Women: Does Orgasm Give You A Hangover?

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Medusa, with live snakes for hairResearch reveals lingering postcoital cycle in women

In 2011, UK researchers released an interesting survey of postcoital symptoms in women. It didn't fit the standard script about how sex and orgasms transform women into glowing, satisfied beings or eager, contented lovers. Researchers noted,

Despite a wealth of evidence from specific internet sites and forums suggesting that irritability, crying and mood swings after sex seem to be common in females and males, to date no scientific study has tried to explore the nature of the phenomenon. ... Reports from female sufferers describing their condition suggest that [postcoital symptoms] can occur after sexual intercourse, both with and without orgasm.

The research found that some ten percent of women had experienced "postcoital psychological symptoms," or PPS. In 7.7% of women, the phenomenon was "persistent" (chronic). The researchers also pointed out that,

It is not unlikely that postcoital and/or postorgasmic endocrine alterations may cause symptoms of PPS in women, since a substantial amount of evidence exists proving effects of hormones on mood, depression, anxiety and so on.

In fact, a German pilot study revealed that sexual intercourse with orgasm induces a lingering cycle ("a ‘memory’—characterized by short-term neural activity resulting in long-term neuroendocrine response") in women. Might these hormonal (prolactin) surges be one of the dominos behind the chronic mood swings reported in the UK study?

A closer look at the UK study

The UK researchers noted that "recent" PPS was strongly correlated with relationship imbalances or lack of trust, and emotional difficulties, such as stress or a history of sexual and physical abuse. Certainly, there's no reason to doubt that relationship or other stressors indeed increase anxiety, tears and irritability.

However, for the chronic PPS sufferers, that is, the great majority of sufferers, the disatisfaction-abuse model didn't hold up:

While accounting for 70% of the variance in recent PPS, relationship satisfaction and previous events of physical abuse only explained 10% of the variability in persistent PPS, suggesting that there are other unknown factors that contribute to ... persistent PPS.

In our view, it's the chronic PPS sufferers who potentially offer the most intriguing clues for understanding human sexuality. In light of the new German findings, these 7.7% of women could well be at one end of a bell curve in how they experience a natural neuro-endocrine postorgasm/copulation cycle (PCC).*

Cycles are normal in the body, which constantly restores homeostasis through rising and falling levels of hormones and neurotransmitters. Some cycles are programmed (sleep-wake, menstrual cycles); others occur in response to changing conditions (blood sugar levels, water levels).

A postcoital cycle may be as common as a menstrual cycle, and the women's distress merely the postcoital counterpart of severe pre-menstrual syndrome (PMS). Keep in mind that PMS (once dismissed as fiction) affects up to 85 percent of women during their monthly cycles. Only some 5 percent have severe symptoms (irritability, depression, swelling). Others experience mild effects, which they may not associate with the cyclical cascade of hormonal events. Still others experience no symptoms.

Back to postcoital distress. Might the tearful, testy women be at one end of a spectrum, with symptom-free women at the other end? What if women in the middle simply haven't correlated milder symptoms with sexual activity? What if the effects are so subtle in some women that they automatically project them onto a partner, and blame him for being irritating, insensitive, more selfish or less attentive? Or what if some women experience neurochemical ripples later in an extended cycle, such that they can't easily make the connection?

The UK postcoital survey is the first research of its kind, so we simply don't know the answers. As the lead researcher said privately, there's "plenty more to discover." Already, however, it may be time to stop assuming that mood swings during this postcoital cycle are automatically "psychological" (due to issues requiring counseling) or "pathological" (abnormal), and consider the possibility that they're more often physiological and perfectly normal in many women because they are associated with a postcoital cycle. It may even be time for women who think they may be strongly affected by such a cycle to experiment with an alternative approach to seeking sexual happiness. (More below.)

A neuro-endocrine cycle after orgasm/intercourse?

