Persistent Genital Arousal Associated With a Tarlov Cyst: A Case Report.

Persistent genital arousal syndrome (PGAS) is a rare and distressing condition characterised by spontaneous genital arousal in the absence of sexual desire or stimulation. Although its aetiology is multifactorial, neurogenic causes such as Tarlov cysts are increasingly recognised. We report the case of a 79-year-old woman who presented with persistent, intrusive genital arousal unrelieved by orgasm, developing shortly after initiating vaginal oestrogen therapy. Despite discontinuation, her symptoms persisted and caused significant psychological distress. Gynaecological examination was unremarkable, prompting consideration of a neurogenic cause. MRI revealed small Tarlov cysts at the S2 level and filum terminale, consistent with possible sacral nerve root irritation. The patient was referred to neurosurgery and remains under multidisciplinary conservative management, given her significant comorbidities. This case highlights the importance of recognising lumbosacral pathology as a potential cause of PGAS, particularly when other distinguishing features are absent or symptoms are refractory. Early neuroimaging in unexplained cases may reduce diagnostic delay and improve outcomes through timely, individualised, and multidisciplinary care.