Some time ago I posted the following:
<<
45 yr old man, executive , business going well, married 15 years , thin
file, very pleasant "normal" punter.
Complains that after sexual intercourse with his wife he develops within a
few hours a profound physical exhaustion (NO headache) that lasts for 3 to 4
days with full recovery after this time, (unless intercourse within this
time (not usual) in which case the fatigue is longer).
Same problem with masturbation. Sex life seems satisfactory. Full and frank
discussions about "stress", "marital relations" ect and have already put him
through the practice counsellor who feels there is no psychological
component to this.
Needless to say examination unremarkable ( overweight only BMI 28) and no
other physical problems in the history inc alcohol and smoking.
FBC,U&E,Glucose,TFT,LFT(GGT) all normal. >>
Thought you might like an update ....
I referred him to an endocrinologist (also professor of medicine)
Underwent a variety of tests including
Cortisol levels 30 mins post intercourse (had fun arranging that with the
lab :))
VMAs, tumour markers, thallium scans ... "loads- a- money"
The outcome? I quote from the reply I had today
"This gentleman may well be deficient or indeed have an excess of a
neurotransmitter that is not yet fully described" ..." I suggest 25mg
Amitriptyline od"
I suppose we all might have too much or too little of something no one has
yet discovered but it doesn't make for a very sound EBM decision
Me and the patient had a jolly good laugh today :)
My advice "No one has got a bloody clue, so enjoy the sex and sweet dreams
sleeping it off"
Guess which one he is going to follow ;-)
Mark O'Connor
GP
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