Persistent genital arousal disorder misdiagnosed because of Islamic religious bathing rituals: a report of three cases.

Persistent genital arousal disorder is not well known or adequately understood by physicians. The disorder is characterized by a persistent and highly unwanted state of genital arousal and orgasm-like feelings. Ghusl is an ablution in Islamic culture, which is an obligatory ritual wherein the body is washed thoroughly after exposure to religious contaminants such as sexual intercourse, menstruation, and childbirth. Muslim women suffering from the disorder may bathe frequently because of their religious beliefs. The authors summarize the case histories of 3 patients with persistent genital arousal disorder who were initially misdiagnosed with obsessive-compulsive disorder. All 3 patients presented with complaints of unwanted, persistent orgasms or orgasm-like arousals, and as a result, they performed ghusl several times a day. At previous interviews, the genital arousal was diagnosed as a sexual and somatic obsession, and repeatedly performing ghusl was considered a cleansing compulsion. Physicians' lack of awareness or knowledge of persistent genital arousal disorder, combined with the unwillingness of patients to discuss sexual problems, can lead to a focus on the repetitive bathing, and thus, a misdiagnosis of the problem as obsessive-compulsive disorder. These cases are presented to highlight the possible pitfalls in the diagnosis of persistent genital arousal disorder cases in Islamic countries where ghusl is common.