Weak with sex: sexual intercourse as a trigger for cataplexy

J Sex Med. 2009 Aug;6(8):2271-7. doi: 10.1111/j.1743-6109.2009.01328.x. Epub 2009 Jun 2.


Introduction: Sudden, often positive emotions are typical triggers for cataplexy in patients with narcolepsy-cataplexy (NC). Cataplexy during sexual intercourse and orgasm (orgasmolepsy) has been previously reported, but its frequency and characteristics are poorly known.

Aim: To assess frequency and features of loss of muscle tone during sexual intercourse in a series of patients with NC, other sleep-wake disorders, and healthy controls.

Methods: Review of sleep questionnaires (including the Stanford Cataplexy Questionnaire) of 75 subjects (29 with NC, 26 with other sleep-wake disorders, and 20 healthy controls), followed by an interview with specific focus on muscle loss during sexual activity in suspicious cases.

Main outcome measures: Cataplexy during sexual intercourse and orgasm (orgasmolepsy).

Results: Orgasmolepsy was reported by three NC patients (two female, one male), one male patient with behaviorally induced insufficient sleep syndrome (BIISS) and cataplexy-like symptoms, and none of the healthy controls. In the two female NC patients, orgasmolepsy occurred by each sexual intercourse, and the male patient reported orgasmolepsy only when in a relationship involving emotional commitment and trust. In the patient with BIISS and orgasmolepsy, cataplexy-like symptoms involved unilaterally upper or lower limbs in association with negative emotions or sports activities.

Conclusions: Cataplexy during sexual intercourse is a distinct feature of NC, which can, however, be reported rarely also by patients with other sleep-wake disorders. Insufficient arousal may favor the occurrence of cataplexy and cataplexy-like symptoms, including orgasmolepsy. Hypocretin deficiency and reward dysregulation in narcolepsy may further facilitate this phenomenon and contribute to its repetitive occurrence.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cataplexy / etiology*
  • Coitus*
  • Female
  • Health Status Indicators
  • Humans
  • Male
  • Narcolepsy / etiology
  • Orgasm*
  • Risk Factors
  • Surveys and Questionnaires