Persistent Genital Arousal Disorder After Motor Vehicle Accident: A Case Report

Abstract

Persistent genital arousal disorder (PGAD) is a clinical syndrome characterized by persistent unwanted feelings of sexual arousal that are not associated with any specific sexual arousal or stimulus. The severity of symptoms range from mild to severe distress that interrupts daily life for patients. We present a 44-year-old previously healthy woman who developed PGAD after involvement in a motor vehicle accident in 2018. After sustaining lower spinal trauma, 3 months later, she began to experience intermittent tingling feelings in her clitoris. She noticed that exacerbations in back pain were also associated with PGAD symptoms. These symptoms progressively worsened to which she was constantly feeling as if she was on the verge of an orgasm. Her quality of life was severely diminished for 3 months, after which she presented to gynecology. Treatment of lidocaine patches applied to the sacrum were found to completely eliminate the feelings of clitoral stimulation. She also began physical therapy for the residual back pain. One year after initiation of treatment, she has experienced significant improvement in both the back pain and PGAD symptoms. Her quality of life is much improved and plans on continuing a treatment plan of lidocaine patches and physical therapy. Recognition of PGAD in women is important for clinicians as that it can go undiagnosed for long periods of time and can interfere with quality of life for patients.

Effectiveness of Brexpiprazole in a Patient With Bipolar Disorder and Comorbid Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: A Case Report

“…In fact, it has been reported that the symptoms of PGAD/GPD due to trauma and other problems responded relatively well to physical treatments [ 5 , 6 ]. Our patient underwent various tests, but no organic cause was observed; however, she had received many physical treatments due to the severity of her symptoms.…”

A review of persistent genital arousal disorder: Symptoms, diagnosis, and treatment

“…The associated unsettling elements include restless legs syndrome and signs of an overactive bladder. In a clinical study, Waldinger and Schweitzer reported that shaking legs occurred in 67% of 18 women with a final diagnosis of PGAD (Parus et al, 2020). Similar to postural instability disorder (PGAD), restless leg syndrome symptoms intensify in response to immobility and improve with lower limb movement or stimulation.…”

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)

“…Radiculopathy of sacral spinal nerve roots within the cauda equina or sacrum are contributors to PGAD/GPD. 23,24,125 Temporary iatrogenic radiculopathy producing PGAD/GPD symptoms has been noted after sacral neuromodulation. 126 In 2012, Komisaruk and Lee first reported the occurrence of sacral Tarlov cysts in women with PGAD symptoms, which were previously thought to be incidental radiologic findings.…”

“…These intervertebral disc pathologies can be mechanical (disc bulge or herniation impinging against the dura and the nerve roots) or chemical due to annular tear. 125 Annular tears involve extrusion of nucleus pulposus material through the annulus into the epidural space and produce irritation, through the dura, of the nerve roots by inflammatory modulators such as tumor necrosis factor-alpha. 131 The disc herniations and/or annular tears related to these symptoms often appear at L5eS1 and/or L4eL5 spinal levels.…”