Left hand sleep masturbation in a right-handed male patient with sexsomnia.

Sexsomnia is a NREM parasomnia characterized by involuntary sexual behavior during confusional arousal. Video examples are rare. Here we present the case of a man who was accused of sexually assaulting his girlfriend during the night but had no memory of doing so. During a video polysomnography, he masturbated in his sleep with his left hand during the N2 and N3 sleep stages, confirming sexsomnia. However, he always masturbated with his right hand when awake. Treatment with gabapentin did not alleviate sexsomnia and triggered obstructive sleep apnea, which improved when the treatment was replaced with paroxetine. The effect of paroxetine on sexsomnia was unknown. This case supports the concept of automatic behavior in sexsomnia.