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S. Parish, B. Brody, 073 Persistent Genital Arousal Disorder Associated with Depression and Suicidality in Two Psychiatric Inpatients, The Journal of Sexual Medicine, Volume 16, Issue Supplement_3, June 2019, Page S27, https://doi.org/10.1016/j.jsxm.2019.03.515
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Introduction
Persistent genital arousal disorder (PGAD) is a genital dysesthesia characterized by persistent or recurrent, unwanted or intrusive, distressing feelings of genital arousal. Its etiology is multifactorial. In women, it is associated with despair, emotional lability, catastrophization, and suicidality. No current literature exists describing its presentation and association with depression and suicide risk or attempts in psychiatric inpatients.
Objective
To provide two case descriptions of psychiatric inpatients with suicidality self-attributed to genital dysesthesia.
Methods
The medical records describing the patients’ clinical features, assessment, and interventions were reviewed.
Results
Case 1: Ms. A was a 58-year-old woman admitted for worsening depression, anxiety, and suicidal thoughts ascribed to worsening PGAD previously diagnosed by a sexual pain specialist. Symptoms included genital engorgement, persistent arousal sensation, and genital and bilateral lower extremity dysesthesias. She was treated with duloxetine 60mg for depression, melatonin 6mg for sleep, gabapentin 300mg for neuropathic pain, and diazepam-baclofen 5mg-5mg vaginal suppositories that lead to improvement of depression and resolution of suicidality, but minimal relief of PGAD symptoms. Discharge plan included psychiatric follow-up; MRI of lumbar plexus to assess pudendal nerve, lumbosacral plexus, and lower lumbar roots; assessment by a physiatrist for a pudendal nerve block; and possible small fiber nerve biopsy.
