engleski

Persistant genital arousal syndrome or hypersexuality disorder

Introduction / Patient Information Female patient in her 40s, married, in a stable relationship, employed. Suffers from schizophrenia and has been taking quetiapine (400 mg) for eight years. Clinical Presentation The patient was distressed by her unwanted genital and psychological arousals, that took place up to seven times a day. She explained that she felt aroused when in the presence of a man. She was making mistakes at work due to her physical and psychological arousal, often needed to go to the toilet and masturbate. Sometimes she masturbated so much and so vigorously that she hurt herself. Physical examination, laboratory findings, brain CT scan showed no abnormalities. After several consultations it was evident that her arousals were not painful, nor physically disturbing, but she felt guilt for having such feelings toward (what she felt to be) inappropriate men. She had strong religious believes and also thought that her condition was a kind of punishment. Treatment She was treated with valproate 600 mg ; and psychotherapy. The aim of psychotherapy was to diminish the guilt feelings, to explore her sexuality and to find more appropriate means at more appropriate time, how to satisfy her sexual urges. After 11 sessions she engaged in sexual activity three times a day and was more satisfied, and had less guilt and distress. Discussion This is a case of a women with psychological (schizophrenia), religious (guilt feelings) and pharmacological (quetiapine) burden. The differential diagnosis was between persistant genital arousal syndrome and hypersexuality. With pharmacotherapy (valproate) her impulsiveness (to act on sexual urges) was taken under control and with psychotherapy she was more willing to explore her sexuality, to think and talk (and even fantasize) about sexual matters. Conclusion / Take home message Sexual desire and sexual arousal are influenced by biological, iatrogenic (i.e. pharmacological), psychological, cultural and religious factors. It is important to take them all into account when considering aetiology of sexual problems. Also, it is important to combine pharmacotherapy, psychotherapy and counselling in the treatment of female sexual problems.

Persistant genital arousal; hyperactivity disorder; schizophrenia; valproat

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