INTRODUCTION: Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is associated with poor quality of life. Due to social stigma and its heterogeneous nature, many patients suffer without treatment. AIMS: This case presents the first example of the successful use of a glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonist (GLP1/GIP RA) medication for the treatment of PGAD/GPD. METHODS: The patient was identified by the Sexual Medicine Research Team, retained as a patient at a sexual medicine clinic, and interviewed for the purposes of this case report. RESULTS: This case presents a 44-year-old woman with a lifelong history of PGAD/GPD symptoms that caused extreme distress and depression who experienced 95% resolution of her symptoms within 2 days of starting tirzepatide, a GLP1/GIPRA medication, for weight loss. CONCLUSION: Increasing benefits of GLP1/GIPRAs are being uncovered, and further studies must investigate the potential for these medications to be used in patients with PGAD/GPD. This study also provides a potential mechanism for decreased arousal resulting from GLP1/GIP receptor activation in attention/reward pathways in the brain.

College of Human Medicine Michigan State University East Lansing MI 48824 United States

Department of Psychology and Life Sciences Charles University Klecany 116 36 Czech Republic

Department of Psychology Queen's University Kingston ON K7L 3N6 Canada

Department of Psychology Rutgers University Newark NJ 08854 United States

Department of Psychology University of British Columbia Vancouver BC V6T 1Z4 Canada

Department of Urology Georgetown University Hospital Washington DC 20007 United States

San Diego Sexual Medicine San Diego CA 92120 United States

Sexual Medicine Research Team Washington DC 20001 United States

Stritch School of Medicine Loyola University Chicago Chicago IL 60153 United States

Zobrazit více v PubMed

McCabe  MP, Sharlip  ID, Atalla  E, et al.  Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135–143. 10.1016/j.jsxm.2015.12.019 PubMed DOI

Leiblum  R, Sharon  G, Nathan  S. Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality. J Sex Marital Ther. 2001;27(4):365–380. 10.1080/009262301317081115 PubMed DOI

RobynA  J, CarolineF  P. Prevalence of persistent genital arousal disorder in 2 North American samples. J Sex Med. 2020;17(12):2408–2416. 10.1016/j.jsxm.2020.09.004 PubMed DOI

Pink  L, Rancourt  V, Gordon  A. Persistent genital arousal in women with pelvic and genital pain. J Obstet Gynaecol Can. 2014;36(4):324–330. 10.1016/S1701-2163(15)30608-3 PubMed DOI

Jackowich  RA, Poirier  É, Pukall  CF. A comparison of medical comorbidities, psychosocial, and sexual well-being in an online cross-sectional sample of women experiencing persistent genital arousal symptoms and a control group. J Sex Med. 2020;17(1):69–82. 10.1016/j.jsxm.2019.09.016 PubMed DOI

Leiblum  S, Seehuus  M, Goldmeier  D, Brown  C. Psychological, medical, and pharmacological correlates of persistent genital arousal disorder. J Sex Med. 2007;4(5):1358–1366. 10.1111/j.1743-6109.2007.00575.x PubMed DOI

Goldstein  I, Komisaruk  BR, Pukall  CF, et al.  International Society for the Study of Women’s Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD). J Sex Med. 2021;18(4):665–697. 10.1016/j.jsxm.2021.01.172 PubMed DOI

Gadit  A. Persistent genital arousal disorder: a clinical challenge. BMJ Case Rep. 2013;2013(1):bcr2013009098. 10.1136/bcr-2013-009098 PubMed DOI PMC

Goldmeier  D, Leiblum  S. Interaction of organic and psychological factors in persistent genital arousal disorder in women: a report of six cases. Int J STD AIDS. 2008;19(7):488–490. 10.1258/ijsa.2007.007298 PubMed DOI

Bedell  S, Goldstein  AT, Burrows  L. A periclitoral mass as a cause of persistent genital arousal disorder. J Sex Med. 2014;11(1):136–139. 10.1111/jsm.12165 PubMed DOI

Uloko  M, Yih  J, Hartzell-Cushanick  R, Goldstein  S, Goldstein  I. 129 neuroproliferative vestibulodynia as a cause of persistent genital arousal disorder: a first-ever case series. J Sex Med. 2021;18(Supplement_1):S69–S70. 10.1016/j.jsxm.2021.01.148 DOI

Armstrong  GL, Vancaillie  TG. Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal. BMJ Case Rep. 2016;2016(1):bcr2015213513. 10.1136/bcr-2015-213513 PubMed DOI PMC

