Case report
Sexsomnia: An uncommon variety of parasomnia

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Abstract

Sexsomnia is considered a particular form of parasomnia characterized by atypical sexual behaviour during sleep. Only a few cases have been reported in the literature. We describe here two cases of sexsomnia that took place in adult women whose personal history was remarkable for traumatic sexual psychological stress during childhood. In addition, the first patient had a medical history of alcoholism during adolescence and current sleepwalking. In the second patient, drug consumption was reported during adolescence, and psychiatric assessment found a major depressive disorder. Neurological examination was normal for both patients. The sexual behaviour was reported by the bed partner because of total amnesia of the event by the patients. Events included moaning, vocalizations with dirty talk, masturbation, sexual assault, and sexual intercourse. The behaviour was harmful for the bed partner in the second case. For both patients, electroencephalogram and brain magnetic resonance imaging were normal whereas nocturnal polysomnography recordings revealed several abrupt and spontaneous arousals from slow-wave sleep. Patients were successfully treated by serotonin reuptake inhibitors. Our observations underline the fact that efforts need to be made to increase awareness of the issue of sexsomnia, in order to identify patients suffering from this atypical parasomnia, which can be associated with adverse psychological consequences and serious medico-legal issues.

Introduction

Sexsomnia is a particular form of parasomnia characterized by atypical sexual behaviour during sleep [1], [2], [3]. This clinical entity has only rarely been reported in the literature and its frequency is certainly largely underestimated because patients are reluctant to talk about their symptoms, and physicians have insufficient information to identify the disease. However, over the last few years, increasing attention has been paid to this disorder because of the forensic aspects, i.e. sleep-related violence and its consequences with regard to the law [4].

We report herein two patients exhibiting abnormal sexual behaviour during sleep. Diagnosis of sexsomnia was made after complete clinical and neurophysiological evaluation.

Section snippets

Case 1

A 36-year-old married woman with five children was referred to our sleep disorder centre because of abnormal behaviour during sleep. Her personal medical history was characterized by moderate to heavy alcohol consumption up to the age of 19 years. She had a history of sleepwalking that started in childhood and continues to the present day. Her husband complained that she regularly sexually assaulted him while he was sleeping. Indeed, he frequently woke up while his wife was masturbating him or

Discussion

Abnormal sexual behaviour during sleep was first described by Motet in 1897 [5]. The author reported the case of a man who attempted to entice a policeman by exposing his genitals. The patient had no memory of the episode and was sentenced to 3 months’ imprisonment. However, since this initial description, only a few cases of atypical sexual behaviour during sleep have been reported. The frequency of such behaviour, also called somnambulistic sexual behaviour, sleepsex, or sexsomnia, is

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