the Link Between Physical Symptoms and Mental Health in Patients

excuse me?

Hello, Doctor.
I engaged in oral sex with a sex worker at the end of August 2004 without protection, which resulted in persistent pain in my mouth, throat, and tongue.
I subsequently visited an otolaryngology clinic, where the doctor performed an endoscopic examination and a saliva test.
I also took medication for two months, including antibiotics and anti-inflammatory drugs, and I complied with the treatment, but it has not been effective.
I wanted to see a urologist, but the nurse advised that my symptoms should be evaluated by an otolaryngologist.
Ultimately, the otolaryngologist referred me to psychosomatic medicine, which is a branch of psychiatry.
I am not opposed to seeing a psychiatrist; perhaps I am overthinking it, but after undergoing so many tests, the doctor still could not determine the cause.
However, I am very curious as to why the doctor suggested I see a psychiatrist.
My understanding is that, as the doctor mentioned, my throat still shows signs of redness and inflammation, and my chest pain is becoming increasingly severe.
These are concrete physiological symptoms.
Why does the doctor still believe that it is a matter of my overthinking and that psychological factors are affecting my physiology? Please help me understand how I can seek appropriate assistance from a qualified physician regarding my persistent pain in the mouth, throat, tongue, and chest.
My symptoms are as follows: small spots covering the roof of my mouth; persistent throat pain; continuous pain at the base of my tongue, under the tongue, and around the tongue, but no ulcers or open wounds; pain from the ear down to the neck; nausea without vomiting; phlegm that I cannot clear; chest pain and discomfort, especially sharp pain in the chest when my heart beats.
Thank you.

KK, 30~39 year old female. Ask Date: 2005/01/04

Dr. Tang Xinbei reply Psychiatry

Dear KK,
It seems that your concerns began after engaging in unprotected oral sex with a sex worker at the end of August last year? The ENT specialist has examined you and found no issues, but you still feel uneasy? It appears that you are feeling regret, shame, and difficulty in expressing what you've done! You are quite worried about potentially contracting serious diseases such as HIV or other sexually transmitted infections (STIs)? Have you discussed your symptoms and the timeline of your discomfort with them?
My knowledge of STIs is limited, so I cannot provide comprehensive information.
However, what I know about HIV transmission is as follows: the transmission risk from a female carrier to a male is relatively low, approximately 1 in 700 to 1 in 3000; the risk from a male carrier to a female is about 1 in 200 to 1 in 2000; and the highest transmission risk is from a male carrier to another male, ranging from 1 in 10 to 1 in 1600, especially if ejaculation occurs.

I wonder how your experience was? I recommend that you openly discuss your concerns with the ENT specialist.
You may also want to consult a urologist or an infectious disease specialist for more information regarding STIs.
If you still have reservations, you can visit a sexually transmitted disease clinic for relevant tests and information.
Avoiding medical consultation may only delay your condition! Regardless of the test results, seeing a psychiatrist can help you with emotional adjustment.

Wishing you peace and joy!

Reply Date: 2005/01/04

More Info

Hello! Thank you for sharing your concerns. It sounds like you are experiencing a complex interplay between physical symptoms and mental health issues, which is not uncommon. Let's break down your situation and explore the connections between your physical symptoms and mental health.

First, it's important to understand that the body and mind are intricately linked. Physical symptoms can often be exacerbated or even caused by psychological factors such as anxiety, stress, and depression. In your case, the persistent pain in your throat and chest, along with other symptoms like nausea and difficulty clearing phlegm, may have both physical and psychological components.

The fact that you have undergone various medical examinations and treatments without significant improvement can be frustrating. It's understandable that you would seek further medical assistance, especially when experiencing ongoing pain. However, when conventional medical treatments do not yield results, healthcare providers may consider the possibility that psychological factors are at play. This does not mean that your symptoms are "all in your head" or that they are not real; rather, it suggests that your mental state may be influencing your perception of pain or your body's ability to heal.

Your symptoms, such as throat pain, chest discomfort, and nausea, could be related to a condition known as somatic symptom disorder, where psychological distress manifests as physical symptoms. Anxiety and stress can lead to muscle tension, which may contribute to sensations of pain or discomfort in various parts of the body. Additionally, conditions like gastroesophageal reflux disease (GERD) can cause throat pain and discomfort, which may be aggravated by stress and anxiety.

Given your situation, it may be beneficial to consider a holistic approach to your health. Here are some steps you can take:
1. Consult a Mental Health Professional: Since your doctor has recommended seeing a psychiatrist or psychologist, it might be worthwhile to explore this option. A mental health professional can help you understand the psychological factors contributing to your physical symptoms and provide strategies to manage anxiety and stress.

2. Cognitive Behavioral Therapy (CBT): This type of therapy is effective for addressing anxiety and can help you develop coping strategies for managing your symptoms. CBT focuses on changing negative thought patterns and behaviors that may be contributing to your distress.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety and improve your overall sense of well-being. These techniques can also help you become more aware of your body and its sensations, which may alleviate some of your discomfort.

4. Physical Health Follow-Up: While exploring mental health options, continue to monitor your physical symptoms. If your throat pain and chest discomfort persist, consider seeking a second opinion from another ENT specialist or a gastroenterologist to rule out any underlying physical conditions.

5. Lifestyle Modifications: Pay attention to your diet, exercise, and sleep patterns. A healthy lifestyle can significantly impact both physical and mental health. Regular exercise, a balanced diet, and adequate sleep can help improve your mood and reduce anxiety.

6. Support System: Engage with friends, family, or support groups. Sharing your experiences and feelings with others can provide emotional support and help you feel less isolated in your struggles.

In conclusion, your symptoms are valid, and it's essential to approach them from both a physical and psychological perspective. By addressing the mental health aspects of your condition, you may find relief from your physical symptoms as well. Don't hesitate to seek the help you need, and remember that healing is often a multifaceted journey. Wishing you the best on your path to recovery!

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