PJ, et al. Sperm proteins and cancer-testis antigens are released by the seminiferous tubules in mice and men.FASEB J. 2021;35:e21397. [DOI] [PubMed] [PMC]
Chereshnev VA, Pichugova SV, Beikin YB, Chereshneva MV, Iukhta AI, Stroev YI, et al. Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation.Pathophysiology. 2021;28:471–88. [DOI] [PubMed] [PMC]
Nam J, Lee J, Choi S, Jung N, Song J, Seo H, et al. Functional Ambivalence of Dendritic Cells: Tolerogenicity and Immunogenicity.Int J Mol Sci. 2021;22:4430. [DOI] [PubMed] [PMC]
Møller SH, Wang L, Ho P. Metabolic programming in dendritic cells tailors immune responses and homeostasis.Cell Mol Immunol. 2022;19:370–83. [DOI] [PubMed] [PMC]
Barrachina F, Ottino K, Elizagaray ML, Gervasi MG, Tu LJ, Markoulaki S, et al. Regulatory T cells play a crucial role in maintaining sperm tolerance and male fertility.Proc Natl Acad Sci U S A. 2023;120:e2306797120. [DOI] [PubMed] [PMC]
Walsh TJ, Turek PJ. Chapter 16-Immunologic infertility. In: Lipshultz LI, Howards SS, Niederberger CS, editors. Infertility in the Male. Cambridge University Press; 2010. pp. 277–94.
Shi X, Zhao H, Kang Y, Dong X, Yu C, Xie Q, et al. The Role of Mononuclear Phagocytes in the Testes and Epididymis.Int J Mol Sci. 2022;24:53. [DOI] [PubMed] [PMC]
Zhang Q, Sioud M. Tumor-Associated Macrophage Subsets: Shaping Polarization and Targeting.Int J Mol Sci. 2023;24:7493. [DOI] [PubMed] [PMC]
Graney PL, Ben-Shaul S, Landau S, Bajpai A, Singh B, Eager J, et al. Macrophages of diverse phenotypes drive vascularization of engineered tissues.Sci Adv. 2020;6:eaay6391. [DOI] [PubMed] [PMC]
Koinis F, Xagara A, Chantzara E, Leontopoulou V, Aidarinis C, Kotsakis A. Myeloid-Derived Suppressor Cells in Prostate Cancer: Present Knowledge and Future Perspectives.Cells. 2021;11:20. [DOI] [PubMed] [PMC]
Babinets LS, Migenko BO, Borovyk IO, Halabitska IM, Lobanets NV, Onyskiv OO. The role of cytocin imbalance in the development of man infertility.Wiadomości Lekarskie. 2020;73:525–8. [DOI]
Lo-Man R. Regulatory B cells control dendritic cell functions.Immunotherapy. 2011;3:19–20. [DOI] [PubMed]
Havrylyuk A, Chopyak V, Boyko Y, Kril I, Kurpisz M. Cytokines in the blood and semen of infertile patients.Cent Eur J Immunol. 2015;40:337–44. [DOI] [PubMed] [PMC]
Archana SS, Selvaraju S, Binsila BK, Arangasamy A, Krawetz SA. Immune regulatory molecules as modifiers of semen and fertility: A review.Mol Reprod Dev. 2019;86:1485–504. [DOI] [PubMed]
Salzmann M, Tosev G, Heck M, Schadendorf D, Maatouk I, Enk AH, et al. Male fertility during and after immune checkpoint inhibitor therapy: A cross-sectional pilot study.Eur J Cancer. 2021;152:41–8. [DOI] [PubMed]
Brunner-Weinzierl MC, Rudd CE. CTLA-4 and PD-1 Control of T-Cell Motility and Migration: Implications for Tumor Immunotherapy.Front Immunol. 2018;9:2737. [DOI] [PubMed] [PMC]
Margni RA, Perdigón G, Abatángelo C, Gentile T, Binaghi RA. Immunobiological behaviour of rabbit precipitating and non-precipitating (co-precipitating) antibodies.Immunology. 1980;41:681–6.
