« on: 04/11/2013 14:23:07 »
I am a 51 year old female, and I had the most frightening pain in my head two nights ago, which began very suddenly and severely, at the base of my head and spread throughout my head and settling in my temples, right before orgasm. We stopped of course and I cried for a little while due to the pain which mostly subsided to a tolerable level fairly soon, and then I went onto the internet to search for what happened. I called my ob/gyn the following day, since I'm 5-6 weeks postop from a partial hysterectomy, and this was my first time resuming intercourse with my husband...
I should visit this forum more often, but it's a double-edged sword, as well as getting hope and new ideas you're also concentrating on what is a painful problem, both physically and psychologically. Mimosa, your post from last year suddenly struck me - '5-6 weeks post-op'. Something tells me your procedure was keyhole surgery, am I right?
I'm convinced there's a link between keyhole surgery, where they pump CO2 into you, literally to make space so they can see what they're doing, and the heart problem I was banging on about in my latest posts. The CO2 technique is called pneumoperitoneum. It increases pressure both in your abdomen and your chest cavity.
Brief recap: Over 1 in 4 of us have a PFO = Patent Foramen Ovale. The FO is the hole in your heart between left and right atria that, when you were in the womb, allowed oxygenated blood from your mother to travel via the umbilical cord, up your main vein to the right side of your heart and then cross over to the left side, which is the side that pumps it round the body. This is necessary in unborn babies because your lungs aren't working yet, the pressure in those blood vessels is too high so blood can't flow round them & wouldn't pick up any oxygen anyway! When you're born, lungs start working, pressure decreases, blood starts flowing from right heart around lungs, picks up oxygen, back to left heart. Pressure is now higher on left side, this makes the FO close up and, in 3/4 of people, by your 1st birthday it's permanently closed. In the other 1/4, the FO is 'patent' - i.e. it's still openable, like a cat-flap, if enough pressure is put on it. Normally, left-side pressure is greater than right-side, so the cat-flap stays shut. But if anything happens to alter the pressures...
Now, my guess is that there's not a sharp division between the 1/4 with a PFO and the 3/4 without. The process of closure is going to be complete in some people, absent in others, and somewhere in between for some guys. The closure process has happened, but it's weaker than it should be. Now read these quotes from medical websites:
Here's what one paper http://m.ceaccp.oxfordjournals.org/content/11/5/177.full says about the use of laparoscopic surgical techniques - 'keyhole surgery' - which include pneumoperitoneum:
'Generally accepted contraindications include ... patients with known right-to-left cardiac shunts or patent foramen ovale.'
'As a result of the pneumoperitoneum during laparoscopic procedures central venous pressure exceeds pulmonary wedge pressure, leading to temporary reversal of intracardiac pressure gradients between the atria. In consequence, the risk of intraoperative cardiac right-to-left shunting with consecutive systemic embolisation is increased, because a PFO, although normally closed, may open during this reversal of pressure gradients.'
OK, pulmonary wedge pressure = a way of measuring the pressure in the left atrium, which is the chamber of your heart that receives oxygenated blood from the lungs. And the 'embolisation' they're talking about is one way for blood clots in your veins to get into your arteries and travel to your brain or other organs; this paper was primarily about strokes. Basically, what this adds up to is, pressure in right side of heart exceeds pressure on left side, for as long as they're inflating your abdomen with CO2: several hours depending on the operation. This is common knowledge to anaesthetists, which is why they don't recommend keyhole surgery for people with known heart defects like PFOs.
So it seems pretty plausible to me that one way for orgasm headaches to suddenly start happening in the middle of your life is this:
* You have, unknown to you or anyone else, a borderline PFO
* You have a keyhole operation, they blow you up with CO2 for several hours and the pressures in your heart are reversed
* This opens up the PFO, you're now not borderline, your FO is definitely P, as it were.
* Next time you do anything that reverses the pressures (known medically as a Valsalva manoeuvre) - heavy coughing, sneezing, vomiting, straining during defecation, having an orgasm - the PFO opens readily, whereas before the operation it was a bit stronger and stayed closed.
* The crossover of venous blood directly into the arterial system, bypassing the filter of the lungs, causes severe headache, possibly because of high concentrations of hormones - e,g, norepinephrine - present during the build-up to orgasm.
Of course, the trigger for the weakening of the FO might not be keyhole surgery, it might be exercise - which might explain why there's a mixture of relatively fit, young people on this forum, along with relatively unfit, middle-aged folk like myself. Or constipation, or coughing, or anything that reverses the pressures enough, for long enough.
Since my last post I've had mixed fortunes - several periods of remission followed by 'back to square one', all unrelated to anything I can identify, it's depressingly random but the remissions are good, I try to take full advantage of them, even if orgasms themselves are a risk for re-occurrence! I'm pretty convinced that the sequence I've described above is what happened to me. I've no idea if a PFO is capable of healing in an adult, if I refrain from anything that could 'open the cat-flap' for long enough. More research needed, and a friendly doctor. Maybe we need to set up a proper self-help group, or a campaign for research? I've no idea how to do that.