Persistent genital arousal disorder

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Persistent genital arousal disorder
Other namesPGAD
Specialty Sexology, neurology   OOjs UI icon edit-ltr-progressive.svg

Persistent genital arousal disorder (PGAD), originally called persistent sexual arousal syndrome (PSAS), [1] is spontaneous, persistent, unwanted and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, [2] [3] and is typically not relieved by orgasm. [3] [4] Instead, multiple orgasms over hours or days may be required for relief. [4]

Contents

PGAD occurs in people of both sexes. [5] [4] [6] It has been compared to priapism in male and female genitalia. [6] [7] PGAD is rare and is not well understood. [2] [4] The literature is inconsistent with the nomenclature. It is distinguished from hypersexuality, which is characterized as heightened sexual desire. [1] [4]

Classification

In 2003, "persistent genital arousal" was considered for inclusion with regard to the International Consultation on Sexual Medicine (ICSM). In 2009, "persistent genital arousal dysfunction" was included in its third edition. [4] PGAD is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10), which may be due to the disorder requiring further research. [4]

The condition has been characterized by a researcher as being a term with no scientific basis. [8] There is concern that the title may be misleading because, since the genital arousal is unwanted, it is dubious to characterize it as arousal. [8]

Other researchers have suggested that the disorder be renamed "persistent genital vasocongestion disorder (PGVD)" [9] or "restless genital syndrome (ReGS)." [9] [10]

Signs and symptoms

Physical arousal caused by PGAD can be very intense and persist for extended periods, days, weeks or years at a time. [3] [4] Symptoms may include pressure, pain, vibrating, pleasure, irritation, clitoral or penile [5] tingling, throbbing, vaginal congestion, vaginal contractions, penile spasms, arousal, clitoral or penile erections, and prolonged spontaneous orgasms. [3] Pressure, pleasure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris, penis, labia, vagina, perineum, or the anus. [11] The symptoms may result from sexual activity or from no identified stimulus, and are not relieved by a single orgasm, instead multiple strong orgasms over hours, days or weeks are needed for short term relief. [4] The symptoms can impede on home or work life. [3] [9] Women and men [5] may feel embarrassment or shame, and avoid sexual relationships, because of the disorder. [3] [4] Stress can make the symptoms worse. [9] [11]

Cause

Researchers do not know the cause of PGAD, but assume that it has neurological, vascular, pharmacological, and psychological causes. [1] [4] Tarlov cysts have been speculated as a cause. [3] [11] PGAD has been associated with clitoral priapism, [12] and has been compared to priapism in men. [6] [7] It is also similar to vulvodynia, in that the causes for both are not well understood, both last for a long time, and women with either condition may be told that it is psychological rather than physical. [3] It has been additionally associated with restless legs syndrome (RLS), but a minority of women with PGAD have restless legs syndrome, [9] as with men as well.

In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the clitoris. [11] [13] Surgical treatment was effective in this instance. [13] There is evidence that some drugs such as SSRIs and SNRIs might induce or worsen PGAD. [14]

Diagnosis

The following five criteria must be met by patients in order to be diagnosed with PGAD: [15] [16]

  1. Typical physiological responses from sexual arousal persist for an extended amount of time and do not cease on their own
  2. Feelings of arousal remain even after orgasm or multiple orgasms are needed to lessen the arousal
  3. Arousal is experienced without desire or sexual excitement
  4. Arousal occurs with both sexual and non-sexual stimuli or with no stimuli
  5. Symptoms are intrusive, unwanted, and cause distress

Treatment

Because PGAD has only been researched since 2001, there is little documenting what may cure or remedy the disorder. [4] Treatment may include extensive psychotherapy, psycho-education, and pelvic floor physical therapy. [4] [9] In one case, serendipitous relief of symptoms was concluded from treatment with varenicline, a treatment for nicotine addiction. [4] It was reported in a study that repeated masturbation (51%), strong or prolonged orgasms (50%), distraction (39%), intercourse (36%), exercise (25%), and cold compresses (13%) were the most relieving treatments that could be done without the help of a professional. [17]

Having a team of professionals such as a medical provider, a pelvic floor physical therapist, message therapist and sex therapist has been shown to aid patients. One study found that after working with professionals patients felt validated, listened to, and that their sexual function had improved. [15] Many patients felt practicing mindfulness allowed them to adjust to living with PGAD by recognizing thoughts and emotions corresponding to the symptoms and avoiding brooding over them. [17] This treatment method focuses on reducing the anxiety that is caused by the condition and pushes the patient to develop effective distraction and relaxation techniques. [16]