Calabrò RS, Cacciola A, Bruschetta D, Milardi D, Quattrini F, Sciarrone F, et al. Neuroanatomy and function of human sexual behavior: A neglected or unknown issue?Brain Behav. 2019;9:e01389. [DOI] [PubMed] [PMC]
Velez D, Ohlander S. Medical therapies causing iatrogenic male infertility.Fertil Steril. 2021;116:618–24. [DOI] [PubMed]
Kanno H, Kurata S, Hiradate Y, Hara K, Yoshida H, Tanemura K. High concentration of dopamine treatment may induce acceleration of human sperm motility.Reprod Med Biol. 2022;21:e12482. [DOI] [PubMed] [PMC]
Kaewman P, Nudmamud-Thanoi S, Amatyakul P, Thanoi S. High mRNA expression of GABA receptors in human sperm with oligoasthenoteratozoospermia and teratozoospermia and its association with sperm parameters and intracytoplasmic sperm injection outcomes.Clin Exp Reprod Med. 2021;48:50–60. [DOI] [PubMed] [PMC]
Ajayi AF, Onaolapo MC, Omole AI, Adeyemi WJ, Oluwole DT. Mechanism associated with changes in male reproductive functions during ageing process.Exp Gerontol. 2023;179:112232. [DOI] [PubMed]
Sengupta P, Jr EB, Dutta S, Krajewska-Kulak E. Decline in sperm count in European men during the past 50 years.Hum Exp Toxicol. 2018;37:247–55. [DOI] [PubMed]
Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years.BMJ. 1992;305:609–13. [DOI] [PubMed] [PMC]
Jørgensen N, Joensen UN, Jensen TK, Jensen MB, Almstrup K, Olesen IA, et al. Human semen quality in the new millennium: a prospective cross-sectional population-based study of 4867 men.BMJ Open. 2012;2:e000990. [DOI] [PubMed] [PMC]
Geoffroy-Siraudin C, Loundou AD, Romain F, Achard V, Courbière B, Perrard M, et al. Decline of semen quality among 10 932 males consulting for couple infertility over a 20-year period in Marseille, France.Asian J Androl. 2012;14:584–90. [DOI] [PubMed] [PMC]
Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review.Hum Reprod Update. 2007;13:209–23. [DOI] [PubMed]
Cocuzza M, Esteves SC. Shedding light on the controversy surrounding the temporal decline in human sperm counts: a systematic review.Sci World J. 2014;2014:365691. [DOI] [PubMed] [PMC]
El-Reshaid KA, Sallam HT. Male genital allergy.J Drug Deliv Ther. 2021;11:4–6. [DOI]
Bernstein JA, Perez A, Floyd R, Bernstein IL. Is burning semen syndrome a variant form of seminal plasma hypersensitivity?Obstet Gynecol. 2003;101:93–102. [DOI] [PubMed]
Köhn F. Suspected hypersensitivity to cervicovaginal fluid - what can we learn from the seminal plasma allergy story?J Eur Acad Dermatol Venereol. 2018;32:10. [DOI] [PubMed]
Tan J, Bernstein JA. Fertility and human seminal plasma (HSP) hypersensitivity.Ann Allergy Asthma Immunol. 2013;111:145–6. [DOI] [PubMed]
Lema VM. Allergy to human seminal plasma: case report and literature review.Women’s Health Gynecol. 2017;3:1–4.
Wolthers OD. A five-year followup of human seminal plasma allergy in an 18-year-old woman.Case Rep Med. 2012;2012:257246. [DOI] [PubMed] [PMC]
Smith ML. Honey bee sting pain index by body location.PeerJ. 2014;2:e338. [DOI] [PubMed] [PMC]
Martí-Garrido J, López-Salgueiro R, Bartolomé-Zavala B, Perales-Chordá C, Rojas DHd. Anaphylaxis after anal intercourse with tolerance by vaginal route.Ann Allergy Asthma Immunol. 2019;122:346–7. [DOI] [PubMed]
Caminati M, Giorgis V, Palterer B, Racca F, Salvottini C, Rossi O. Allergy and Sexual Behaviours: an Update.Clin Rev Allergy Immunol. 2019;56:269–77. [DOI] [PubMed]
Calogiuri G, Nettis E, DiLeo E, Foti C, Vacca A. Is the localized seminal plasma hypersensitivity the mucosal aspect of protein contact dermatitis?J Allergy Clin Immunol. 2015;135:1090–91. [DOI] [PubMed]
Carroll M, Horne G, Antrobus R, Fitzgerald C, Brison D, Helbert M. Testing for hypersensitivity to seminal fluid-free spermatozoa.Hum Fertil (Camb). 2013;16:128–31. [DOI] [PubMed]
Marfatia YS, Patel D, Menon DS, Naswa S. Genital contact allergy: A diagnosis missed.Indian J Sex Transm Dis AIDS. 2016;37:1–6. [DOI] [PubMed] [PMC]
Abbas M, Moussa M, Akel H. Type I hypersensitivity reaction.In: StatPearls. Treasure Island: StatPearls Publishing; 2021.