Rosenbaum  TY. Case reports: physical therapy treatment of persistent genital arousal disorder during pregnancy: a case report. J Sex Med. 2010;7(3):1306–1310. 10.1111/j.1743-6109.2009.01654.x PubMed DOI

Thorne  C, Stuckey  B. Pelvic congestion syndrome presenting as persistent genital arousal: a case report. J Sex Med. 2008;5(2):504–508. 10.1111/j.1743-6109.2007.00666.x PubMed DOI

Villot  A, Thubert  T, Deffieux  X, et al.  Perineal neurophysiological assessment in 23 patients suffering from persistent genital arousal disorders: evidence of pudendal neuropathy?  Int J Sex Health. 2016;28(1):50–54. 10.1080/19317611.2015.1080778 DOI

Dallagiacoma  S, Flora  G, Ferrone  S, Parodi  F, Federico  A. Tarlov’s cyst as an underestimated cause of persistent genital arousal disorder: a case report and review. Neurol Sci. 2020;41(11):3337–3339. 10.1007/s10072-020-04504-4 PubMed DOI

Kim  CW, Goldstein  I, Komisaruk  BR, et al.  Lumbar endoscopic spine surgery for persistent genital arousal disorder/genitopelvic dysesthesia resulting from lumbosacral annular tear–induced sacral radiculopathy. J Sex Med. 2023;20(2):210–223. 10.1093/jsxmed/qdac017 PubMed DOI

Anzellotti  F, Franciotti  R, Bonanni  L, et al.  Persistent genital arousal disorder associated with functional hyperconnectivity of an epileptic focus. Neuroscience. 2010;167(1):88–96. 10.1016/j.neuroscience.2010.01.050 PubMed DOI

Yero  SA, McKinney  T, Petrides  G, Goldstein  I, Kellner  CH. Successful use of electroconvulsive therapy in 2 cases of persistent sexual arousal syndrome and bipolar disorder. J ECT. 2006;22(4):274–275. 10.1097/01.yct.0000244247.33038.26 PubMed DOI

Calabrò  RS. Lamotrigine-induced persistent genital arousal disorder: an unusual side effect. Epilepsy Behav. 2017;68(1):234–235. 10.1016/j.yebeh.2017.01.012 PubMed DOI

Mahoney  S, Zarate  C. Persistent sexual arousal syndrome: a case report and review of the literature. J Sex Marital Ther. 2007;33(1):65–71. 10.1080/00926230600998532 PubMed DOI

Battaglia  C, Venturoli  S. Persistent genital arousal disorder and trazodone. Morphometric and vascular modifications of the clitoris. A case report. J Sex Med. 2009;6(10):2896–2900. 10.1111/j.1743-6109.2009.01418.x PubMed DOI

Leiblum  SR, Goldmeier  D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. J Sex Marital Ther. 2008;34(2):150–159. 10.1080/00926230701636205 PubMed DOI

Xie  Y, Choi  T, Al-Aly  Z. Mapping the effectiveness and risks of GLP-1 receptor agonists. Nat Med. 2025;31(3):951–962. 10.1038/s41591-024-03412-w PubMed DOI

Kelly  AS, Auerbach  P, Barrientos-Perez  M, et al.  A randomized, controlled trial of liraglutide for adolescents with obesity. N Engl J Med. 2020;382(22):2117–2128. 10.1056/NEJMoa1916038 PubMed DOI

Wilding  JPH, Batterham  RL, Calanna  S, et al.  Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989–1002. 10.1056/NEJMoa2032183 PubMed DOI

Kosiborod  MN, Abildstrøm  SZ, Borlaug  BA, et al.  Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069–1084. 10.1056/NEJMoa2306963 PubMed DOI

Wharton  S, Blevins  T, Connery  L, et al.  Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. 2023;389(10):877–888. 10.1056/NEJMoa2302392 PubMed DOI

Fanshier  AV, Crews  BK, Garrett  MC, Johnson  JL. Tirzepatide: a novel glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist for the treatment of type 2 diabetes: the first twincretin. Clin Diabetes. 2023;41(3):367–377. 10.2337/cd22-0060 PubMed DOI PMC

Jastreboff  AM, Aronne  LJ, Ahmad  NN, et al.  Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–216. 10.1056/NEJMoa2206038 PubMed DOI

