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Experiencing Pain or Orgasm with Color Synesthesia: A Rare Case in
a Young Previously Healthy Male
Afsaneh Rezaei Kalat1, Reza Jafarzadeh Esfehani2, Farhad Farid Hosseini1*
Abstract
Objective: Synesthesia is a unique experience with an unclear mechanism. The clinical condition usually presents when
a sensation stimulates other senses. While more than 150 types of synesthesia have been reported; however, some
types are considered uncommon, and co-occurrence of these rare types of synesthesia are rare. In the present report,
we described a case of synesthesia with experience of pain and orgasm in color.
Method: A 31-year old healthy male presented with visual equity changes during orgasm. In addition, he described a
color-pain sensation every time he experienced severe chest pain during his childhood. None of these sensations
negatively affected his daily or sexual life. Based on the patient’s history, a possible diagnosis of synesthesia was made
and further clinical evaluations were performed.
Results: The patient did not have any color vision abnormalities or problems in solving Hooper visual organization test,
bells test, Rey complex figure test, card sorting test, and Trail making tests. The Brief Male Sexual Inventory did not
reveal any sexual dysfunction. Therefore, regarding the patient's experiences without any visual disturbance and
absence of any underlying diseases, the diagnosis of synesthesia was made.
Conclusion: The present report demonstrates coexistence of a rare form of synesthesia as orgasm to color with specific
pain to color synesthesia. In contrast to previous reports, our case demonstrated color orgasm as a type of synesthesia
that might not negatively affect sex life in men.
Key words: Orgasm; Pain; Synesthesia
Iran J Psychiatry 2022; 17: 2: 243-246
Case Report
1. Psychiatry and Behavioral Sciences Research Center and Department of Psychiatry, School of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran.
2. Blood Borne Infections Research Center, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi,
Mashhad, Iran.
*Corresponding Author:
Address Department of Psychiatry, Ibn Sina Hospital, BuAli Square, Mashhad, Iran, Postal Code: 8313491959.
Tel: 98-51 37112701, Fax: 98-51 37112701, Email: faridhoseinif@mums.ac.ir
Article Information:
Received Date: 2021/07/23, Revised Date: 2021/10/18, Accepted Date: 2021/12/26
Rezaei Kalat, Jafarzadeh Esfehani, Farid Hosseini
Iranian J Psychiatry 17: 2, April 2022 ijps.tums.ac.ir
244
Synesthesia is a rare clinical condition in which the
stimuli meant to stimulate one sense stimulates other
senses. This neuropsychological phenomenon has
received different names since its introduction in the
eighteenth century (1). The first case of synesthesia, as
we know it today, was introduced by Austrian Georg
Tobias Ludwig Sachs who reported that people with
synesthesia experience specific sensations concomitant
with unusual secondary feelings (1). Although earlier
studies considered synesthesia an extremely rare
phenomenon, a recent clinical report demonstrated that
the prevalence of synesthesia is around 4% in the
population (2, 3). Moreover, prevalence of synesthesia in
some specific populations, including those studying the
arts, is reported to be higher than 7% (4). Individuals
with synesthesia experience various sensations, as more
than 150 different manifestations are reported in the
literature (5). Although there are no specific criteria for
the diagnosis of synesthesia, the phenomenon had three
main characteristics. Synesthesia has automaticity
meaning that it cannot be controlled or inhibited by the
patients. Second, the sensation is consistent, and some
individuals may experience synesthesia from childhood.
Third, the sensation reliably experiences the response
when a specific trigger stimulates the phenomenon (6).
Among various types of synesthesia, some
manifestations are rarely reported. Colored pain and
orgasm in colors account for 2.5% and 1% synesthesia,
respectively (7). Moreover, co-occurrence of different
types of synesthesia is also very rare, and up to now,
there is no published report about concurrent synesthesia
involving both pain and orgasm in color. In the present
article, we will discuss a case of synesthesia with
experience of pain and orgasm in color.
Case Report
Case information
Mr. R is a 31-year-old married Caucasian male living
with his wife and he is a medical doctor (general
practitioner or GP). There was no positive history of
psychiatric illness in his family history, and there were
no remarkable medical findings or abnormal growth and
development in his childhood. He self-prescribed
Sertraline (25 mg once daily) for three months since he
had been experiencing obsessive-compulsive disorder
symptoms. Mr. R stated that during his second decade of
life, he experienced multiple episodes of chest pain for
which he was investigated and diagnosed with mitral
valve prolapse; however, he did not receive any specific
medication.
Ethics approval
The principles outlined in the Declaration of Helsinki
regarding human experimentation have been met.
Consent
An informed consent form was taken from the
participant.
