Content written by Irwin Goldstein, MD

Trazodone is a drug that has several actions including an antidepressant effect, an effect against anxiety, and an effect to help improve sleep. Trazodone administration in women is associated with the development of persistent genital arousal disorder (PGAD) and also clitoral priapism. Trazodone is also associated with prolonged genital arousal activity in men and is one of the well-reported causes of priapism.

Genital tissues in women, such as the clitoris and vagina, contain smooth muscles that have the ability to contract and relax. Researchers have shown that the state of tone of genital smooth muscles determines, in part, the state of genital arousal. In states where the genital smooth muscles are relaxed, genital engorgement and genital arousal will exist. In states where the smooth muscles are contracted, a baseline, non-aroused state will exist.

Trazodone is a drug that is associated with the unique ability to cause persistent drug-induced inhibition of genital smooth muscle contraction and persistent drug-induced enhancement of genital smooth muscle relaxation. This is, in part related to trazodone having both alpha-blocking activity (blockade of adrenalin effect, a strong contracting agent) and serontonergic blocking activity (blockage of sterotonin, a strong inhibitor). The result, in some situations, is that trazodone is associated with persistent engorgement of clitoris and vaginal erectile tissues, consistent with persistent genital arousal.

If a woman has persistent genital arousal, it is important to discontinue use of the drug trazodone. In some cases of women with trazodone-induced persistent sexual arousal, discontinuation of trazodone led to discontinuation of the persistent genital arousal.