Epidemiology

PGAD is very rare and is believed to affect about 1% of women, [15] and is considered even more rare in men. [5] Although online surveys have indicated that hundreds of women and men [5] may have PGAD, [4] documented case studies have been limited. [18] [19] [20]

History

The earliest references to PGAD may be Greek descriptions of hypersexuality (previously known as "satyriasis" and "nymphomania"), which confused persistent genital arousal with sexual insatiability. [4] While PGAD involves the absence of sexual desire, hypersexuality is characterized as heightened sexual desire. [1] [4]

The term persistent sexual arousal syndrome was coined by researchers Leiblum and Nathan in 2001. [1] [3] In 2006, Leiblum renamed the condition to "persistent genital arousal disorder" to indicate that genital arousal sensations are different from those that result from true sexual arousal. [1] The rename was also considered to give the condition a better chance of being classified as a dysfunction. [1] Now PGAD is often called or termed Genito-Pelvic Dysesthesia. [21]

Impact on mental health

Women and men [21] with PGAD report having unstable mental health with thoughts of suicide and difficulty completing daily activities. [22] [23] Most people that suffer from PGAD report having to masturbate 6, 20 or even more times a day and may have to use many types of sexual devices to experience any type of relief from symptoms. [24] Many people are afraid to leave their homes due to fears that PGAD symptoms may flare up while in public and they will not be able to wait until they are able to relieve themselves. [24]

Before the start of their PGAD, many women were seen to have higher stress scores as well as symptoms of depression and anxiety. [23] Panic attacks (31.6%) and major depression (57.9%) were reported commonalities between patients occurring at least one year prior to the onset of PGAD symptoms. Up to 45% of women and men with the disorder have reported having a history with antidepressants. [17] [21]

A small study found that several women and men began to see symptoms of PGAD after discontinuing the use of their selective serotonin reuptake inhibitors. [21] It is not known whether reintroduction of the SSRIs would improve PGAD symptoms. [22]

See also

Related Research Articles

<span class="mw-page-title-main">Clitoris</span> Erectile female sexual organ

In many animals, the clitoris is a female sex organ. In humans, it is the vulva's most sensitive erogenous zone and generally the primary anatomical source of female sexual pleasure. The clitoris is a complex structure, and its size and sensitivity can vary. The visible portion, the glans, of the clitoris is roughly the size and shape of a pea and is estimated to have 8,000 and possibly more than 10,000 sensory nerve endings.

<span class="mw-page-title-main">Orgasm</span> Intense physical sensation of sexual release

Orgasm or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region characterized by sexual pleasure. Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are usually associated with involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation, and, frequently, body movements and vocalizations. The period after orgasm is typically a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins.

Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months.

<span class="mw-page-title-main">Priapism</span> Medical condition where an erection lasts excessively long

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases are ischemic. Ischemic priapism is generally painful while nonischemic priapism is not. In ischemic priapism, most of the penis is hard; however, the glans penis is not. In nonischemic priapism, the entire penis is only somewhat hard. Very rarely, clitoral priapism occurs in women.

Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation. Anorgasmia is far more common in females than in males and is especially rare in younger men. The problem is greater in women who are post-menopausal. In males, it is most closely associated with delayed ejaculation. Anorgasmia can often cause sexual frustration.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Epispadias</span> Medical condition

An epispadias is a rare type of malformation in which the urethra ends, in males, in an opening on the upper aspect of the penis, and in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.

<span class="mw-page-title-main">Sexual stimulation</span> Stimulus that causes and maintains sexual arousal

Sexual stimulation is any stimulus that leads to, enhances and maintains sexual arousal, and may lead to orgasm. Although sexual arousal may arise without physical stimulation, achieving orgasm usually requires it.

Hypoactive sexual desire disorder (HSDD), hyposexuality or inhibited sexual desire (ISD) is sometimes considered a sexual dysfunction, and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician. For this to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug, or some other medical condition. A person with ISD will not start, or respond to their partner's desire for, sexual activity. HSDD affects approximately 10% of all pre-menopausal women in the United States, or about 6 million women.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.

