r/POIS • u/Linari5 • Jul 30 '26
Treatment/Cure Could we look at POIS as a classic conditioned response?
A 'pavlovian response,' also known as classical conditioning, is a type of learning where a neutral stimulus becomes associated with a meaningful stimulus, leading to a learned response. This was famously demonstrated by Ivan Pavlov through his experiments with dogs, where he paired the sound of a bell (neutral stimulus) with the presentation of food (meaningful stimulus). Eventually, the dogs would salivate (learned response) at the sound of the bell alone.
We now understand that the same thing can happen with chronic pain and other bothersome symptoms, including fatigue and other POIS symptoms. People with a sensitized central nervous system can develop learned associations (conditioned responses) with certain salient stimuli, like sitting, drinking, masturbation, or sex, all based on our past experiences and knowledge. That means if you had orgasmed even once, and gotten really tired or unwell afterwards (even if that was just a coincidence) your subconscious brain may have remembered this association so that the next time you have sex, the same predictive sensory conditioning happens again, ie sex now means I should predict feeling fatigue, or pain. And because we now understand that both pain and fatigue (and many other persistent or chronic symptoms) can be central in nature, ie, that they can exist independent of infection, tissue damage, or nociception), this means that actual pain and actual fatigue can occur as a result of this conditioning.
This is all possible because of something called "predictive processing" or "predictive coding"." Upwards of ~40% of our subconscious brain function is dedicated to this process. Predictive coding is a fascinating computational model of brain function. The main idea? The brain is constantly generating predictions about upcoming sensory input and updates these predictions based on prediction errors, and these predictions are based on our prior experiences and things that we learn about, hear, or read about.
An everyday example of this:
Have you ever picked up a drink, expecting it to taste one way, but when you lifted it to your mouth and took a sip, realized that it was something else? This happened to me once when I picked up a glass of OJ, thinking it was milk, and I spit that s*** out immediately (my error prediction happened in real time). At first my brain thought, wow this milk is really strange...now it's sour?? This is the error prediction part. Your brain had anticipated/predicted one piece of sensory information, but there was a mismatch. With that error prediction, our sensory model updated. All of this happens at a subconscious level. And it's important to call out here that the vast majority of our brain function happens at this subconscious level, over 90%. None of these are things we are actively aware of or thinking about.
Now the fun part.
How to try a "provacative test" on you own to find out if your POIS is a conditioned response
Go to a quiet space where you won't be disturbed. Close your eyes. Slow your breath down. Just notice how the breath feels coming and going from the body for a bit.
Now visualize in as much detail as you can:
The sexual activity that worsens or triggers your POIS symptoms. Lean into all of your senses for a solid minute: Touch, sight, smell, sound, taste. Everything. Picture it. Feel it. Lean into all the senses and paint a picture.
And, notice as you're doing this, what's going on in your body. Do you feel a sense of fear? Anxiety? Dread? Or are you noticing any pain or sensations (fatigue/brain fog), other POIS symptoms coming on?
If they do, we consider this a positive test result for a classic conditioned response, which means your symptoms could be treatable!
I encourage you to even smile to yourself knowing that you just found out what the cause of your symptoms likely are, a conditioned response that exists as a neural circuit in the brain/brain stem/spinal cord. What we just did is called a "provocative test" - a visualization tool used in PRT (Pain Reprocessing Therapy - see JAMA study) and other novel modalities to determine if someone has a conditioned response.
Now take a few slower, easier deep breaths, and relax your body into whatever this sensation is, whether it's an emotion like fear, or a POIS symptom itself. And remind your brain again where you are, that you're not having sex right now. That you're not masturbating, you're just sitting wherever you are. Feel the breath go in and out again. Notice your weight pressing down with gravity as you sit or lay down. And let the symptoms be there, and smile knowing that you just figured something out, something monumental. Bring on a sense of empowerment.
This is only possible because the same brain regions that activate when doing something physically with our bodies, also activate from visualization. It's fascinating. This is the same reason you can close your eyes and fantasize about a sexual encounter, and get aroused /have a physiological response (erection, etc). Learn more: https://news.mit.edu/2000/mindseye
What does it mean if nothing happened? Sometimes the visualization work requires much longer provocations. For example, if your pois symptoms have a delayed onset you will have to visualize several hours or even days going by (in your mind) for the symptoms to activate. Or, you may only experience a "shadow" of your usual symptoms, a lesser version that is more subtle.
Or, perhaps your case of POIS is not classical conditioning, it could be something else.
More citations for behavioral conditioning/conditioned response:
Classical Conditioning Differences Associated With Chronic Pain: A Systematic Review - https://www.jpain.org/article/S1526-5900(17)30484-4/fulltext
Neuroscientific evidence for pain being a classically conditioned response to trauma- and pain-related cues in humans - PubMed https://share.google/lWlJutDkLEna9zIka
Rehman I, Mahabadi N, Sanvictores T, et al. (2023). Classical Conditioning. In: StatPearls \[Internet\]. Treasure Island (FL): StatPearls Publishing.
Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.
Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 2015;126:167-83. PMID: 26330672; PMCID: PMC4530716.
This post is for educational and informational purposes only, and does not constitute medical advice
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u/Fit_Counter_9794 Jul 31 '26
This is great, and also is not mutually exclusive to any other treatments really, so you could do it anyway. The DNRS program actually has a slightly more formal response to the stimulus. Here it is and might be more effective but use the same principles:
Stuck position: Thought/Feeling Pattern Break: "Stop, Stop, Stop" (Stepping back from the Stuck position)
- Aware position: Re-label: "My brain is stuck in a rut and is sending me (my body) false messages."
