The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report

Abstract

Introduction: Persistent Genital Arousal Disorder (PGAD) is defined as "spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing, pulsating) in the absence of sexual interest and desire" and traditionally causes marked distress, embarrassment and shame. PGAD may be caused by starting, discontinuing, or making adjustments in certain antidepressants or other medications. Aim: To report the case of a 36-year-old woman with PGAD, likely due to changes in her psychiatric medications, who was treated with pramipexole and experienced improvement in her PGAD symptoms. Methods: Patient self-report and literature review. Written informed consent was obtained from the patient.Main Outcome Measure: Improvement in PGAD symptoms. Results: Patient reported improvement in her symptoms by "90%" on a low dose of pramipexole, although higher doses exacerbated her symptoms. Conclusions: It is likely that an effective treatment window exists for the treatment of PGAD with drugs that possess the ability to exert their control of dopaminergic transmission. This includes direct acting receptor agonists like pramipexole, which produce feedback inhibition. Limitations to their efficacy then involve co-treatments that counteract their ability to exert a dampening effect on hyperstimulated dopamine transmission. It is recommended that clinicians be aware of drugs taken by patients to treat psychiatric disorders that could induce PGAD symptoms, drugs recently discontinued where a rebound effect could lead to PGAD symptoms, and drug mechanisms that could counteract the effect of treatments for PGAD.

A review of persistent genital arousal disorder: Symptoms, diagnosis, and treatment

“…PGAD is treated with medications that modulate dopamine-related signaling pathways. One direct-acting channel blocker that induces feedback inhibition is pramipexole (Lynn et al, 2021). Second, restrictions on their effectiveness include cooccurring treatments that lessen their capacity to exert a calming effect on overexcited dopaminergic transmission.…”