Rodriguez  PJ, Goodwin Cartwright  BM, Gratzl  S, et al.  Semaglutide vs tirzepatide for weight loss in adults with overweight or obesity. JAMA Intern Med. 2024;184(9):1056. 10.1001/jamainternmed.2024.2525 PubMed DOI PMC

Frías  JP, Davies  MJ, Rosenstock  J, et al.  Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385(6):503–515. 10.1056/NEJMoa2107519 PubMed DOI

Andraos  J, Muhar  H, Smith  SR. Beyond glycemia: comparing tirzepatide to GLP-1 analogues. Rev Endocr Metab Disord. 2023;24(6):1089–1101. 10.1007/s11154-023-09825-1 PubMed DOI PMC

Jerlhag  E. The therapeutic potential of glucagon-like peptide-1 for persons with addictions based on findings from preclinical and clinical studies. Front Pharmacol. 2023;14(1):1063033. 10.3389/fphar.2023.1063033 PubMed DOI PMC

Klausen  MK, Thomsen  M, Wortwein  G, Fink-Jensen  A. The role of glucagon-like peptide 1 (GLP-1) in addictive disorders. Br J Pharmacol. 2022;179(4):625–641. 10.1111/bph.15677 PubMed DOI PMC

Bruns, N Vi, Tressler  EH, Vendruscolo  LF, Leggio  L, Farokhnia  M. IUPHAR review – glucagon-like peptide-1 (GLP-1) and substance use disorders: an emerging pharmacotherapeutic target. Pharmacol Res. 2024;207(1):107312. 10.1016/j.phrs.2024.107312 PubMed DOI PMC

Rubin  R. Could GLP-1 receptor agonists like semaglutide treat addiction, Alzheimer disease, and other conditions?  JAMA. 2024;331(18):1519. 10.1001/jama.2024.1017 PubMed DOI

Wang  W, Volkow  ND, Berger  NA, Davis  PB, Kaelber  DC, Xu  R. Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population. Nat Commun. 2024;15(1):4548. 10.1038/s41467-024-48780-6 PubMed DOI PMC

Wang  W, Volkow  ND, Berger  NA, Davis  PB, Kaelber  DC, Xu  R. Association of semaglutide with tobacco use disorder in patients with type 2 diabetes: target trial emulation using real-world data. Ann Intern Med. 2024;177(8):1016–1027. 10.7326/M23-2718 PubMed DOI PMC

Tuesta  LM, Chen  Z, Duncan  A, et al.  GLP-1 acts on habenular avoidance circuits to control nicotine intake. Nat Neurosci. 2017;20(5):708–716. 10.1038/nn.4540 PubMed DOI PMC

Zhang  Y, Kahng  MW, Elkind  JA, et al.  Activation of GLP-1 receptors attenuates oxycodone taking and seeking without compromising the antinociceptive effects of oxycodone in rats. Neuropsychopharmacology. 2020;45(3):451–461. 10.1038/s41386-019-0531-4 PubMed DOI PMC

Hernandez  NS, Schmidt  HD. Central GLP-1 receptors: novel molecular targets for cocaine use disorder. Physiol Behav. 2019;206(1):93–105. 10.1016/j.physbeh.2019.03.026 PubMed DOI PMC

Angarita  GA, Matuskey  D, Pittman  B, et al.  Testing the effects of the GLP-1 receptor agonist exenatide on cocaine self-administration and subjective responses in humans with cocaine use disorder. Drug Alcohol Depend. 2021;221(1):108614. 10.1016/j.drugalcdep.2021.108614 PubMed DOI PMC

Volkow  ND, Michaelides  M, Baler  R. The neuroscience of drug reward and addiction. Physiol Rev. 2019;99(4):2115–2140. 10.1152/physrev.00014.2018 PubMed DOI PMC

Floresco  SB, West  AR, Ash  B, Moore  H, Grace  AA. Afferent modulation of dopamine neuron firing differentially regulates tonic and phasic dopamine transmission. Nat Neurosci. 2003;6(9):968–973. 10.1038/nn1103 PubMed DOI

Cork  SC, Richards  JE, Holt  MK, Gribble  FM, Reimann  F, Trapp  S. Distribution and characterisation of glucagon-like peptide-1 receptor expressing cells in the mouse brain. Mol Metab. 2015;4(10):718–731. 10.1016/j.molmet.2015.07.008 PubMed DOI PMC