<span class="mw-page-title-main">Clitoromegaly</span> Unusually large clitoris

Clitoromegaly is an abnormal enlargement of the clitoris that is mostly congenital; it is otherwise acquired through deliberately induced clitoral enlargement e.g. body modification by use of anabolic steroids, including testosterone. It is not the same as normal enlargement of the clitoris seen during sexual arousal.

Female sexual arousal disorder (FSAD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.

<span class="mw-page-title-main">Vibrator (sex toy)</span> Electric-powered sex toy

A vibrator, sometimes described as a massager, is a sex toy that is used on the body to produce pleasurable sexual stimulation. There are many different shapes and models of vibrators. Most modern vibrators contain an electric-powered device which pulsates or throbs. Vibrators can be used for both solo play and partnered play by one or more people. Devices exist to be used by couples to stimulate the genitals of both partners. They can be applied to erogenous zones, such as the vulva, vagina, penis, scrotum, or anus, for sexual stimulation, for the release of sexual frustration and to achieve orgasm. Vibrators may be recommended by sex therapists for women who have difficulty reaching orgasm through masturbation or intercourse.

A vaginal disease is a pathological condition that affects part or all of the vagina.

<span class="mw-page-title-main">Human female sexuality</span> Physiology, identity and behavior

Human female sexuality encompasses a broad range of behaviors and processes, including female sexual identity and sexual behavior, the physiological, psychological, social, cultural, political, and spiritual or religious aspects of sexual activity. Various aspects and dimensions of female sexuality, as a part of human sexuality, have also been addressed by principles of ethics, morality, and theology. In almost any historical era and culture, the arts, including literary and visual arts, as well as popular culture, present a substantial portion of a given society's views on human sexuality, which includes both implicit (covert) and explicit (overt) aspects and manifestations of feminine sexuality and behavior.

Postorgasmic illness syndrome (POIS) is a syndrome in which human males have chronic physical and cognitive symptoms following ejaculation. The symptoms usually onset within seconds, minutes, or hours, and last for up to a week. The cause and prevalence are unknown; it is considered a rare disease.

<span class="mw-page-title-main">Clitoral erection</span> Physiological phenomenon involving the engorgement of the clitoris

Clitoral erection is a physiological phenomenon where the clitoris becomes enlarged and firm.

<span class="mw-page-title-main">Vulva</span> External genitalia of the female mammal

In mammals, the vulva consists of the external female genitalia. The human vulva includes the mons pubis, labia majora, labia minora, clitoris, vestibular bulbs, vulval vestibule, urinary meatus, the vaginal opening, hymen, and Bartholin's and Skene's vestibular glands. The urinary meatus is also included as it opens into the vulval vestibule. The vulva includes the entrance to the vagina, which leads to the uterus, and provides a double layer of protection for this by the folds of the outer and inner labia. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

<span class="mw-page-title-main">Sexual arousal</span> Physiological and psychological changes in preparation for sexual intercourse

Sexual arousal describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind as preparation for sexual intercourse, and continue during intercourse. Male arousal will lead to an erection, and in female arousal, the body's response is engorged sexual tissues such as nipples, clitoris, vaginal walls, and vaginal lubrication.

