A 37-year-old woman says she has 300 orgasms a day —
without ever really finding satisfaction. An 81-year-old
patient says nothing provides relief from her constant
arousal, not even masturbating for 90 straight minutes.
And yet another 52-year-old woman says the only time she
gets a break from the longing in her loins is when she's
asleep.
Unbelievable as it may seem, this
is no joke. It's a real medical condition called persistent
sexual arousal syndrome (PSAS) that's just starting
to get physicians' attention.
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Signs it's PSAS
•
The physiological responses — vasocongestion
and sensitivity of the genitals and breasts —
persist for an extended period (hours to days),
and don't subside completely on their own.
•
The signs of physiologic arousal don't resolve
with ordinary orgasmic experience and may require
multiple orgasms over hours or days to remit.
•
These physiologic signs of arousal are usually
experienced as unrelated to any subjective sense
of sexual excitement or desire.
•
The persistent sexual arousal may be triggered
not only by sexual activity, but also by seemingly
nonsexual stimuli or no apparent stimulus at all.
•
The physiologic signs of persistent arousal
are experienced as uninvited, intrusive and unwanted.
Adapted from the article "Persistent Sexual Arousal
Syndrome in Women", Female Patient, April 2002
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A study published in the April
issue of the International Journal of STD & AIDS
attempts to shed light on the uncommon condition.
Dr Sandra Leiblum, one of the study authors, was the
first to publish on the disorder in late 2002. To date,
most studies have included no more than 30 patients.
But in this most recent paper, she and lead author Dr
David Goldmeier reviewed the literature to try to get
to the bottom of the disorder.
"The causes [of PSAS] are basically
unknown," says Dr Goldmeier. But he believes the evidence
suggests it's either a neurological or vascular problem.
Some cases in postmenopausal women have been associated
with excess phytoestrogen — taken to relieve hot
flashes and other symptoms of menopause — while
others have been linked to the presence of certain types
of fistulas.
But some of the most interesting
findings link cessation of antidepressants to the onset
of PSAS. "The SSRI discontinuation syndrome might indeed
be a clue as to one possible causation of PSAS," writes
Dr Goldmeier. A large percentage of the members of on
an online support group for PSAS sufferers report having
been on SSRIs prior to the start of symptoms, according
to a patient-letter published in the September 2005
issue of the Journal of Sexual Medicine.
How does Dr Goldmeier explain
the link? "A likely important biologically plausible
mechanism [in SSRI withdrawal] is downregulation of
serotonin receptors, which has a suppressive action
on the production of atrial natriuretic peptide," he
wrote in a letter in the March issue of the Journal
of Sexual Medicine. A decrease in the levels of
this peptide can increase blood flow to the genital
area, leading to engorgement, lubrication and arousal.
ALL
HOT AND BOTHERED
Theories aside, both the diagnosis and treatment of
PSAS seem almost hopeless. Women are reluctant to come
forward for fear of humiliation and many physicians
aren't even aware the condition exists.
As for treatments, nothing has
been found to do much good. "All treatments are empirical,"
says Dr Goldmeier. "Cognitive behaviour therapy has
helped, as has ECT [electroconvulsive therapy] in two
patients who were also depressed. Coming off phytoestrogens
helped for one case as did mending the arteriovenous
fistula."
More research obviously needs to
be done to better understand the syndrome and develop
effective treatments, but it's certainly something new
to be on the lookout for.
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