Persistent Genital Arousal Disorder and Trazodone. Morphometric and Vascular Modifications of the Clitoris. A Case Report

INTRODUCTION: Persistent genital arousal disorder (PGAD) is an unwanted genital arousal which occurs in absence of sexual interest and desire. AIM: To report a case of PGAD presumably due to the use of trazodone in a young eumenorrheic woman. METHODS: A young (29 years old), eumenorrheic (menstrual cycle of >25 and <35 days) woman suffered of unwanted genital arousal and uncontrollable orgasms. In the past, the patient undertook trazodone treatment. The patient was submitted, in the periovulatory (day 12) phase of the menstrual cycle, to bi- and tri-dimensional ultrasonographic and color Doppler analyses of the clitoral structures prior and after an unwanted orgasm. MAIN OUTCOMES MEASURES: 2D ultrasonographic evaluation of the clitoral body volume and color Doppler evaluation of the dorsal clitoral arteries; 3D power Doppler reconstruction of the clitoral vascularization. RESULTS: The clitoral volume was 1.33 mL before the orgasm and resulted 1.36 mL and 1.33 mL, respectively after 1 minute and 15 minutes from the orgasm. The Pulsatility Index (PI) of the dorsal clitoral artery was 1.05 before the orgasm. It resulted lower after 1 minute (PI = 0.82) and 15 minutes (PI = 0.85) from the orgasm. CONCLUSIONS: A subtle and intermittent clitoral priapism may favor the feeling of arousal persistence and elicit unbidden and unwelcomed orgasms.