Sleep exacerbation of persistent sexual arousal syndrome in a postmenopausal woman.
OBJECTIVE
To investigate possible causes and treatment of persistent sexual arousal syndrome, which was exacerbated by sleep onset, in a postmenopausal subject.


METHODS
A clinical examination and interviews with the patient to obtain her case history and follow-up of the effects of drug treatments. Pretreatment laboratory investigations monitored vaginal blood flow by photoplethysmography and heated electrode. Routine blood chemistry and endocrine assessments were undertaken. Magnetic resonance imaging (MRI) scans of brain, pelvis, and spinal cord and genito-sensory neural analysis of clitoral and vaginal areas were performed. A selective internal iliac artery arteriogram was utilized to check the normality of the pelvic blood supply.


RESULTS
Genitalia appeared normal and uncongested. No structural abnormalities were observed in the MRI scans. Hormonal levels and blood chemistry were commensurate with the subject's postmenopausal status. Basal vaginal blood flow (heat electrode) was within the range of normal premenopausal women and showed (photoplethysmography) normal vasomotion. On becoming drowsy and falling lightly asleep in the laboratory the vaginal pulse amplitude (VPA) increased by 95% of the basal value and the low-amplitude VPAs were replaced by high-amplitude VPAs--all evidence of increased vaginal blood flow and congestion and confirming the subject's complaint of persistent sexual arousal during sleep. A simple cognitive task of repeatedly subtracting 7 from 500 out aloud did not hasten the reversion to the basal level. There was no evidence of malfunction of the brain, spinal cord, or pelvic area by MRI but genito-sensory analysis of the clitoral and vaginal area showed evidence of reduced sensory function.


CONCLUSIONS
Of the treatments tried only risperidone has been effective allowing the subject to sleep throughout the night without disturbance and according to the subject has significantly reduced the aggravation of the arousal during the day.
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK. k.r.wylie@sheffield.ac.uk
Kevan
K
Wylie
Roy
R
Levin
Ruth
R
Hallam-Jones
Amanda
A
Goddard
D001143:Arousal / Q000187:drug effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012039:Regional Blood Flow; D018967:Risperidone / Q000008:administration & dosage; D012735:Sexual Dysfunction, Physiological / Q000150:complications* / Q000523:psychology; D020919:Sleep Disorders, Intrinsic / Q000188:drug therapy / Q000209:etiology*; D014621:Vagina / Q000098:blood supply
D018967:Risperidone