Case history
Mr. R was referred to our psychiatry clinic because of a
bizarre sensation during his recent intercourse. He stated
that during his orgasms (orgasmic phase), he
experienced visual equity changes whenever his eyes
were open, and he saw objects sharper and brighter than
usual. He described these changes as "high contrast
vision with dominant pink color everywhere" and said
that the environment became brighter as it was early
morning even if the environment was dark. When we
explained to him that this finding could be considered
synesthesia and also explained other types of
synesthesia, he stated that he experienced other bizarre
feelings when he was younger and whenever he had
chest pain sensation. He explained that every time he
had severe chest pain because of his valvular heart
disease in childhood, he felt "white". The "white" feeling
was not sensed during any other types of pain. The
severe chest pains did not continue to adulthood, and,
therefore, he did not experience the “white” feeling in
adulthood. The "white" feeling was not associated with
any visual disturbances, and he could differentiate the
"white" feeling with other possible sensations, including
lightheadedness, reported by most cases with mitral
prolapse due to orthostatic hypotension.
Further examinations
He did not have any color vision abnormalities or
problems in solving the Hooper visual organization test,
bells test, Rey complex figure test, card sorting test, and
Trail making test (8-11). Moreover, he scored 125 (sum
of both open and closed eye scores) on the Vividness of
Visual Imagery Questionnaire (VVIQ). The Brief Male
Sexual Inventory did not reveal any sexual dysfunction
(12, 13). Regarding the patient's experiences and these
examinations, a diagnosis of synesthesia was made for
him.
Discussion
The present article briefly reported two rare types of
synesthesia in a young male. The orgasm in color is
among the rarest types of synesthesia which is
challenging to diagnose. In contrast to other types of
synesthesia that questionnaires or visual studies could
test, the orgasm to color synesthesia is challenging to
study as there is no previous experimental study
available for provoking the synesthetic sensation (14).
One of the main issues that should be considered in
evaluating synesthetic individuals is their developmental
history. Although our patient did not have a history of
abnormal growth or development, some authors
suggested that synesthesia is more common among
autistic patients (15). There is growing evidence
suggesting the possible relationship between synesthesia
and psychiatric disorders, including anxiety, post-
traumatic stress disorder, and even schizophrenia (15).
Moreover, a recent study by Rinaldi et al. demonstrated
Orgasm to Color Synesthesia
Iranian J Psychiatry 17: 2, April 2022 ijps.tums.ac.ir
245
that synesthesia is more likely to be related to specific
personality traits, including openness to experience
among the pediatric population (16). In our approach for
evaluating the case, we first differentiated the acquired
types from developmental forms of synesthesia. While it
has been demonstrated that synesthesia might be induced
by underlying medical illnesses, including migraine and
seizure and using hallucinogens, our case did not have a
previous history of such conditions (17, 18). Moreover,
Sertraline was self-prescribed after recognition of
synesthesia, and, therefore, drug-induced synesthesia has
been ruled out in our case. We decided to rule out every
possible visual problem related to the synesthetic
sensation in the next step. Our case did not show any
difficulty in various visual challenge tests. Then, we
took the detailed history of the synesthetic experience
during sexual intercourse, as it has been demonstrated
that synesthesia might be cited differently during human
sexual response phases. It has been reported that some
individuals experienced each of the sexual phases with
different colors and various intensities, initiating with
experiencing an orange character appetence phase to
yellow and pink in the resolution phase (14).
In our case, synesthesia only appeared in the orgasmic
phase of sexual intercourse. While some studies
demonstrated that synesthesia could affect sexual
satisfaction, we decided to evaluate the sexual function
of our case. According to Mosher's theory regarding
sexual satisfaction, the three dimensions, including "role
enactment", “engagement with the sex partner”, and
“sexual trance” are the main factors. Emphasizing one
dimension may negatively affect overall sexual
satisfaction (19). Nielsen et al. demonstrated that
females would show decreased overall satisfaction;
however, their synesthetic experience could increase
their level of sexual appetence (14). Therefore, the
authors concluded that synesthesia in females might
increase “sexual trance” and result in paying less
attention to the “engagement with the sex partner” (14).
We believe a similar conclusion could not be made, as
our case did not have any sexual dysfunction and was
satisfied with his sexual life. We did not provide further
diagnostic workups because our case did not have any
daily activity and sexual life difficulties.
Although physicians may not be good cases for research,
we believe that our case report has some significant
limitations. First of all, although some reports indicate
that synesthesia may have variable severity and
consistency, synesthesia is commonly considered a
consistent sensation (20). Our case began experiencing
the sensation because of an unknown trigger in his life,
and he could not remember if the sensation was present
in his earlier orgasm. Moreover, the pain-color
synesthesia was only experienced with chest pain since
childhood which is not common for pain-color
synesthesia which has been reported with almost every
type of pain in one individual.
Limitation
One of the main limitations of the present study was the
absence of further studies including brain functional
imaging workups which could provide more diagnostic
clues in some patients.
Conclusion
Coexistence of different types of sensory perception
with color is rare without a clearly understood
mechanism. In contrast to previous reports, our case
demonstrated that colored orgasm as a type of
synesthesia might not negatively affect sexual life in
men.
Acknowledgment
None declared.
Conflict of Interest
None.
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