Farfetched as it sounds, in other mammals this phenomenon has been recognized for years. In female rats, for example, vigorous "intromission," i.e., stimulation of the vagina (and orgasm?) sets off at least 10 days of twice-daily surges of the multi-purpose hormone, prolactin, as part of a series of endocrine events initiated by the surge of oxytocin during mating. (Humans, too, release oxytocin during mating.) This postorgasm/copulation cycle  kicks in whether or not a female rat's "vigorous sex" results in conception.

Why does this happen? Researchers have two theories:

First, prolactin may dampen dopamine sensitivity in the brain's reward circuitry for a while, such that sexual responsiveness temporarily drops, perhaps facillitating the Coolidge effect (movement to novel mates). In humans, a subtle neurochemical dampening such as this could lead to effects such as "Not tonight, Dear" or, somewhat paradoxically, feelings that one's own needs aren't being met. Interestingly, the German scientists called for human studies to determine if there is a correlation between the extent of the prolactin surge and fluctuations in sexual interest.

Second, prolactin surges might (also) be part of an orgasm-induced neuro-endocrine reproductive reflex that optimizes fertility and conception. That is, vigorous copulation may be the cue for the body to adjust itself with specific hormones in order to maximize chances of pregnancy—whether or not orgasm occurs.

In other words, prolactin may feedback to dopamine systems in the brain, which help regulate sexual behavior, and/or it may influence reproductive organs.

Does this lingering postorgasm/copulation cycle happen in humans too? Yes! As mentioned above, German researchers recently reported that human females, too, show a long-term change in prolactin secretory rhythm after sexual intercourse with orgasm. This change is in addition to normal, daily prolactin fluctuations.

The postcoital rhythmic change is also in addition to the prolactin surge that immediately follows orgasm. This surge actually occurs in both men and women, with significantly higher levels in females. Researchers hypothesize that it disturbs the prolactin-dopamine-oxytocin balance, which then alters their prolactin secretion patterns for a time. It may be that it disturbs this balance more in some women than others.

This study is the first endocrine evidence of a cycle induced by sexual intercourse in humans. Researchers simply haven't been looking for it until now. Yet if this cycle has been conserved in human evolution, what similar unexamined effects have too?

"What do women want?" asked a baffled Freud

Given that there is a PCC of at least 10 days in rats, how long is it in humans? In the pilot study, prolactin levels were only measured for 32 hours. Keep in mind that the postcoital surge may be only one aspect of a more complex cycle. For how long, and in what percentage of women, would such endocrine "memories" affect mood and perception, if at all? Which neurochemical/hormonal dominos might correspond with which symptoms? There's much to learn.

A neuro-endocrine mechanism that dampens sexual responsiveness could temporarily alter a woman's perception of her mate. While her neurochemical balance is tipping, she could easily feel less satisfied with her relationship. A partner's enthusiastic foreplay, which got rave reviews on the weekend, may only get one star during the week, because she now perceives it as grabby...or inadequate.

Without a solid biological explanation for these mysterious, apparently random, perception shifts, both partners can wonder if they've fallen out of love. If a postcoital cycle were verified and common knowledge, mates could more easily accept that they need to wait for their mutual physiology to catch up with their desires.

Prolactin has also been shown to suppress dopamine levels, so a neuro-endocrine cycle after intercourse could conceivably have an negative impact not only on a woman's libido, but also on her mood and energy level. (Dopamine is but one neurochemical player that contributes to a sense of cheerfulness, optimism and wellbeing.)

The bottom line is that the mates of women who are struggling against a postcoital neuro-endocrine tide may find their ladies very hard to please for a bit. (Think PMS.) Happily, lovers who are out of sync can still benefit from employing daily, soothing bonding behaviors. These increase trust between couples and encourage a nourishing relaxation response.