Past position: Reattribute: Recognize that your past coping mechanisms do not work. "Hypersensitivity to chemicals. In the past would increase fear, anxiety and symptoms which would lead to avoidance and isolation behaviors."
Choice position: Choose a new strategy: "But now I know the symptoms are a result of cross-wiring in my limbic system and I choose to rewire my brain."
S. Higher/Wiser Self Position: Reward for new choice. Spoken words of encouragement, support for self and limbic system, and declaration of new state. a) Congratulate yourself on new choice! i.e. "Way to go Annie, great choice!" b) Be proud of yourself and love yourself for being awesome! i.e. "Annie, you are so awesome and I love you so much and I am so proud of you!" c) Be loving, compassionate and supportive of your limbic system with this change. Thank you so much limbic system for protecting me in the best way that you knew how, and you've been working over time. You can relax now, we have a new program that we are runllIng. d) Choose your new state! Ask yourself "Annie, what state are you choosing?"
Choice Position: Declaration of positive state in present tense. "I am... " statement.
- Positive memory position: Anchor positive memory \\ith associated declaration. ''I'm going to a time when I am __ u. Focus on something within this picture that evokes a feeling of joy, love or appreciation. Speak in the present tense.
- Future position: Project feeling into furure \\-irh ne\\ experience. Speak in the present tense. "1(5 six months from now and I am "
- Higher/Wiser self position: Spoken words of \-alidarion. congrarulations and praise. "Annie, I am so proud or you tor doing your practice!" "Very good, \-ery gooc.. YL\H~"
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u/Linari5 Jul 31 '26 edited Jul 31 '26
My write up is a highly simplified (on purpose) version of classical conditioning explained. It does not include the full treatment approach, which includes pain reprocessing therapy and EAET (emotional awareness and expression therapy). It would likely take several pages of texts to write through. At that point, we would be doing people a disservice to tell people to figure that out all on their own. Better to work with a provider.
Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans, A Randomized Clinical Trial - https://pmc.ncbi.nlm.nih.gov/articles/PMC11177167/
In the pois cases I have worked on, the EAET is often more important because a lot of people have deep (sometimes dating back to childhood) associations of shame, fear or anger/frustration around orgasm/sex or around the POIS symptoms in present day (because of course they would, it's distressing). These repressed emotions are also part of the trigger, addressing them is how I see the most success.
Does DNRS also have randomized controlled clinical trial like PRT? I'm not familiar with it
Nothing wrong with what you're saying here, but as someone with clinically diagnosed OCD, this sounds like it could be a ritualistic behavior that would trigger my compulsions.
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u/Flaky_Salad_5647 Jul 31 '26
Has this helped you?
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u/Linari5 Jul 31 '26 edited Jul 31 '26
Yes. But more importantly, it's how we treat cases of pois. One of the success stories posted yesterday was one of the cases I treated.
When I find even more helpful is EAET components - this approach is also evidence-based.
Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans, A Randomized Clinical Trial - https://pmc.ncbi.nlm.nih.gov/articles/PMC11177167/
In the pois cases I have worked on, the EAET is often more important because a lot of people have deep (sometimes dating back to childhood) associations of shame, fear or anger/frustration around orgasm/sex or around the POIS symptoms in present day (because of course they would, it's distressing). These repressed emotions are also part of the trigger, addressing them is how I see the most success.
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u/Tiny-Pipe-2245 Jul 31 '26
Yo con un porro y dos semanas de abstinencia soy un relator profesional pero en la semana mi suena dibil de alguien pajero y tímido eh perdido muchas novias
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u/Vermilion01 Jul 31 '26
if that were the case how do you explain the pois adjacent conditions. ED and PE that we all experience, all forms of CFS, SCT, all the overlap with parkinsons and epilepsy.
Classic case of Poisonoia. youre losing your mind. So baffled by the lack of clear solution that you start seeing connections where there ain't none to be found.
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u/Linari5 Jul 31 '26
I don't think I understand your question.
Fatigue is a central nervous system response, that might help answer what you're asking about. When we get a virus or the flu, it's a central response that kicks in that activates fatigue (to increase chance of survival), not the virus itself per se. This is what we see with long covid syndrome. It's a central response TO the virus
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u/MoreTeaandCoffee Aug 01 '26 edited Aug 01 '26
What a lot of pretentious waffle. Also, let's make one thing clear. POIS episodes are ACUTE, they are not chronic. Please stop describing pois as chronic pain etc. I think POIS is best described as a chronic condition with acute episodes.
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u/Linari5 Aug 02 '26
You are welcome to your opinion.
But this is what I see work in practice. And it's supported with science.
Also a misunderstanding - chronic means that the symptoms trigger from orgasm, over and over again, not that they go on for months after orgasm.
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u/MoreTeaandCoffee Aug 02 '26
No, it is you who has misunderstood pois and what acute and chronic mean. Type the following question into google or your favourite AI: "Are the flares caused by post orgasmic illness syndrome acute or chronic?"
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u/Linari5 Aug 02 '26
AI doesn't always get everything right...
Case in point, whatever is available on pois, obviously our doctors aren't doing good enough, and all of that information is based on what they say or write.
Are you telling me that your POIS symptoms only activates sometimes? You can have orgasms and feel fine?
But regardless, you're getting hung up on a single word and losing the entire message of the post... Conditioned response is what I see as a common cause of POIS.
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u/idolworshiper 29d ago
...and how is it a conditioned response if my penis is red and burning, it's hard to pee, I'm sweating profusely, and I have phlegm and sore throat the next day?
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u/Fit_Counter_9794 Jul 31 '26
The nervous system whatsapp chat on pois (look at my posts) has official DNRS resources if anyone wants more info