Unraveling Persistent Genital Arousal Disorder-A Case Report on Innovative Therapeutic Approaches

Persistent genital arousal disorder (PGAD) is a rare and distressing condition characterized by persistent, unwanted genital arousal in the absence of sexual desire, often leading to significant psychological distress and functional impairment. We present the case of a married woman in her 30s with a 5 month history of spontaneous genital tingling, throbbing, and warmth that was exacerbated by sitting and not associated with sexual thoughts or behaviors. Her symptoms were accompanied by anxiety, depressive features, sleep disturbance, and social withdrawal. The patient had a significant psychosocial history, including early parental loss, multiple miscarriages, and emotional distress related to infertility and family responsibilities. Investigations revealed a hyperdense focus in the right parietal lobe on computed tomography, while magnetic resonance imaging and electroencephalography were unremarkable. Pelvic imaging demonstrated a bicornuate uterus. Psychometric evaluation indicated moderate anxiety and depression. Multiple prior pharmacological treatments yielded minimal or temporary benefit. A multidisciplinary treatment approach was initiated, including risperidone, sodium valproate, fluoxetine, and short-term clonazepam, alongside structured psychotherapy focusing on relaxation techniques and cognitive behavioral strategies. Significant clinical improvement was observed within 1 week, with marked reduction in symptoms and improved overall functioning. This case highlights the multifactorial etiology of PGAD, involving neurophysiological, reproductive, and psychological factors. It underscores the importance of a comprehensive biopsychosocial approach, where combined pharmacotherapy and psychotherapy can lead to meaningful symptom relief and improved quality of life in affected individuals.