@Matchew 325 wrote:

The most worrying problem I am having at the moment is about my breathing after orgasm. For the past 6 or so months I have had unequal pupils, before that for a few months it was intermittent, usually after orgasm. These symptoms have gradually worsened over the last few months, I don’t get all of them every time…

Immediately after orgasm:

• Pupils become more unequal
• Certain movements, particularly fingers and toes become twitchy
• Slurring of speech, mixing words together
• Facial twitching, particularly eyelids, eyebrows and mouth area

In neurology, the sudden onset of neurological problems is a stroke unless otherwise ruled out.

Transient ischemic events are also possible (meaning there is temporary loss of blood flow to certain parts of the brain). Such events usually last less than 24-hours. Longer than 24-hours is a stroke.

For example, sometimes when a person has a migraine headache, that person may lose eyesight transiently since there may be spasms of the blood vessels affecting the eye during a migraine. These transient loss of blood flow can be dangerous since the tissues involved could be damaged or killed.

Thus, in cases like this, I would get a consultation from a neurologist for further assessment, testing, etc. Neurologists are great for structural problems like this.

@Matchew 493 wrote:

Thanks for the responses. I will make an appointment again with a different doctor and ask to be referred to a neurologist. Unfortunately they think I am a hypochondriac because I have been down a lot lately. I don’t think they can refuse me if I ask, though.

I guess there isn’t much more to discuss until I can get that appointment, just hope there isn’t any lasting damage. It’s terrifying and much worse when my doctor treats me like I’m making it all up 🙁

With many doctors, it is important to remove references to mental health when describing physical health problems.

Unfortunately, mental health issues can cloud medical thinking. For example, when people go to the emergency room complaining about a panic attacks with chest pain, up to 25% are actually having a heart attack. But this can be missed if the doctor overly focuses on anxiety as the cause of chest pain.

One of my patients had a stroke and nearly complete paralysis. However, this was missed by numerous doctors (including multiple primary care doctors, emergency room doctors and even psychiatrists) because they thought her unresponsiveness was an emotional response to her family dying the week before in a car accident – a condition called conversion disorder. I made the diagnosis by realizing the suddenness of her neurologic symptoms was a stroke unless otherwise proven, and realizing she was responsive and awake but she could only move her eyelids. I questioned her through a series of yes and now questions and learned what happened.

Often, as soon as a physician thinks a person has a mental illness, they often blame every physical problem on the mental illness. It is a very human response due to the stigma mental illness has. But it causes physicians to miss actual physical illness. It happens too often, sometimes with dire consequences.

Some of my patients have learned about the prejudice that mental health symptoms have on their primary care doctor. Thus, they avoid talking about it when discussing physical health issues.