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| Persistent Sexual Arousal Syndrome |
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| Written by Sandra R Leiblum, PhD, et al. | |||||
Page 3 of 3 Ms. J. had been examined by a family physician,
three gynecologists, a urologist, and a psychiatrist.
None had ever heard of such a condition. Her blood
test results and hormone levels were within norm a l
limits. There was no history of psychological trauma,
and she did not display any obvious psychopathology.
Over the previous 6 years, she had tried various
antianxiety and antidepressant drugs, including divalp
roex, sertraline, buspirone, and fluoxetine without
success. She was disheartened by the failure to find a
cause or cure for her condition, and said it was only
her sense of humor and the support of family and
friends that kept her from succumbing to depression.
The final assessment of her condition included an MRI, which had normal results. To date, she is still suffering
from PSAS, and is discouraged about ever finding
an explanation or solution for her complaint.
Case 3 A gynecologist in Australia contacted the authors for advice. The patient was described as a 51- year-old woman with a "continual, distressing feeling of sexual arousal." Androgen values were within normal limits, and results of abdominal computed tomography were unremarkable, including the adrenal glands, lumbosacral spine, and pelvis. Orgasms did not relieve the patients congestion, and she was unwilling to masturbate. The patient had been using hormone replacement therapy for some years for osteopenia. There was no history of thrush, the vagina and vulva were normal, and the patient was not taking any alternative or herbal medications. The only anomalous finding was mild tenderness in the suprapubic area. Neurologic findings were likewise normal. Again, despite many suggestions from a variety of physicians and therapists, the physician was unable to identify an explanation for the patient’s complaints. DISCUSSION In all the cases reported to date, results of extensive anatomic, hormonal, neurologic, and psychiatric evaluation have been normal. The women seen by the authors are psychologically healthy and functional individuals. While in some instances the symptoms may be attributable to psychological hypotheses, this in no way confirms a psychological cause of the problem; psychosomatic explanations can be postulated for many complaints in the absence of an unambiguous physical etiology. It is unknown whether PSAS is a new, as opposed to a newly recognized, entity. This is an important distinction in the search for a cause because, if PSAS is truly a new phenomenon, then modern environmental factors (eg, food additives, infectious agents, tight jeans, long-distance bicycling) deserve special attention. More research is needed to determine whether PSAS tends to occur in special populations (eg, long-distance cyclists, women who engage in many hours of spin classes). The prevalence of PSAS is unknown, though it may be more common than supposed because many women may be too embarrassed to report the complaint to their physicians. As indicated, the authors have spoken with some affected women who are not troubled by the feelings of spontaneous arousal, except when they persist unabated for weeks. Physician inquiry can be helpful in identifying the prevalence of this phenomenon and validating the patient's experience as genuine, disturbing, and not "all in her head."” Such complaints must be taken seriously if physicians are to identify the causes, sustaining factors, and therapies for this perplexing problem. REFERENCES
Reprinted with permission from "The Female Patient"
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| Last Updated ( Monday, 26 March 2007 ) | |||||
