Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst

Abstract

We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

Penile Priapism, Clitoral Priapism, and Persistent Genital Arousal Disorder: A Contemporary Review

“…Battaglia and Venturoli have demonstrated that the use of trazodone, while rare, can lead to PGAD. The cessation of the medication does not always improve the symptoms or frequency of unwanted orgasms, as demonstrated in case reports [115,117]. In some patients, withdrawal of the medication may in fact worsen or lead to PGAD.…”

“…These occur most commonly at S2 and S3 vertebral levels and can lead to radiculopathy or be completely asymptomatic. Case reports from Ebiye and Jensen describe a 30‐year‐old female who experienced PGAD after stopping paroxetine and was found to have a 1‐cm S2‐S3 Tarlov cyst [115]. She underwent electroconvulsive therapy and after five treatment sessions her symptoms slowly abated.…”

022 Predictors and Moderators of Sexual Distress in Women with Persistent Genital Arousal Disorder

“…PGAD is unfortunately associated with embarrassment and shame for many of the women suffering from the disorder (Leiblum, 2008). This can theoretically lead to women being less likely to report their symptoms to healthcare providers (Leiblum, 2009), and increased distress and/or the development of suicidal ideation (Eibye & Jensen, 2014). With so little research of the disorder in existence, women suffering from PGAD need more facts and clarity from well-conducted research in order to inform both the general public and clinicians about the nature of this disorder, the distress it brings, and viable treatment options.…”

“…In the aforementioned Eibye and Jensen (2014) They noted that women with PGAD were "more likely than women who only met some of the criteria to report depression, anxiety, panic attacks, and certain obsessive-compulsive symptoms such as monitoring their physical sensations." The authors hypothesized that for some women with PGAD, "psychological factors, namely anxiety, reinforce, exacerbate and maintain PGAD."…”

“…,Goldmeier and Leiblum (2008),Bedell et al (2014),Leiblum et al (2005),Komisarik and Lee (2014),Eibye and Jensen (2014), have unearthed a broad potential of etiologies such as Tarlov Cysts, pelvic varices, neural concerns, psychological factors, or previous SSRI/SNRI use. Waldinger et al (2010, 2009) expanded the etiological theories to suggest PGAD may be part of a grouping of symptoms they collectively deem restless genital syndrome.…”