The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report.

INTRODUCTION: Persistent Genital Arousal Disorder (PGAD) is defined as "spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing, pulsating) in the absence of sexual interest and desire" and traditionally causes marked distress, embarrassment and shame. PGAD may be caused by starting, discontinuing, or making adjustments in certain antidepressants or other medications. AIM: To report the case of a 36- year- old woman with PGAD, likely due to changes in her psychiatric medications, who was treated with pramipexole and experienced improvement in her PGAD symptoms. METHODS: Patient self-report and literature review. Written informed consent was obtained from the patient. MAIN OUTCOME MEASURE: Improvement in PGAD symptoms. RESULTS: Patient reported improvement in her symptoms by "90%" on a low dose of pramipexole, although higher doses exacerbated her symptoms. CONCLUSIONS: It is likely that an effective treatment window exists for the treatment of PGAD with drugs that possess the ability to exert their control of dopaminergic transmission. This includes direct acting receptor agonists like pramipexole, which produce feedback inhibition. Limitations to their efficacy then involve co-treatments that counteract their ability to exert a dampening effect on hyperstimulated dopamine transmission. It is recommended that clinicians be aware of drugs taken by patients to treat psychiatric disorders that could induce PGAD symptoms, drugs recently discontinued where a rebound effect could lead to PGAD symptoms, and drug mechanisms that could counteract the effect of treatments for PGAD. Lynn BK, Grabenhorst C, Komisaruk BR, et al. The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report. Sex Med 2021;9:100372.

Sexual desire and hypoactive sexual desire disorder in women. Introduction and overview. Standard operating procedure (SOP Part 1).

INTRODUCTION: Hypoactive sexual desire disorder (HSDD) is defined in Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for or receptivity to sexual activity, which causes personal distress. As a largely subjective experience, sexual desire may or may not be accompanied by externally observable changes in sexual behavior. AIM: Describe the models of understanding HSDD and the contributing factors to provide the basis for a diagnostic interview and guidance for care for healthcare professionals as a standard operating procedure method. Review of the literature. RESULTS: There are several models which have been developed to describe sexual desire, although there is still no universally accepted definition or description of it. The models are generally divided into more general two-factor models (e.g., excitation-inhibition, appetitive-consummatory) or more specific multifactorial models (in which the different components of sexual activity and their interaction are delineated). The etiology of the disorder is generally considered as multifactorial. Biomedical factors like diseases, drugs, and hormones, and psychological factors like life events, sexual biography, affective state, etc., as well as interpersonal factors like partner satisfaction, communication, duration of the relationship, and sociocultural factors interact with each other and contribute to the individual experience of desire or lack or absence of desire. In analogy to the multifactorial pathogenesis the therapeutic approach is usually multidimensional and includes basic counseling, individual and couple psychotherapy, hormonal and psychopharmacological treatment. CONCLUSION: The standard operation procedure for HSDD in women must be based on a biopsychosocial, multidimensional, and integrative perspective.

A standardized diagnostic interview for hypoactive sexual desire disorder in women: standard operating procedure (SOP Part 2).

INTRODUCTION: Taking into account that Hypoactive Sexual Desire Disorder (HSDD) is a patient-reported symptom and that the disorder is in general the result of the interaction of biological and psychosocial factors (see part 1), it is necessary to provide healthcare professionals with an operating procedure that is patient centered and multidimensional. AIM: Describing a patient-centered and multidimensional standard procedure to diagnose and manage HSDD on a primary care level. METHODS: Review of the literature. Semistructured interview and description of process. RESULT.: The interactive process with the patient follows several steps: initiation, narrative of the patient to understand the individual profile of the disorder, differentiating questions, descriptive diagnosis, exploration of conditioning biomedical, individual psychological, interpersonal, and sociocultural factors (including biomedical examinations), establishment of a biopsychosocial comprehensive explanatory diagnosis, which can be summarized in a nine-field matrix. This matrix will serve as orientation for therapeutic interventions adapted to the individual person. These interventions should always be based on basic counseling as a basis of treatment. Then adapted to the individual condition specific hormonal treatments (mainly estrogen and testosterone alone or combined) can be used after exclusion of contraindications. In patients with predominant psychosocial factors contributing to HSDD individual or couple psychotherapy is indicated. Psychopharmacological drugs are in development and partially investigated and will add to the therapeutic possibilities in the future. CONCLUSION: This model can serve as an ideal basis for the approach to the female patient with HSDD. It can be adapted to the individual clinical setting.

Summary of the recommendations on sexual dysfunctions in men.

INTRODUCTION: Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being. AIM: To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men. METHODS: An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations. RESULTS: Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism. CONCLUSIONS: Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective.