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

Yıldırım, Ejder Akgün; Yıldırım, Münevver Hacıoğlu; Carpar, Elif; Sarac, Irmak

doi:10.1080/0167482x.2017.1296427

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Attempts to treat PGAD include reduction of identifiable factors exacerbating the symptoms, application of anesthetizing agents to numb the area, cognitive behavioral therapy (CBT) and mindfulness techniques (MBCT) [41], hypnotherapy [42], pelvic floor physical therapy [43], pharmacotherapy (e.g., mood stabilizing, anti-seizure medications, SNRI) [44][45][46][47][48][49][50], injection of Botulinum toxin [51], electroconvulsive therapy (ECT) [52,53], variceal embolization [54], and transcutaneous electrical nerve stimulation. Due to the fact that PGAD is still a poorly understood disorder, there are no clinical trials testing the safety and effectiveness of proposed treatments, neither is there a recommended treatment algorithm.…”

Section: Treatments For Pgadmentioning

confidence: 99%

Persistent genital arousal disorder – the present knowledge

Kapuśniak¹,

Piegza²

2022

Psychiatr Pol

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Zespół przetrwałego pobudzenia seksualnego (PGAD) to stosunkowo niedawno opisane zaburzenie seksualne, polegające na spontanicznym podnieceniu genitaliów, które utrzymuje się pomimo braku subiektywnego pożądania i fantazji seksualnych oraz może dotyczyć zarówno mężczyzn jak i kobiet. Dotychczas przeprowadzone badania epidemiologiczne wskazują, że rozpowszechnienie PGAD wśród populacji może sięgać 1-4%. Etiologia PGAD pozostaje niejasna i ma charakter złożony, przypuszcza się, że w patogenezie tego zespołu rolę odgrywają czynniki naczyniowe, neurologiczne, hormonalne, psychologiczne, farmakologiczne, dietetyczne, mechaniczne lub kombinacje powyższych. Proponowane sposoby leczenia uwzględniają farmakoterapię, psychoterapię, terapię elektrowstrząsową, hipnoterapię, iniekcje toksyny botulinowej, fizjoterapię mięśni dna miednicy, stosowanie środków miejscowo znieczulających, redukcję czynników nasilających objawy oraz przezskórną elektryczną stymulację nerwów, brakuje jednak algorytmu leczenia ze względu na brak badań klinicznych (evidence-based medicine). Dyskusji podlega klasyfikacja PGAD jako: osobnej jednostki chorobowej, podtypu wulwodynii lub schorzenia z kręgu chorób o patogenezie podobnej do zespołu pęcherza nadreaktywnego (OAB) i zespołu niespokojnych nóg (RLS). Ze względu na specyfikę objawów, pacjenci mogą odczuwać wstyd i dyskomfort w trakcie badania lub też przez długi czas wstrzymywać się ze zgłaszaniem niepokojących dolegliwości u specjalisty, dlatego istotne jest szerzenie wiedzy o tym zespole, co pozwoliłoby lekarzom na szybszą diagnostykę, a tym samym szybszą pomoc osobom z PGAD.

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Section: Treatments For Pgadmentioning

confidence: 99%

Persistent genital arousal disorder – the present knowledge

Kapuśniak¹,

Piegza²

2022

Psychiatr Pol

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“…The patient reported a reduction in the frequency and intensity of genital discomfort. Yildirim, 2017 45 7 Case studylongitudinal 25-70 24 Clomipramine Clomipramine (75 mg/day, increased to 150 mg/day) was prescribed.…”

Section: Chronic Pudendal Neuromodulationmentioning

confidence: 99%

“…36 Treatment with clomipramine alone (75−150 mg/ day) also proved effective in the remission of symptoms, especially arousal. 45 Studies have reported that treatments using other drugs such as venlafaxine (150 mg/day), sertraline (200 mg/day), and escitalopram (10 mg/day) 54 or citalopram (20 mg/day) showed no significant benefits. 32 Anxiolytics.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

Martin-Vivar

Villena-Moya

Mestre‐Bach

et al. 2022

The Journal of Sexual Medicine

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Background Persistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. Aim To perform a scoping review of the proposed treatments for PGAD and their efficacy. Methods A scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. Outcomes Three different effective treatments were found (physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). Results Thirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive–behavioral strategies with pharmacological treatment. Clinical implications Pharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. Strengths and limitations This study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. Conclusions To date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD.

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“…If symptoms include genito-pelvic pain and mood problems, consider SNRIs such as duloxetine or paroxetine and/or tricyclic antidepressants such as nortriptyline, amitriptyline, or clomipramine. 82,158,171 If PGAD/ GPD symptoms are associated with leg and back pain, implying a spinal cord site of action (Regions 3 and 4), a combination of an SNRI (eg, duloxetine) and baclofen suppository could activate the pain gate mechanism plus GABAergic inhibition in the conus medullaris of the spinal cord. If PGAD/GPD symptoms are associated with pelvic floor dysfunction, consider oral muscle relaxants such as methocarbamol or cyclobenzaprine, baclofen and/or diazepam suppositories, and/or botulinum neurotoxin A intramuscular injection as strategies to temporarily reduce symptoms.…”

Section: Region 5: Brainmentioning

confidence: 99%

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Goldstein

Komisaruk

Pukall

et al. 2021

The Journal of Sexual Medicine

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Background: Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim: To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods: A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes: The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. Results: The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. Clinical Implications: The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and Limitations: Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the

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

Abstract: 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.

Cited by 9 publications

References 28 publications

Persistent genital arousal disorder – the present knowledge

Persistent genital arousal disorder – the present knowledge

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

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