Historical lovemaking prescriptions

Aphrodite withholds Eros' arrowThe existence of a postorgasm/copulation cycle (PCC) could explain why sages around the globe recommended techniques to keep lovers in balance and sustain the harmony of their unions. For example, classical European artists often painted the theme of sensual Aphrodite withholding the arrow of Eros—signifying the need to keep Eros in check in the interest of love.

Kosher sex is more explicit. It prescribes almost two weeks a month in separate beds. This hiatus returns a woman's partner to her at her maximum fertility, but it also would also give her time to restore her libido and energy levels to homeostasis.

Daoist dual cultivation recommended a controlled approach to sex as well, without weeks of separation. The ancient Chinese Classic of Su Nu states, “If one engages in sex without emission…exercising self-control and calming the passion, love actually increases.” Both karezza and Michael and Diana Richardson's tantra also place an emphasis on frequent, gentle intercourse, rather than frequent climax, as a means to sexual happiness.

Such relaxed approaches apparently make good biological sense, given that they tiptoe around both the known triggers for the extended prolactin surges found by researchers: vigorous sexual stimulation and the hormonal surge at climax itself.

Anecdotal evidence

While scientists work out the details, it's worth noting that we've been hearing anecdotal evidence of this PCC and writing about it for years. Here's a forum exchange:

Man: My wife turns into a major bitch on occasion the morning after a night of really great sex. I’m talking multiple orgasms and a 2–3-hour session. And the next morning I am the anti-Christ!

Woman: This happens to me, too! I wake up in the morning after a great night with my dear husband and feel like the bitch from hell sometimes . . . really irritable and moody. Normally I’m a very even-keel kind of gal. Things feel better when orgasms are more spread out. I have personally noticed a significant decrease in my attraction and warm fuzzy feelings toward my spouse when the “O” is on a constant, regular basis.

Another woman described her experience:

I’ve always been a very sensual woman. I could have five and as many as nine orgasms in a single encounter. Afterward, I often felt a sense of having conquered my partner rather than having been with him in a romantic,mutually loving exchange. I usually felt distant from him emotionally; I would play silly power games, or else just go off and spend a fortune on expensive clothes and jewelry, fantasizing about our wonderful social life together where I’d be the center of attention in all my finery with this great guy and me together.

Within days I’d become weepy and reminisce about very sad periods in my life and fall into a mild depression. If I did this with the guy present, I wanted him somehow to say the right thing and ease the pain, be the protective man. However, men never seemed to say the right thing or not often enough for the depth of my despair. Then when a guy didn’t come up to snuff—too weak and tired and unreliable, or had fled off to the next conquest to escape the drain of a now-possessive or demanding woman—I’d be left with my expensive purchases and not able to pay my phone bill.

A husband, who began experimenting with karezza, reported in amazement that his wife,

does not miss orgasm and has no desire to have any more. I asked about that, as she had extremely powerful orgasms in the past. For me, they were quite fun to participate in and watch! I asked how she could be so powerfully orgasmic, but not want them anymore. She said they left her wiped out for days afterwards! I never knew that. She said orgasm is just not worth it for her.

The effects can be subtle, as this woman recounted,

My orgasm was precious in many ways, a beautiful gift of love from him, and I don't regret it at all. But soon after, I was feeling my legs drag as I walked. Gone was the bounce in my step. My thinking wasn't clear anymore either, and I burned a few fingers grabbing a hot frying pan wrong. We love each other so very much - always have - but we kept going through these cycles of irritation towards each other and truly couldn't understand it. [Knowledge of this cycle has given us] a whole new perspective, so we don't react negatively as easily.

A female "karezza-naut" said,

The neurochemical hangover is real for me. I was *sure* it wouldn't be! It took months for me to see myself as the source of the problem. My partner was very patient with me, he would let me pout and rant and have fits, but wouldn't engage in a fight. When I am post orgasm, I feel more critical, and far more emotionally unstable. I also feel more alone and misunderstood. For example, I would move to the far side of the bed, but blame my partner for some slight.

