(PM-25) Persistent genital arousal disorder (PGAD): diagnostic and therapeutic challenges in an underdiagnosed condition – a case report

Abstract Introduction Persistent Genital Arousal Disorder (PGAD) is a rare and underdiagnosed condition characterized by unwanted and persistent genital sensations without associated sexual desire, leading to intense psychological distress and functional impairment. Objectives To report a case of PGAD associated with psychiatric comorbidities and discuss diagnostic and therapeutic challenges, with emphasis on the use of validated clinical instruments within a multidimensional approach. Materials and Methods Clinical data were obtained through patient interview and medical record review. The patient provided informed consent. Results A 27-year-old female patient with a history of migraine, endometriosis, obsessive-compulsive disorder (OCD), and a past episode of major depression—both under treatment—reported recurrent episodes of pain and burning in the clitoris and pelvic region since the age of 11. Symptoms worsened during menstruation and OCD exacerbations. She had been seeking medical care in various services since 2018, without adequate diagnosis or treatment. Upon referral by the public health system to a sexology outpatient clinic, she described daily symptom exacerbations with an intensity of 10/10, along with feelings of guilt, emotional suffering, and low self-esteem. After ten months of multidisciplinary treatment (sexual therapy, pelvic physiotherapy, psychotherapy, and pharmacotherapy with paroxetine and pregabalin), she showed significant improvement, with a reduction in discomfort (to 4/10) and subjective impact. The use of validated instruments such as Y-BOCS-II, USP-SPS, CTQ, FAST, and PHQ-9 contributed to clinical characterization and follow-up. Conclusion This case reinforces the importance of early diagnosis of PGAD and the need for a broad, individualized, and multidisciplinary approach, especially in the presence of psychiatric comorbidities and long-standing psychological suffering. Financing No conflict.