Can pharmacotherapy help persistent genital arousal disorder?

ABSTRACT

Introduction: Persistent genital arousal disorder (PGAD) is a presumably rare, although debilitating condition, which was first defined only at the beginning of this century and has not yet found consideration by any of the international classification systems of diseases. As affected patients can suffer tremendously, this report aims at providing an overview and an expert opinion on the few existing studies and case reports, guiding clinicians in the treatment and pharmacotherapy of PGAD.

Areas covered: In this article case reports, case series and surveys on drugs that may both alleviate or worsen/induce PGAD are reported.

Expert opinion: Data on pharmacological treatment options in PGAD are sparse and mainly rely on case reports making conclusions difficult. Most importantly, some drugs such as serotonin reuptake inhibitors (SSRIs) may even induce or worsen PGAD during treatment or withdrawal. We now need an initial spark in order to promote basic research on the etiology of PGAD as well as clinical trials on possible treatment options. In the meanwhile, clinicians should provide careful diagnostics and counseling for affected patients. In case pharmacotherapy is desired, drugs that are able to inhibit sexual excitation and/or modulate sensory perception such as pregabalin or duloxetin might be worth a trial.

KEYWORDS:

• Persistent genital arousal disorder (PGAD)
• sexual arousal
• restless genital syndrome (ReGS)

Article Highlights

• Persistent genital arousal disorder (PGAD) is characterized by persistent and unwanted sensations of genital arousal which are not related to subjective feelings of sexual desire or arousal and which are found predominantly in women.

• There is no conclusive etiological model on PGAD, however, disturbances of neuronal structures on a peripheral, spinal or brain level may serve as a starting point.

• According to case reports, some drugs such as antidepressants and anticonvulsants may alleviate symptoms in women with PGAD.

• However, caution should be exercised: Some drugs such as selective serotonin reuptake inhibitors may not only induce or worsen PGAD symptoms in some cases but also lead to various other sexual dysfunctions––even after cessation of treatment.

• Health care professionals should provide a careful medical history, clinical examinations, counseling and putative treatments on a long-term basis.

• Medical doctors and the scientific community are urgently required to develop better-defined working hypotheses and etiological models and to initiate basic science and clinical trials.

Declaration of interest

THC Kruger has been a speaker and/or member of advisory boards of the following companies: Allergan, Lundbeck, Novartis, Otsuka, Schwabe, Servier, Trommsdorf. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by a grant from the European Society of Sexual Medicine (ESSM).