Han  VKM, Hynes  MA, Jin  C, Towle  AC, Lauder  JM, Lund  PK. Cellular localization of proglucagon/glucagon-like peptide I messenger RNAs in rat brain. J Neurosci Res. 1986;16(1):97–107. 10.1002/jnr.490160110 PubMed DOI

Jensen  CB, Pyke  C, Rasch  MG, Dahl  AB, Knudsen  LB, Secher  A. Characterization of the glucagonlike peptide-1 receptor in male mouse brain using a novel antibody and In situ hybridization. Endocrinology. 2018;159(2):665–675. 10.1210/en.2017-00812 PubMed DOI

Merchenthaler  I, Lane  M, Shughrue  P. Distribution of pre-pro-glucagon and glucagon-like peptide-1 receptor messenger RNAs in the rat central nervous system. J Comp Neurol. 1999;403(2):261–280. 10.1002/(SICI)1096-9861(19990111)403:2<261::AID-CNE8>3.0.CO;2-5 PubMed DOI

Rinaman  L. Ascending projections from the caudal visceral nucleus of the solitary tract to brain regions involved in food intake and energy expenditure. Brain Res. 2010;1350(1):18–34. 10.1016/j.brainres.2010.03.059 PubMed DOI PMC

Vrang  N, Grove  K. The brainstem preproglucagon system in a non-human primate ( PubMed DOI

Francois  M, Kaiser  L, He  Y, et al.  Leptin receptor neurons in the dorsomedial hypothalamus require distinct neuronal subsets for thermogenesis and weight loss. Metabolism. 2025;163(1):156100. 10.1016/j.metabol.2024.156100 PubMed DOI PMC

Heatherton  TF, Wagner  DD. Cognitive neuroscience of self-regulation failure. Trends Cogn Sci. 2011;15(3):132–139. 10.1016/j.tics.2010.12.005 PubMed DOI PMC

Arnaoudova  M. Persistant genital arousal disorder in elderly women: a case study. J IMAB - Annu Proceeding Sci Pap. 201218;3(2012):284–286. 10.5272/jimab.2012183.284 DOI

Hirose  Y, Oda  Y, Kobayashi  T, Okada  K, Iyo  M. Effectiveness of brexpiprazole in a patient with bipolar disorder and comorbid persistent genital arousal disorder/genito-pelvic dysesthesia: a case report. Cureus. 2023;15(12):e50349. 10.7759/cureus.50349 PubMed DOI PMC

Fountoulakis  KN, Tegos  T, Goulis  DG, Nimatoudis  I, Kimiskidis  V. Treatment of a female patient with persistent genital arousal and Parkinson’s disease with paliperidone. Aust N Z J Psychiatry. 2017;51(1):98–99. 10.1177/0004867416660200 PubMed DOI

Lynn  BK, Grabenhorst  C, Komisaruk  BR, Goldstein  I, Pfaus  J. The use of pramipexole to treat persistent genital arousal disorder: a case report. Sex Med. 2021;9(4):100372. 10.1016/j.esxm.2021.100372. PubMed DOI PMC

Korda  JB, Pfaus  JG, Goldstein  I. Persistent genital arousal disorder: a case report in a woman with lifelong PGAD where serendipitous administration of varenicline tartrate resulted in symptomatic improvement. J Sex Med. 2009;6(5):1479–1486. 10.1111/j.1743-6109.2008.01210.x PubMed DOI

Calabrò  RS, Cacciola  A, Bruschetta  D, et al.  Neuroanatomy and function of human sexual behavior: a neglected or unknown issue?  Brain Behav. 2019;9(12):e01389. 10.1002/brb3.1389 PubMed DOI PMC

Pfaus  JG, Kippin  TE, Coria-Avila  G. What can animal models tell us about human sexual response?  Annu Rev Sex Res. 2003;14(1):1–63. 10.1080/10532528.2003.10559810 PubMed DOI

Oei  NYL, Rombouts  SA, Soeter  RP, Van Gerven  JM, Both  S. Dopamine modulates reward system activity during subconscious processing of sexual stimuli. Neuropsychopharmacology. 2012;37(7):1729–1737. 10.1038/npp.2012.19 PubMed DOI PMC

Rahman  S, Zusman  G. (285) A case report of multimodal approach to PGAD in a 47 year old woman with anxiety, obesity and perimenopause. J Sex Med. 2024;21(Supplement_6):qdae161.215. 10.1093/jsxmed/qdae161.21 DOI