CASE REPORTS

To date, the authors have interviewed 15 women who presented with PSAS, and have heard of dozens more from OB/GYNs and other primary care physicians.

Case 1 Mrs. B was a healthy 81-year-old woman, 4’11”, 95 lb, who had undergone a hysterectomy. She was married to her third husband, a 91-year-old man. She was referred for psychosexual evaluation by her endocrinologist after consulting a number of physicians for the unrelenting feelings of sexual arousal that plagued her. In the questionnaire mailed to patients prior to consultation, she had written that the complaint "makes me so upset that I cry, as I cannot function normally; I make mistakes, get very hungry, and do not sleep."” She went on to say that "I would like the sensations to go away. I want to feel I can make plans and not have the strong sexual desire to make me miserable… not knowing if I'll get satisfied."

Her genital sensations were almost continuous, but worsened during the night. She initially sought release from the arousal by initiating intercourse with her husband, but he had not been able to engage in coitus for the past 2 to 3 years due to a cardiac condition. Her husband was supportive and loving, however, and willingly stimulated her manually and with a vibrator whenever she could no longer tolerate the feelings of sexual arousal. Although she was initially orgasmic with masturbation and manual stimulation, it was becoming more difficult to reach a climax, and even if she did, the sensations of arousal persisted. She sometimes masturbated with a vibrator for up to 90 minutes without relieving the unwanted feelings of sexual tension.

The problem began 6 years earlier. The patient believed that her sexual appetite had increased following her hysterectomy. She said that she initiated or engaged in coitus between 15 and 22 times per month prior to her husband’s cardiac problems, after which she masturbated 7 to 13 times per month. When she began experiencing PSAS, she kept track of the time spent with vibrator stimulation, and reported that it had increased from a few minutes to 1 hour per session.

The patient found the persistent arousal very distressing, and began to cry during the consultation. She was sometimes awakened in the morning by hot flashes, which had only begun during the past year, and with congestion in her pelvic area. Although she was using low-dose estrogen (Premarin), she reported that her vagina was dry and that she occasionally used estrogen cream or other lubricants. She also noted a loss of sensitivity in her clitoris. She was using no other medications, and had even stopped taking vitamins. She was an intelligent, alert, verbal, fully oriented woman who had kept prodigious and reliable notes about her condition. Although always sexually receptive, she had never engaged in unusual sexual behavior.

While this case is unusual, it is tempting to ascribe it to some neurologic abnormality given that the authors were unable to rule out this hypothesis. However, the next case illustrates the wide variability in presentation in that the woman is much younger and has had every conceivable medical evaluation with no abnormal findings.

Case 2 Ms. J. was a 52-year-old divorced woman who was a successful editor. She reported having symptoms of PSAS for 6 years, which over time restricted her activities and destroyed her well-being. She was plagued by persistent feelings of genital vasocongestion that were not relieved by masturbation. She said that "Whereas I had always been content with one orgasm, I now have a constant need for release. Immediately after an orgasm, [and] with no…thoughts of sex, my body begins pulsating intensely and persistently…my orgasms are far deeper and [more] exhilarating than usual. The constant need for release is relentless, with relief coming only while I sleep."”She had come to believe that she was the only person in the world with this problem, and eventually resorted to antidepressants. The problem made it difficult to get through the work day, and prevented her from leaving the house otherwise (written communication, 2001).