Persistent Genital Arousal Disorder: A Case Report in a Woman with Lifelong PGAD Where Serendipitous Administration of Varenicline Tartrate Resulted in Symptomatic Improvement

INTRODUCTION: Persistent genital arousal disorder (PGAD) in women is associated with feelings of persistent, spontaneous, intrusive, unrelenting, and unwanted physical arousal in the absence of conscious thoughts of sexual desire or sexual interest. AIM: To report the case of a 49-year-old woman with lifelong PGAD who was recently prescribed varenicline for smoking cessation and who subsequently experienced amelioration of PGAD symptoms. METHODS: Patient self-report and literature review. Written consent was obtained from the patient. RESULTS: Abatement of lifelong PGAD symptoms occurred within approximately two weeks each time varenicline treatment was initiated. PGAD symptoms returned in approximately 2 weeks each time treatment was suspended. CONCLUSIONS: Varenicline is a partial agonist of the alpha2beta4 subtype of nicotinic cholinergic receptor. Its unique pharmacological action stimulates a small amount of brain dopamine release while antagonizing the ability of nicotine to stimulate much larger dopamine release. Genital sexual arousal is controlled in part by the action of hypothalamic and limbic dopamine systems. Based on the mechanism of action of varenicline and the observation of its effectiveness in this case, we hypothesize that: (i) central hyperactive dopamine release is an important component in the pathophysiology of PGAD in this patient; and (ii) use of varenicline resulted in lowering of this hyperstimulated central dopamine release. Objective testing of varenicline's safety and efficacy in the treatment of other women with PGAD is suggested.