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

Varenicline is a partial agonist of the α2β4 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. Korda JB, Pfaus JG, and Goldstein I. Persistent Genital Arousal Disorder (PGAD): A case report in a woman with lifelong PGAD where serendipitous administration of varenicline tartrate resulted in symptomatic improvement. J Sex Med 2009;6:1479-1486.