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Global Translational Medicine Persistent genital arousal disorder

The etiology of PGAD is multifactorial and may be 2. Case presentation
related to vascular, neurological, pharmacological, and
psychological alterations [1,6] . Anomalies in the pelvic A 50-year-old uniparous, married woman, who worked
arteriovenous system, such as pelvic varicose veins and as a teacher, had her first appointment at the AESH on
arteriovenous malformations, can lead to changes in February 13, 2023, with the main complaint of spontaneous
blood flow and cause persistent engorgement of the and recurrent orgasms, with around 15 episodes a day.
This persistent arousal condition became prominent in
genital region, leading to PGAD . Among the known April 2022, when she was diagnosed with a disc herniation
[7]
neurological factors, central and peripheral alterations,
nerve entrapment arousal deserve emphasis as a source of between L2-S1 and radicular compression of L2-S1. The
continuous arousal , however, complementary tests are patient had a history of bilateral pain in the lumbar region,
[8]
not predictive of this association . Furthermore, there with irradiation initially to the anterior surface of the right
[9]
are still gaps regarding the mechanism of female sexual leg, then to the left. She also presented genital arousal and
arousal related to peripheral and spinal nerve pathways constant involuntary orgasms, which worsened when
and neurotransmitters . Nevertheless, it is possible she sat and/or lay down. After undergoing percutaneous
[10]
denervation on January 5, 2023, she complained of sequelae
that expansive lesions or arteriovenous fistulas, as well
as post-surgical changes, cerebrovascular accidents, of high-intensity compressive pain in the coccygeal region,
and cervical disc anomalies, result in alterations in the which was triggered by touch. The patient associated the
ascending and descending nervous pathways responsible intense distress with the condition and claimed to have had
for the autonomic and motor regulation of the pelvic suicidal thoughts. She also reported having undergone two
region, leading to the engorgement of the genital area lumbar sympathetic blocks in June 2022 and January 2023
and thereby triggering arousal. There is evidence that (undocumented), which however did not improve her
definitive treatment of the underlying neurological factor clinical condition.
promotes the improvement or resolution of symptoms in The patient suffered from systemic arterial hypertension,
up to 80% of cases . Epilepsy is an example in which, after fibromyalgia, and type 2 diabetes mellitus. The medications
[10]
optimization of the anticonvulsant drug regimen, patients she used include desogestrel 75 µg/day, fluoxetine
showed improvement in the concomitant presentation of 60 mg/day, enalapril 10 mg/day, hydrochlorothiazide
PGAD . 25 mg/day, ezetimibe 10 mg/day, alprazolam 0.5 mg/day,
[11]
trazodone 50 mg/day, pregabalin 150 mg, and amlodipine
Tarlov cysts are single or multiple structures that
originate from the nerve root, located mainly in the sacral 10 mg/day. The patient had undergone bariatric surgery in
spine , and are found in 38% of patients with PGAD . 2016 and percutaneous denervation of the sacral region in
[13]
[12]
Surgical treatment has been shown to alleviate or eliminate 2022 (undocumented).
the symptoms . Genital examination did not reveal anatomical
[14]
Drug-related causes are particularly associated with the alterations nor abnormal exposure of the clitoris. Her
initiation or abrupt discontinuation of selective serotonin vaginal muscle had adequate tone, with no trigger points
reuptake inhibitors (SSRIs) . In addition, psychological for pain, although she claimed that applying pressure on
[15]
factors such as anxiety can exacerbate the presentation of the vaginal wall could relieve the arousal sensation.
PGAD . Transvaginal ultrasonography in July 2022 showed
[16]
Here, we report the clinical management of PGAD in a no abnormality. On April 17, 2023, nuclear magnetic
female patient. To this end, a review of the medical records resonance spectroscopy of the patient’s spine was
was carried out to obtain data concerning the patient’s first conducted, revealing spondylosis, discrete disc alterations,
consultation at the Human Sexuality Studies Outpatient and a cystic image in the vertebral canal at the level of the
Clinic (AESH) of the Center for Human Reproduction S2, which was suggestive of a Tarlov cyst. The magnetic
of the Department of Gynecology and Obstetrics of the resonance imaging (MRI) of the right hip showed
Ribeirão Preto Medical School - University of São Paulo insertional tendinopathy and peritendinitis of the gluteus
(FMRPUSP). One of the researchers in this study (T.T.M.) medius and minimus muscles, without ruptures, while the
approached the woman while she was waiting to be attended MRI of the left hip revealed insertional tendinopathy and
at the clinic and explained the characteristics of the case peritendinitis of the gluteus medius and minimus muscles,
report. After agreeing to participate, the participant signed with trochanteric bursitis.
an informed consent form. This case report was approved Bilateral transcutaneous blockage of the pudendal
by the Research Ethics Committee of the FMRPUSP Clinics nerve was performed, guided by digital palpation of the
Hospital (approval ID: CAAE - 69898023.0.0000.5440). ischial spines that can be identified along the vaginal

Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/gtm.2341