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  1. The clitoral or female priapism is not caused from arousal, it is a more accurate term than persistent genital arousal disorder (PGAD) or Restless genital syndrome.

    In 2013 Gadit stated "A 54-year-old woman presented to a community- based psychiatric clinic with unique problem of persistent genital arousal disorder. ... this case has become a clinical challenge in terms of treatment" [1]. The clitoris is an external organ ("internal" clitoris does not exist) and has three erectile tissue parts, in the free part of the organ, is composed of the body and the glans located inside of the prepuce; the hidden part of the clitoris are the roots or crura, they are covered by the ischiocavernosus muscles. Their contraction results in a surge of blood in the crura toward the corpora cavernosa of the clitoris and compression of the deep dorsal veins, contributing to erection of the clitoris. Studies by Dickinson, in 1949, identified a small number of reports showing that pronounced erection can occur. In fact, as in males, in females, it is possible to have the priapism of the clitoris, a rare condition associated with prolonged painful erection of the corpora cavernosa lasting for more than 6 hr and unassociated with sexual arousal, not associated with sexual stimulation. It causes engorgement, swelling, pain of the clitoris and of its immediate adjacent area [2-4]. Female priapism treatment depends on aetiology. The cause of priapism, in male and female, is impaired outflow of blood from the corpora cavernosa because of venous obstruction or because of failure of the alpha- adrenergic relaxation system. ''Most reported cases of female priapism describe the association with the use of antidepressant and other psychotropic drugs, all with alphaadrenergic blocking potential, such as trazodone, buproprion citalopram and nefazodone. Treatment consisted of discontinuing the offending medication or providing symptomatic pain relief. Serious permanent damage where treatment has been delayed has been reported in men but not in women. Furthermore, the association between congenital clitoromegaly and priapism has also not been reported previously. With this concern in mind, we felt justified to resort to management options described for male priapism but hitherto not for female priapism, i.e. the direct injection with epinephrine and heparin, followed by aspiration to provide immediate decompression''[4,5]. The etiology of PGAD is not completely understood, it is described as spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. PGAD definition is equal to that of clitoral/female priapism. PGAD is not a newly recognized condition. In addition, if the "genital arousal" is unwanted, why to use "arousal"? This term could suggests that women should, may end up feeling "abnormal" from sexuality viewpoint. Restless Genital Syndrome includes restless legs and/or overactive bladder, and it may include PGAD: it cannot be defined how PGAD. The term clitoral, or female, priapism is a more accurate term than persistent genital arousal disorder or Restless genital syndrome. Treatment described for male priapism must be divulged to the sexual medicine experts [4,5]: it must be a therapy also for clitoral/female priapism. Sexologists and sexual medicine experts use questionnaires for the prevalence, etiology, diagnosis and treatment of female sexual dysfunctions (FSD). Female Sexual Function Index (FSFI) questionnaire is the most widely used scale to assess sexual dysfunction in women. Physiologically the FSFI questionnaire does not provide an assessment of female sexual function, but primarily assesses vaginal intercourse: many questions seem to assess the degree of lubrication and ease of penetration, while very little attention is paid to clitoral sensation. Questionnaires for women's sexual function must mainly assess the presence or absence of orgasm with masturbation and in the questions there must not be the words "intercourse" and "satisfaction"[6]. As a matter of fact female sexual dysfunctions are popular because they are based on something that doesn't exist, i.e. the vaginal orgasm[2,3,6]. Clitoral/female priapism is not a sexological disease, but a gynecological/urological disease. I warn colleagues to maintain a high level of professionalism and not to be use nonmedical or not scientific definition, terms and questionnaires.

    References

    [1] Gadit A. Persistent genital arousal disorder: a clinical challenge. BMJ Case Rep. May 21; 2013. doi:10.1136/bcr-2013-009098

    [2] Puppo V. Anatomy and Physiology of the Clitoris, Vestibular Bulbs, and Labia Minora With a Review of the Female Orgasm and the Prevention of Female Sexual Dysfunction. Clin Anat 2013; 26: 134-52.

    [3]Puppo V. Embryology and anatomy of the vulva: The female orgasm and women's sexual health. Eur J Obstet Gynecol Reprod Biol 2011; 154:3-8.

    [4] Arntzen BW, de Boer CN. Priapism of the clitoris. BJOG 2006; 113: 742-43.

    [5] Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. American Urological Association guideline on the management of priapism. J Urol 2003; 170(4 Pt 1): 1318-24.

    [6] Puppo V. Female sexual function index (FSFI) does not assess female sexual function. Acta Obstet Gynecol Scand 2012; 91:759.

    Conflict of Interest:

    None declared

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