Nishihara Y, Shimizu T, Ichihara S, Suekata Y, Maeda K. Seminal plasma allergy: a literature review.J Gen Fam Med. 2015;16:265–70.
Lavery WJ, Stevenson M, Bernstein JA. An Overview of Seminal Plasma Hypersensitivity and Approach to Treatment.J Allergy Clin Immunol Pract. 2020;8:2937–42. [DOI] [PubMed]
Burguete-Cabanas MT, Fajardo-Ramirez OR, Yesaki R, Estrada-Maganas R, Salazar-Meza S, Rios-Chavez O, et al. Omalizumab for hypersensitive reaction to seminal plasma: A case report.Allergol Int. 2018;67:278–9. [DOI] [PubMed]
Weidinger S, Mayerhofer A, Raemsch R, Ring J, Köhn F. Prostate-specific antigen as allergen in human seminal plasma allergy.J Allergy Clin Immunol. 2006;117:213–5. [DOI] [PubMed]
Waldinger MD, Meinardi MMHM, Zwinderman AH, Schweitzer DH. Postorgasmic Illness Syndrome (POIS) in 45 Dutch caucasian males: clinical characteristics and evidence for an immunogenic pathogenesis (Part 1).J Sex Med. 2011;8:1164–70. [DOI] [PubMed]
Nguyen HMT, Bala A, Gabrielson AT, Hellstrom WJG. Post-Orgasmic Illness Syndrome: A Review.Sex Med Rev. 2018;6:11–5. [DOI] [PubMed]
Le TV, Nguyen HMT, Hellstrom WJG. Postorgasmic illness syndrome: what do we know so far?J Rare Dis Res Treat. 2018;3:29–33. [DOI]
Abdessater M, Elias S, Mikhael E, Alhammadi A, Beley S. Post orgasmic illness syndrome: what do we know till now?Basic Clin Androl. 2019;29:13. [DOI] [PubMed] [PMC]
Strashny A. First assessment of the validity of the only diagnostic criteria for postorgasmic illness syndrome (POIS).Int J Impot Res. 2019;31:369–73. [DOI] [PubMed]
Hamdi G, Ammar HB, Charaa O, Brahmi L, Maamri A, Zalila H. The first Tunisian case of postorgasmic illness syndrome: A case report.Clin Case Rep. 2021;9:e05120. [DOI] [PubMed] [PMC]
Reisman Y. Clinical experience with post-orgasmic illness syndrome (POIS) patients-characteristics and possible treatment modality.Int J Impot Res. 2021;33:556–62. [DOI] [PubMed]
Hernandez NM, Ruiz-Oviedo L, Chiclana-Actis C. Síndrome de enfermedad postorgásmica.Rev.SCHU. 2021;86:18–22.
Shanholtzer A, Stephens JR, Lauter C, Peters KM. Post orgasmic illness syndrome successfully managed with antihistamine: A case report.Urol Case Rep. 2022;45:102189. [DOI] [PubMed] [PMC]
Sonkodi B, Kopa Z, Nyirády P. Post Orgasmic Illness Syndrome (POIS) and Delayed Onset Muscle Soreness (DOMS): Do They Have Anything in Common?Cells. 2021;10:1867. [DOI] [PubMed] [PMC]
Mattson MP. Excitotoxicity-Chapter 11. In: Fink G, editor. Stress: Physiology, Biochemistry, and Pathology. Elsevier Inc; 2019. pp. 125–34.
Carlton SM. Nociceptive primary afferents: they have a mind of their own.J Physiol. 2014;592:3403–11. [DOI] [PubMed] [PMC]
Kim TB, Shim YS, Lee SM, Son ES, Shim JW, Lee SP. Intralymphatic Immunotherapy With Autologous Semen in a Korean Man With Post-Orgasmic Illness Syndrome.Sex Med. 2018;6:174–9. [DOI] [PubMed] [PMC]
Wrotynska-Barczynska J, Swat E, Berger A, Pawelczyk L, Jedrzejczak P. Intensified Hyposensitization Is an Effective Treatment of Postorgasmic Illness Syndrome (POIS).Sex Med. 2022;10:100474. [DOI] [PubMed] [PMC]