Persistent Genital Arousal Disorder-Case Report of Symptomatic Relief of Symptoms With Transcranial Magnetic Stimulation.

To the Editor: P ersistent genital arousal disorder (PGAD) is a rare syndrome of excessive and unremitting sexual arousal in the absence of conscious feelings of sexual desire. It was first described in 2001 by Leiblum and Nathan. Typically, the arousal does not resolve with ordinary orgasmic experience. It is usually experienced as very distressing, intrusive, uncomfortable, and even as a form of pain. When severe, it can lead to significant suicidal ideation. To date, no obvious hormonal, vascular, neurological, or psychological causes have been identified. In 2003, PGAD was recognized as a clinical condition by the International Definitions Committee. Limited available literature suggests that PGAD may be related to an unspecified nervous system dysfunction, and therefore benzodiazepines, anesthetics, and anticonvulsants have been experimentally used to treat the symptoms. Various treatment modalities including local anesthetics, birth control pills, dietary modifications, α-adrenergic agonists, anticonvulsants, and anxiolytic and selective serotonin reuptake inhibitor medications have been tried without notable success. Regional nerve blocks with transcutaneous electrical nerve stimulation and electroconvulsive therapy have shown varying degrees of success in some cases.