Weak with sex: sexual intercourse as a trigger for cataplexy.

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.