Search

Persistent genital arousal disorder (PGAD) is characterized by persistent unwanted feelings of sexual arousal that can be debilitating. Despite first being defined >20 years ago, the precise etiology and treatment of this disorder remain elusive. Mechanical disruption of nerves, neurotransmitter changes, and cyst formation have all been considered as etiologies involved with the development of PGAD. With limited and ineffective treatment modalities, many women live with their symptoms untreated or undertreated. To broaden the literature, we present two cases of PGAD and present a novel treatment modality of the disorder with the use of a pessary. Although there was subjective success in dampening the symptoms, they were not completely resolved. These findings open the door for the potential of similar treatments in the future.

Plain English summary Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is characterized by recurrent physiological genital arousal without corresponding psychological arousal. PGAD/GPD is a poorly understood and researched disorder. It is often associated with significant psychological impairment and distress. Eating disorders are severe psychological illnesses that predominantly affect the female sex. They have a high psychological comorbidity and are often associated with severe physical consequences. We treated two female patients in whom there was a direct association between PGAD/GPD and eating disorder. In our systematic review of the literature, we found no study that further investigated the co-occurrence between PGADPGAD/GPD and eating disorders. This paper is the first to describe and investigate a relationship between PGAD/GPD and eating disorders. In previous literature, several factors have been hypothesized for the development of PGAD/GPD but also eating disorders. We argue that there are several common factors that appear to be important in the etiology, course, and treatment of both disorders (e.g. hormonal dysregulation or sensory sensitivity and avoidance), warranting future research on the possible comorbidity of these disorders.

Persistent genital arousal disorder (PGAD) is a clinical syndrome characterized by persistent unwanted feelings of sexual arousal that are not associated with any specific sexual arousal or stimulus. The severity of symptoms range from mild to severe distress that interrupts daily life for patients. We present a 44-year-old previously healthy woman who developed PGAD after involvement in a motor vehicle accident in 2018. After sustaining lower spinal trauma, 3 months later, she began to experience intermittent tingling feelings in her clitoris. She noticed that exacerbations in back pain were also associated with PGAD symptoms. These symptoms progressively worsened to which she was constantly feeling as if she was on the verge of an orgasm. Her quality of life was severely diminished for 3 months, after which she presented to gynecology. Treatment of lidocaine patches applied to the sacrum were found to completely eliminate the feelings of clitoral stimulation. She also began physical therapy for the residual back pain. One year after initiation of treatment, she has experienced significant improvement in both the back pain and PGAD symptoms. Her quality of life is much improved and plans on continuing a treatment plan of lidocaine patches and physical therapy. Recognition of PGAD in women is important for clinicians as that it can go undiagnosed for long periods of time and can interfere with quality of life for patients.

Introduction: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent, unwanted sensations of genital arousal (eg, feelings of being on the verge of orgasm, and of lubrication, swelling, tingling, throbbing) that occur in the absence of sexual desire. Although PGAD/GPD is associated with significant impairments in psychosocial functioning, the healthcare (HC) experiences of affected individuals are not well understood. Aim: The aims of this study were to examine the barriers to HC, the costs of HC, and the associations among HC experiences, symptoms, and psychosocial outcomes in those with PGAD/GPD symptoms. Methods: One hundred and thirteen individuals with PGAD/GPD symptoms completed an online, cross-sectional self-report questionnaire about their HC history and experiences. Main Outcome Measures: Self-reported HC barriers, and financial costs associated with PGAD/GPD HC. Validated measures of HC experiences (eg, comfort communicating with HC practitioners [HCPs]), and psychosocial (eg, depression, anxiety) and PGAD/GPD symptom outcomes. Results: The majority of participants (56.6%) reported waiting at least 6 months to seek HC for PGAD/GPD symptoms. Those who sought HC approached many HCPs (46.0% approached 6+ HCPs). Several barriers to HC were identified (eg, lack of HCP knowledge of PGAD/GPD), and high costs were reported. A series of multiple linear regression analyses found an association between HC experiences, psychosocial, and symptom outcomes. Specifically, decreased comfort communicating with one's HCP was associated with greater depressive and anxiety symptoms. Conclusion: High costs and numerous barriers to seeking HC for PGAD/GPD symptoms were identified, and discomfort communicating with an HCP about PGAD/GPD was associated with increased symptoms of depression and anxiety. These results highlight the need for more awareness of this condition in order to improve care for this population. Jackowich RA, Boyer SC, Bienias S, et al. Healthcare Experiences of Individuals With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia. J Sex Med 2021;9:100335.

This abstract gives the case description of a married woman in her 30s who suffered from persistent genital arousal disorder for a decade. This paper reviews the efficacy of mindfulness-based cognitive therapy (MBCT) in the management of her disorder. The client had been reported as experiencing persistent genital arousal, vaginal engorgement, accompanied by feelings of distress, irritability and psychosocial impairment. She had a history of marital discord with her husband as well and never get sexual satisfaction. Besides, she had also suffered from dysthymia for the last eight years. She was prescribed antidepressants for dysthymia and local anesthetic ointment for genital irritability. She appeared normal in her medical evaluations. She reported mild relief in her genital arousal and dysthymia in response to psychiatric medication. She was treated with MBCT for a period of six months. Six months periodical follow-up reported a moderate improvement in symptoms of dysthymia, distress, and persistent genital arousal. She had been advised to see her therapist at regular intervals for periodic evaluation and administration of MBCT. She has been instructed to practice mindfulness exercises on her home regularly to keep the effects intact.

Persistent genital arousal disorder (PGAD) is a phenomenon, in which afflicted women experience spontaneous genital arousal, unresolved by orgasms and triggered by sexual or nonsexual stimuli, eliciting stress. The current case is a 40-year-old female who experienced such orgasms for about a month. Physical examination, investigations, and psychological testing were noncontributory. Carbamazepine (600 mg) was discontinued due to a lack of response. She improved significantly with supportive therapy. Various neuropsychological conditions, pelvic pathology, medications, etc., have been associated with this disorder. Pharmacologic strategies have included the use of antidepressants, antipsychotics, mood stabilizers, and analgesics. Validation, psycho-education, identifying triggers, distraction techniques, and pelvic massage have been tried. Living with PGAD is very demanding. There is a lack of understanding of the problem, shame, and hesitation to seek help. The syndrome has been recently described, and understanding is still evolving.