Clomipramine trial for treatment-resistant persistent genital arousal disorder: a case series

Abstract

Introduction: Treatment of persistent genital arousal disorder (PGAD), as a chronic and disabling condition, implicates substantial compelling complexities.

Methods: In this case series, seven women diagnosed with PGAD who were referred to the Sexual Dysfunction Unit of Psychotherapy Outpatient Clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey between 2006 and 2009 were included. All patients were previously resistant to other antidepressants, antipsychotics and antiepileptics. The additional details of PGAD onset, frequency, type and duration of arousal, previous pharmacological interventions, and maximum and maintenance doses of clomipramine were recorded.

Results: All patients achieved a substantial symptomatic improvement with clomipramine within the follow-up period of 2–9 years.

Discussion: Based on our study results, we recommend clomipramine in combination with psychotherapy as the treatment of choice in PGAD and to be used before any invasive procedure such as electroconvulsive therapy (ECT) or surgery.

Keywords:

• Sexual dysfunction (biological)
• treatment interventions
• Women’s sexuality

Acknowledgements

The authors do not claim any acknowledgments.

Disclosure statement

The authors received no support and declare no conflict of interest.

Current knowledge on this subject

• Persistent genital arousal disorder (PGAD) is a chronic and disabling syndrome with an unknown etiology.

• Current treatment strategies include psychopharmacological agents, psychotherapy and biological and surgical interventions.

• Even in the cases where adequate dose, duration and adherence to treatment are met, unresponsiveness is common in PGAD.

What this study adds

• In this case series, the efficacy of low-dose clomipramine combined with psychoeducation in persistent genital arousal disorder (PGAD) is addressed.

• It is an outstanding finding that seven patients with PGAD who were previously unresponsive to various psychopharmacological agents reported recovery of symptoms with low-dose clomipramine with a sustained effect during follow-up ranging 2–9 years.

• Due to several favorable conditions, clomipramine can be preferred as the treatment of choice in PGAD in combination with psychoeducational modalities.