Leiblum, 2008 Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal.

[Altostrata]

Drs. Leiblum and Goldmeier have written several papers on PGAD.

 

J Sex Marital Ther. 2008;34(2):150-9. doi: 10.1080/00926230701636205.
Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal.
Leiblum SR¹, Goldmeier D.

Abstract http://www.ncbi.nlm.nih.gov/pubmed/18224549

Full text requested from Dr. Goldmeier

Little is known with certitude about the triggers of persistent genital arousal disorder (PGAD) in women, although there appears to be certain common features of the disorder. Women complain of unbidden feelings of genital arousal that are qualitatively different from sexual arousal that is preceded by sexual desire/and or subjective arousal. The majority of women find PGAD distressing and report only brief relief with orgasm. In this article, we describe five women who believe they developed PGAD either after withdrawing from selective serotonin reuptake inhibitor (SSRI) anti-depressants or while using them. We discuss these sexual symptoms in relation to what is already known about prolonged SSRI withdrawal syndromes and the possible etiologies of these conditions. While not a common cause of PGAD, it is possible that use of, and withdrawal from, pharmacological agents contributes to the development of PGAD.

[Altostrata]

Editors' note in European Association of Urology Words of Wisdom

 

Full text PDF http://www.europeanurology.com/article/S0302-2838(09)00098-0/pdf/Re%3A+Persistent+Genital+Arousal+Disorder+in+Women%3A+Case+Reports+of+Association+with+Anti-Depressant+Usage+and+Withdrawal

 

Although apparently implicated in only a small number of PGAD cases, SSRIs definitely play a role. Patients who are being discontinued from a course of antidepressant medication should be actively asked by the physician about sexual side effects, since many patients may be too uncomfor- table to disclose such complaints spontaneously. Discontinuation symptoms generally include gas- trointestinal disturbances, sleep problems, sweat- ing, headaches, or affective symptoms. Specific SSRI symptoms consist of dizziness and sensory abnorm- alities including numbness, paresthesia, and elec- tric shock sensations. Although these symptoms normally resolve within a few days, they can persist for [greater than] 1 yr. As for the mechanisms involved, it has been suggested that SSRI withdrawal can increase levels of atrial natriuretic peptide, which induces cyclic guanosine monophosphate and, hence, vulval vasodilation. SSRIs can also increase angiogenesis and have been shown to reduce cortical and limbic responses. A withdrawal may subsequently magnify these responses, causing a kind of rebound effect. Another possibility is that on discontinuation of the medication, a woman may simply return to her baseline level of desire and arousal, which in turn leads to an increased awareness of and focused attention on genital sensations. In clinical practice, both directions of SSRI sexual side effects (ie, those inhibiting and those increasing sexual responses) should be considered.