References

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  2. 1 2 Gerald L. Andriole (2013). Year Book of Urology 2013, E-Book. Elsevier Health Sciences. p. 160. ISBN   978-1-4557-7316-9 . Retrieved February 8, 2018.
  3. 1 2 3 4 5 6 7 8 9 David A. Gordon; Mark R. Katlic (2017). Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly: An Integrated Approach. Springer. p. 259. ISBN   978-1-4939-6554-0 . Retrieved February 8, 2018.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Brian A. Sharpless (2016). Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research. Oxford University Press. pp. 110–120. ISBN   978-0-19-024586-3 . Retrieved February 8, 2018.
  5. 1 2 3 4 5 "Male PGAD". www.pelvicrehabilitation.com.
  6. 1 2 3 Kevan R. Wylie (2015). ABC of Sexual Health. John Wiley & Sons. p. 52. ISBN   978-1-118-66556-5 . Retrieved February 8, 2018.
  7. 1 2 Sandra R. Leiblum (2006). Principles and Practice of Sex Therapy, Fourth Edition. Guilford Press. p. 60. ISBN   1-60623-827-2 . Retrieved October 14, 2019.
  8. 1 2 Puppo, Vincenzo; Puppo, Giulia (2015). "Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists". Clinical Anatomy. 28 (3): 293–304. doi:10.1002/ca.22471. ISSN   1098-2353. PMID   25283533. S2CID   1981499. Also, female ejaculation, premature ejaculation, persistent genital arousal disorder (PGAD), periurethral glans, vaginal-cervical genitosensory component of the vagus nerve, and G-spot amplification, are terms without scientific basis.
  9. 1 2 3 4 5 6 Anna Padoa; Talli Y. Rosenbaum (2009). The Overactive Pelvic Floor. Springer. p. 25. ISBN   978-3-319-22150-2 . Retrieved February 8, 2018.
  10. ↑ Stetka, Bret S.; De Aquino, Camila Henriques (March 3, 2015). "What Is Restless Genital Syndrome?". Medscape . Retrieved February 8, 2018.
  11. 1 2 3 4 Kevan R. Wylie (2015). ABC of Sexual Health. John Wiley & Sons. p. 39. ISBN   978-1-118-66556-5 . Retrieved February 8, 2018.
  12. ↑ Helen Carcio; R. Mimi Secor (2014). Advanced Health Assessment of Women, Third Edition: Clinical Skills and Procedures. Springer Publishing Company. p. 85. ISBN   978-0-8261-2309-1 . Retrieved February 8, 2018.
  13. 1 2 Goldstein, Irwin (1 March 2004). "Persistent Sexual Arousal Syndrome". Boston University Medical Campus Institute for Sexual Medicine. Retrieved 2007-05-04.
  14. ↑ Kruger, Tillmann H. C.; Schippert, Cordula; Meyer, Bernhard (2020-03-01). "The Pharmacotherapy of Persistent Genital Arousal Disorder". Current Sexual Health Reports. 12 (1): 34–39. doi: 10.1007/s11930-020-00240-0 . ISSN   1548-3592.
  15. 1 2 3 Klifto, Kevin M.; Dellon, A. Lee (April 2020). "Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves". Sexual Medicine Reviews. 8 (2): 265–273. doi:10.1016/j.sxmr.2019.10.001. ISSN   2050-0521. PMID   31704111. S2CID   207938858.
  16. 1 2 Leiblum, Sandra; Nathan, Sharon (2002-05-01). "Persistent sexual arousal syndrome in women: A not uncommon but little recognized complaint". Sexual and Relationship Therapy. 17 (2): 191–198. doi:10.1080/14681990220121301. ISSN   1468-1994. S2CID   144785991.
  17. 1 2 3 Facelle, Thomas M.; Sadeghi-Nejad, Hossein; Goldmeier, David (February 2013). "Persistent genital arousal disorder: characterization, etiology, and management". The Journal of Sexual Medicine. 10 (2): 439–450. doi:10.1111/j.1743-6109.2012.02990.x. ISSN   1743-6109. PMID   23157369.
  18. ↑ r. Leiblum, Sharon g. Nathan; Nathan, S. G. (2001). "Persistent Sexual Arousal Syndrome: A Newly Discovered Pattern of Female Sexuality". Journal of Sex & Marital Therapy. 27 (4): 365–380. doi:10.1080/009262301317081115. PMID   11441520. S2CID   216088649.
  19. ↑ Leiblum, Sandra (September–October 1999). "Sexual problems and dysfunction: epidemiology, classification and risk factors". Journal of Gender-Specific Medicine. 2 (5): 41–45. PMID   11252834.
  20. ↑ Markos, A. R.; Dinsmore, Wallace (November 2013). "Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia?". International Journal of STD & AIDS. 24 (11): 852–858. doi:10.1177/0956462413489276. ISSN   1758-1052. PMID   23970620. S2CID   25460597.
  21. 1 2 3 4 "PGAD, GPD". www.smsna.org.
  22. 1 2 Goldmeier, David; Leiblum, Sandra R. (April 2006). "Persistent genital arousal in women -- a new syndrome entity". International Journal of STD & AIDS. 17 (4): 215–216. doi:10.1258/095646206776253480. ISSN   0956-4624. PMID   16595040. S2CID   38012437.
  23. 1 2 Jackowich, Robyn A.; Pink, Leah; Gordon, Allan; Pukall, Caroline F. (October 2016). "Persistent Genital Arousal Disorder: A Review of Its Conceptualizations, Potential Origins, Impact, and Treatment". Sexual Medicine Reviews. 4 (4): 329–342. doi:10.1016/j.sxmr.2016.06.003. ISSN   2050-0521. PMID   27461894.
  24. 1 2 "Effective Healthcare Program". effectivehealthcare.ahrq.gov.
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