Urticaria and masturbation

KV Godse

 Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi Mumbai-400706, India

Correspondence Address:
K V Godse
Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi Mumbai-400706
India

Sir,

We read with interest an article by Ghiya et al. on masturbation and urticaria. ^[1] Authors describe a 30-year-old, married male with a history of recurrent itching, redness and swelling on the penis 1-5 min after masturbation for the last three months. These lesions persisted for 4-6 h after which they gradually disappeared on their own accord within 24 h.

Dermographism is the most common mechanical type of physical urticaria, affecting 2-5% of the population.^[2],[3] Stroking of the skin with a tongue blade elicits linear wheals within a few minutes. Individual hives may last 30 min to 2 h. ^[4] In one case series, dermographism could be exacerbated by hot water, emotion, exercise or cold exposure. ^[5]

Delayed-pressure urticaria can occur after application of pressure to the skin. It most commonly affects the palms, soles and buttocks and can be disabling. It can be diagnosed by hanging a 15-lb weight across the shoulder while walking for 20 min. ^[6] Author has devised a simple test to diagnose delayed pressure urticaria. ^[7]

In a study vitiligo and chronic urticaria groups experienced significantly more difficulties in sexual arousal and higher failure in attaining and maintaining the lubrication-swelling response of sexual excitement until the completion of sexual act than did controls. This study demonstrated that chronic skin diseases such as vitiligo and chronic urticaria have negative impacts on sexual life. ^[8] Ghiya et al . report a patient who found masturbation to be more satisfying than normal vaginal intercourse points toward difficulties in sexual arousal. ^[1]

Sites that have reacted to pressure have been found refractory to an additional pressure stimulus for at least 24-48 h. ^[9] This could be tested in the patient by asking him to reproduce lesions within 24-48 h.Authors report lesions appearing within 1-5 min is atypical for delayed pressure urticaria (DPU); however, lesions lasting for 4-6 h fits in to signs of DPU. Authors have not performed simple tests to diagnose physical urticaria. Lesions lasting for 4-6 h after masturbation suggest that it could be manifestation of delayed pressure urticaria. Authors also mention that the urticaria probably arises due to unusual and unnatural friction and pressure during masturbation as compared to natural vaginal intercourse. Similar friction and pressure should induce redness and swelling at other places of the body. Emotions could also play a part in eliciting these lesions. We feel that this could be a manifestation of delayed pressure urticaria and tests for delayed pressure urticaria could help to find cause of this unusual presentation.

1.	Ghiya BC, Mehta RD, Bumb RA. Masturbation: Can it be urticarogenic?. Indian J Dermatol Venereol Leprol 2008;74:384-5. [Google Scholar]
2.	Orfan NA, Kolski GB, Physical urticarias. Ann Allergy 1993;71:205-12. [Google Scholar]
3.	Kirby JD, Matthews CN, James J., The incidence and other aspects of factitious wealing (dermographism). Br J Dermatol 1971;85:331-5. [Google Scholar]
4.	Kaplan A.P., Clinical practice: Chronic urticaria and angioedema. N Engl J Med 2002;346:175-9. [Google Scholar]
5.	Mathews CN, Kirby JD, James J, Warin RP. Dermographism: reduction in wheal sizeby chlorpheniramine and hydroxyzine.Br J Dermatolol 1973;88:279-82. [Google Scholar]
6.	Ryan TJ, Shim-Young N, Turk JL, Delayed pressure urticaria. Br J Dermatol 1968;80:485-90. [Google Scholar]
7.	Godse KV. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-6. [Google Scholar]
8.	Sukan M. The problems in sexual functions of vitiligo and chronic urticaria patients. J Sex Marital Ther 2007;33:55-64. [Google Scholar]
9.	Estes SA, Yung CW. Delayed pressure urticaria: an investigation of some parameters of lesions induction. J Am Acad Dermatol 1981;5:25. [Google Scholar]