Malignant complications of masturbation - a case study

Area of Science:

• Psychiatry
• Internal Medicine
• Gynecology

Background:

• Neuroleptic Malignant Syndrome (NMS) is a rare but serious complication of antipsychotic medication.
• Catatonia can present with varied symptoms, complicating diagnosis.
• Inflammatory processes can significantly impact psychiatric conditions.

Observation:

• Despite a promising initial response to ECT, the patient's somatic and mental state significantly deteriorated.
• Diagnostic investigations, including imaging and gynecological examination, revealed a foreign body (multivitamin supplement cap) in the vagina.
• The patient disclosed the foreign body was self-inserted during masturbation six months prior, withheld due to shame.

Findings:

• The presence of the vaginal foreign body led to an inflammatory process complicating the presentation of catatonia and NMS.
• The inflammation contributed to a non-specific clinical course, posing diagnostic and therapeutic challenges.
• Surgical removal of the foreign body resulted in the patient's full remission within one month.

Implications:

• This case underscores that inflammation, potentially from foreign bodies in natural orifices, can significantly complicate psychiatric conditions like catatonia and NMS.
• It highlights the critical importance of comprehensive patient interviews, including sensitive aspects of autoerotic activity, for accurate diagnosis and effective treatment in psychiatric patients.
• The findings suggest a need to consider occult inflammatory sources in complex or treatment-resistant psychiatric presentations.