[A Case of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) Improved with Selective Serotonin Reuptake Inhibitor (SSRI) Treatment].

Abstract

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) causes intense abnormal genital sensations without sexual stimulation. A 74-year-old woman visited our clinic with a tingling sensation in the clitoris. Six months earlier, she had felt lower abdominal discomfort, bladder pain, and abnormal genital sensations and visited the urologist at another hospital. She also had appetite loss, weight loss, and insomnia. A gynecologist diagnosed her symptoms as clitoral-related, but topical treatment was ineffective due to the pain caused by contact. During our examination, there was severe burning pain on clitoral palpation, and we suspected PGAD/GPD. Two weeks after administration of Sertraline, a selective serotonin reuptake inhibitor, her symptoms improved. However, since the effect weakened two weeks after starting treatment, the dosage was increased and her symptoms showed remission thereafter. Her symptoms improved after increasing the dosage. Tarlov cysts in the sacrum revealed by magnetic resonance imaging were considered as the potential cause of PGAD/GPD. Since her symptoms had improved and considering her age and surgical risk, the orthopedic surgeon we consulted recommended follow-up instead of surgery.