Persistent genital arousal syndrome: neurology of and comparison to epileptic orgasms

This post details  a  neurologic basis  to persistent genital arousal syndrome (PGAS).  The condition is characterised by unwanted repeated multiple daily episodes of sexual arousal, that often leads to dozens or hundreds of orgasms daily, relieved with masturbation briefly before recurring.  It can be lifelong, occur during pregnancy, or in the postmenopausal state.  Precipitating factors include pudendal nerve injury,  and antidepressant drugs including trazodone.  A strong association with restless legs syndrome and overactive bladder has been noted. Treatments that were successful in many patients include clonazepam, tramadol, pelvic floor massage focusing on the pudendal nerve, varenicycline,and pudendal nerve blocks.

This condition can be differentiated from orgasmic seizures, which itself needs to be divided into different entities.  Orgasms as an aura of a seizure can occur usually due to right hippocampal, but occassionally left hippocampal or left parietal epilepsy.  Reflex epilepsy after orgasm also occurs again usually after right temporal but occassionally left frontal seizures and in one case report reflected the manifestations of complete heart block, cured with a pacemaker.  Reflex epilepsy occurring as orgasmic aura has been reported after toothbrushing in one Taiwanese patient.

see pub med for references