Zolpidem related persistent genital arousal disorder: An interesting case

Abstract

T he present paper is describing a case of persistent genital arousal disorder that developed to a 55-year-old woman, shortly after the initiation of zolpidem. Persistent genital arousal disorder (PGAD) is a clinical entity that appears with a relatively low frequency in women, and is characterized by persistent or recurrent, unwanted and bothersome feelings of genital arousal, which often do not resolve with orgasm and are not associated with sexual desire (sexual interest, thoughts or fantasies). Women who experience PGAD often have feelings of shame, guilt and distress. Although its exact etiology remains unclear, various etiological factors have been proposed, central or peripheral, which may be psychological, vascular, dietary, pharmacological or neurological. Additionally, its presence has been associated to restless legs syndrome and overactive bladder syndrome. Likewise, multiple therapeutic interventions have been proposed and tried in patients with PGAD, either pharmacological (SSRIs, SNRIs, antiandrogens, benzodiazepines, antipsychotics, anticonvulsive agents) or other (ECT, physiotherapy, psychotherapy, nerve stimulation). Zolpidem is a nonbenzodiazepine indirect GABA A receptor agonist, which has lately been used as a therapeutic agent for PGAD in some cases. Nevertheless, in our patient, receiving zolpidem for insomnia seemed to be timely connected to the onset of PGAD symptomatology. The aim of the present paper is to highlight the need for more research into the possible factors that may contribute to PGAD.

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

“…Given their ability to numb the vagina, gabapentinoids, opioids, botox, and SSRIs were likely part of the treatment plan, along with more extreme measures, including clitoridectomy and pudendal nerve ablation (Healy et al, 2022). The indirect GABA receptor agonist zolpidem, which is not a benzodiazepine, has been occasionally used as a treatment for PGAD in recent years (Ferenidou et al, 2019). An emerging diagnosis in women is persistent genital arousal disorder (PGAD).…”

Persistent genital arousal disorder – the present knowledge

“…Attempts to treat PGAD include reduction of identifiable factors exacerbating the symptoms, application of anesthetizing agents to numb the area, cognitive behavioral therapy (CBT) and mindfulness techniques (MBCT) [41], hypnotherapy [42], pelvic floor physical therapy [43], pharmacotherapy (e.g., mood stabilizing, anti-seizure medications, SNRI) [44][45][46][47][48][49][50], injection of Botulinum toxin [51], electroconvulsive therapy (ECT) [52,53], variceal embolization [54], and transcutaneous electrical nerve stimulation. Due to the fact that PGAD is still a poorly understood disorder, there are no clinical trials testing the safety and effectiveness of proposed treatments, neither is there a recommended treatment algorithm.…”

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

“…174 Non-surgical/non-pharmacologic strategies for this region include electroconvulsive therapy 31,32 and transcranial magnetic stimulation. 161,175,176 For PGAD/GPD patients with traumatic brain injury, epileptic seizures, arteriovenous malformations, aneurysms, or other lesions, neurological and neurosurgical consultation is recommended.…”