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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I'm looking for advice concerning suspected nerve damage.

Customer Question

I'm looking for advice concerning suspected nerve damage. Almost 4 months ago I masturbated vigorously and excessively using my hand only and brought myself to orgasm roughly 30 times through direct clitoral contact. Directly following this I experienced fasciculations all over my body that lasted two weeks and intense paresthesias down both legs. The fasciculations have completely disappeared, however the paresthesias remain today, although only in both feet and not both legs. I've had an MRI, a Nerve Conjunction Study and an EMG. None of these tests have indicated nerve damage of any kind, however I'm incredibly distressed by the fact that I'm experiencing constant paresthesias so many weeks later. Will the paresthesias go away or could they be permanent?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hi. Your paresthesis can be seen in anxiety syndromes. Hyperventilation changes your pH and activates your sensory receptors in your feet or distally in your feet, hands, and around your mouth to cause diffuse twitching, and tingling. Have you tried breathing in a lunch size paper bag to increase your serum carbon dioxide and reduce your pH? Have you had any electrolyte testing looking at your anion gap? This is most likely a psychological problem and methods to reduce your stress/anxiety, like biofeedback, relaxation therapy, CBT, etc. will help. I hope that answers your question. Please remember to rate my service by clicking on the rating stars, as that is how I am compensated for this work thanks Dr frank

Customer: replied 1 year ago.
Hi Dr. Frank, thank you for your answer. You don't believe the clitoral trauma to be the underlying cause of the paresthesias? I've not had any electrolyte testing.
Expert:  Dr. Frank replied 1 year ago.

Absolutely not. No possible neurological mechanism. You need to bring down your stress level, I would say that is 80% of the problem if not more from here online. Drink copious amounts of electrolyte containing beverages like gatoraide or sports drinks. Take supplemental magnesium which you can get OTC at any health food store, and lots of green leafy vegetables with extra potassium. Work constructively to find non-medication based method for relaxation, and if that doesn't work, then see a psychiatrist to consider an SSRI medication or TMS (transcranial magnetic stimulation) . As complex as things can be in Neurology, common things are common, and you have an extremely common condition. Dr Frank

Customer: replied 1 year ago.
Could it no be small fibre neuropathy? I came across the following online which could fit with my symptoms and experiences: Small fiber neuropathies affect the small, unmyelinated nerve fibers in the sensory nerves. These fibers convey pain and temperature sensations from the skin, as well as maintain autonomic functions (Stewart el al, 1992; Novak et al 2001). The diagnosis can easily be missed, as the neurological examination may reveal only minor sensory abnormalities and EMG and nerve conduction studies, that measure the large fibers, are frequently normal. Consequently, some patients with small fiber neuropathy are misdiagnosed as having a psychosomatic disorder, RSD, fibromyalgia, or restless leg syndrome instead. (Lacomia, 2002; Hermann et al, 2004; Polydefkis et al, 2005).
Would you rule this out?
My diet is highly nutritious and since the incident, I've been taking magnesium and vitamin B complete & B12 supplements daily.
Expert:  Dr. Frank replied 1 year ago.

small fiber neuropathy does not give you fasciculations or twitching in muscles, it is a sensory disturbance. Large fibers have to be involved. Dr Frank

Customer: replied 1 year ago.
despite having paresthesias, it's unlikely that I have small fiber neuropathy as the paresthesias initially presented with fasciculations which are not indicative of SFN? If the paresthesias I'm experiencing have a psychological cause (which is certainly possible since I struggle with anxiety and am mentally susceptible to somatization) how long could they last? Will they be permanent?
Expert:  Dr. Frank replied 1 year ago.
I will put out the phone option to discuss this further. Please put your number in the box and a time to call if not now.
Customer: replied 1 year ago.
Hi Dr. Frank, I appreciate your kind assistance. Are you able to continue discussing my concerns through the chat option? I'd just like to know how to deal with the paresthesias if they are a symptom of anxiety. Is it possible to experience constant symptoms four months after an event if anxiety is the root cause?
Expert:  Dr. Frank replied 1 year ago.

Hello. This is a medical answer line. You haven't rate my service, so you would have to do that first, then we could discuss this further on the premium service option, which I will put out to you. Or you can repost. Dr Frank