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Persistent genital arousal syndrome (PGAD) is a rarely reported syndrome, which is presented with spontaneous, persistent genital arousal, with or without orgasm. In this paper, we discuss the etiology and treatment of two PGAD cases, which both have Restless Legs Syndrome and urinary problems.
Case 1.A 33-year-old single female was diagnosed as having OCD and major depressive disorder at age of eighteen and had used clomipramine for a while. After cessation of this drug, her PGAD complaints started. PGAD improved with escitalopram and never relapsed. However, she was hospitalized due to a manic episode with mixed features. She also had urinary incontinence and restless legs syndrome. Both conditions could not be explained with an organic etiology. Urinary complaints disappeared after valproic acid and olanzapine treatment.
Case 2.A 28-year-old married female has got a complaint about having persistent sexual arousal. She had experienced genital arousals continuously for several years without response to aripiprazole, valproic acid and sertraline. Frequency of episodes increases in the evenings and some arousals resulted in sleep disruptions. She also had Restless Legs Syndrome and urinary problems such as urgency and hypersensitivity. She was diagnosed with PGAD and bipolar II disorder with borderline personality features. Patients were both middle-aged and from conservative socio-cultural environment. Both were educated in religion. No triggering situations for genital arousal were reported. Both share borderline personality features. Case 1 was induced with antidepressant cessation, while the symptoms of the Case 2 started spontaneously. Both patients had restless legs syndrome and urinary problems, which were associated with PGAD in a study. Case 1 was hospitalized due to a manic episode with mixed features, while Case 2 admitted with genital arousal and had bipolar 2 disorder. Case 2 was sexually active. No decrease of sexual desire was present in both patients. Parental attitudes in their family were conservative in religious and sexual matters. Sexual conservatism was also a predictor of PGAD in a recent study. Genital complaints of Case 1 responded to escitalopram, whereas Case 2 did not benefit from any treatment. Five PGAD cases have been reported from Turkey so far. Misdiagnosis of OCD was present due to religious bath rituals in three of them. Neuropsychiatric assessments of other two cases were normal. In conclusion, these report supports the hypothesis of restless genitalia syndrome and both cases share conservative attitudes and bipolar disorder comorbidity with borderline features.