Case report: sexual intercourse as potential treatment for intractable hiccups.

CME iccup is a pathologic respirator y reflex characterized by a spasm of one or both sides of the diaphragm, causing sudden inspiration and associated closure of the vocal cords. Accessor y muscles of respiration are occasionally involved. 1 Hiccups are usually harmless and self-limiting. Cases have been reported, however, in which hiccups became intractable (singultus) causing insomnia, wasting, exhaustion, and even death. These consequences have prompted scientific scrutiny of an otherwise harmless curiosity. 2 We repor t a case of intractable hiccups that began following treatment with corticosteroids and lasted for 3 days. The hiccups ended immediately and completely following sexual intercourse. A healthy 40-year-old man suffered from low back pain. Drug therapy, including several nonsteroidal anti-inflammatory drugs (NSAIDs), did not alleviate the pain. After a few weeks of suffering, the patient was treated by an alternative medicine practitioner, but to no avail. Four weeks after the pain began, the patient was treated by a neurologist who gave him an injection of a 5-mL mixture of 1% lidocaine, betamethasone sodium phosphate, and betamethasone acetate (6 mg/mL) to the most painful and tender area. The patient felt immediate relief from the back pain, but 6 hours later he developed intractable hiccups. He became ver y anxious and was unable to work or sleep. He tried to treat himself with metoclopramide and chlorpromazine as well as several folk remedies, but the hiccups continued. He made several attempts at massaging his anterior soft palate with a cotton wool bud for 1 minute 3 without success. On the fourth day of continuous hic-cuping, the patient had sexual intercourse with his wife. The hiccups continued throughout the sexual interlude up until the moment of ejaculation when they suddenly and completely ceased and did not recur over a follow-up period of 12 months. Discussion Hiccups are associated with eating. It has been suggested that the physiologic function of hiccuping is to transfer food through the esophagus. The hiccup reflex is complex 4 and is composed of the afferent limb: phrenic nerve, vagus nerve, or thoracic sympathetic fibres; the central connection: not a specific centre, but rather an interaction among the brain-stem, the respiratory system, phrenic nerve nuclei, the reticular formation, and the hypothalamus; and the efferent limb: primarily the phrenic nerve. In one study conducted at the Mayo clinic, 5 220 patients reported hiccups lasting for more than 2 days; 82% of the patients were …