The thing that worked for us was implementing naked sexual snuggling on a daily basis. I'm the one with the higher sex drive, and without the daily sexual snuggling, I would unconsiously make sex too hot, and would frequently end up O'ing. That was a problem because I'm the one with the serious fight-triggering postcoital ripples that can turn into tsunamis at the slightest trigger.

My partner and I started down this path about 18 months ago. Recently, I had someone comment about how happy we loving coupleseemed now. Always smiling and laughing together. And it's true. I can't remember the last time we had an argument. The thing I would recommend doing is keeping a daily mood journal. It can help you pinpoint what might be triggering something, and to help give you a clear picture of how well karezza works.

Without a conscious experiment, it can be tough for a woman to realize that gentle intercourse, without the focus on orgasm, may well increase her sense of wellbeing and improve relationship happiness. Again, an alternative approach may work because it allows her to sidestep any sneaky postorgasm/copulation cycle.

Hopefully, our culture will quickly investigate, and openly acknowledge, any PCC, as well as its full range of effects. This may mean rethinking current beliefs in the unqualified benefit of more orgasms, multiple orgasms, and ejaculatory orgasms for women. It could be time to respect our physiology and fine-tune what works best for us as couples and individuals.

In a future post, we'll look at scientific evidence of a lingering postorgasm/copulation cycle in males. Meanwhile, gentlemen, stay calm when you and your mate go out of sync. No matter how masterful your lovemaking, it cannot hope to fill a neuro-endocrine black hole that must simply run its course before your sweetheart is restored to her usual energy level, lovingness and good humor.


*Note on terminology: Traditionally, hormones worked in the body, and neurotransmitters in the brain, but gradually scientists discovered that many hormones and neurotransmitters have functions in both brain and peripheral organs.

UPDATE 2017: Is standard orgasm-driven sexology advice even right for women? See "Improvements in gender equality & sexual education since the 1970s have not helped women to become more orgasmic"

Contrary to expectations, women did not have orgasms that are more frequent by increasing their experience and practice of masturbation, or by experimenting with different partners in their lifetime.

... There has been a continuous declining trend regarding the age of first orgasm in masturbation, but not regarding the age of the first orgasm in intercourse. Nowadays, half of women have had their first orgasm in masturbation at least 5 years prior their first orgasm in intercourse. They have had more time to practice their sexual pleasure via masturbation before their first intercourse, but that has not helped them to achieve an orgasm any younger during intercourse. This result diverges from expectations.

There are even some findings that masturbation is associated with poorer relationship quality, greater risk of female sexual arousal disorder, impaired sexual satisfaction, impaired orgasm (especially vaginal orgasm) and with other adverse processes (Brody, 2007). In this study, female relationship quality was not associated to masturbation frequency but general sexual satisfaction was lower among women who masturbated actively. Active masturbators considered their intercourse more often very pleasant than women who masturbated less often.

Those women who had orgasms much more easily via masturbation had problems to experience it in intercourse. The ease of attaining an orgasm via masturbation was not a good measure of orgasmic capacity during intercourse. Half of the women surveyed usually had an orgasm in intercourse via stimulating both clitoris and vagina, and only one-third usually via stimulating clitoris. Based on these results, the role of the clitoris is not as dominant in sexual stimulation towards orgasm in intercourse as has been expected.

UPDATE: 2015 study found half of women have experienced post-coital blues. And "There appears to be no relationship between PCD and intimacy in close relationships." Articles for lay readers: Post-sex blues’ hit nearly half of women' and "Why You Sometimes Feel Sad After Sex, Even When It’s Good Sex"

More food for thought: Sperm and sex peptide stimulate aggression in female Drosophila

And for science buffs: Growing evidence of a lingering post-orgasm cycle (links to studies)

And, some men are affected too: Postcoital Dysphoria: Prevalence and Correlates among Males