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Purpose of Review Persistent genital arousal disorder (also referred to as genitopelvic dysesthesia or PGAD/GD) is a distressing and largely underrecognized condition characterized by persistent, unwanted genital arousal (sensations, sensitivity, vasocongestion) in the absence of subjective/cognitive arousal and sexual desire. The purpose of this review is to summarize recent findings on biological and psychosocial factors in PGAD/GD as they pertain to the assessment and treatment of this condition. These findings will be considered within a biopsychosocial framework, for the purposes of considering next steps for clinical and research efforts. Recent Findings A small number of studies have recently examined potential biological aetiologies for PGAD/GD: pharmacological agents, spinal pathology and peripheral nerve involvement. Recent studies have also found that PGAD/GD is associated with a significant negative impact on psychosocial wellbeing and daily functioning as compared to symptom-free individuals. In addition, these results highlight cognitive/affective responses to symptoms (e.g. catastrophizing of symptoms) that may influence outcomes. However, biological and psychological research are rarely integrated in these studies, despite the interrelationship between these factors. Summary Although PGAD/GD was first described in the scientific literature almost two decades ago, most research on PGAD/GD is presented in the form of case studies. Prospective treatment trials that integrate biopsychosocial factors are needed in order to provide effective and efficient care to this population. This research would be facilitated by the development of a patient-reported outcome measure, as well as greater education/awareness among healthcare providers and the public about this distressing condition.

Purpose of Review Persistent genital arousal disorder (PGAD) is a rare, yet debilitating, disease, which was first described at the beginning of this century and has not yet been considered by the ICD-10 or DSM-5. Since affected subjects usually suffer tremendously, this review aims at offering an overview of pharmacological approaches to treat this disorder. Recent Findings Until now, no randomised placebo-controlled clinical trials have been conducted on PGAD, and the international registries have not recorded any ongoing trials. Current knowledge on pharmacological options for the treatment of PGAD relies mainly on case reports/case series. Most importantly, there is evidence that some drugs such as SSRIs and SNRIs might induce or worsen PGAD. Summary Knowledge on pharmacological treatment options for PGAD is not yet evidence-based, while some reports even assume an induction of PGAD by serotonergic antidepressants. Nevertheless, practitioners should be aware of PGAD and carefully discuss with the patient an individual treatment trial by considering the experience up to now.

Persistent genital arousal disorder (PGAD), characterized in 2001, persists as a distressing malady that is not well appreciated, understood, or treated by healthcare providers. This review describes the characteristics of PGAD, hypotheses regarding its etiology, therapies, and recent findings that provide evidence of PGAD as a genital sensory neuropathy. PGAD can result from (a) Tarlov cysts, which contain aberrant sensory nerve fibers and form on the genital sensory nerves where they abrade on the entrance to the sacrum, and/or (b) herniated intervertebral disc-produced irritation of the roots of those genital sensory nerves as they course through the cauda equina within the spinal canal. Local genital anesthesia or peripheral nerve block often fails to alleviate PGAD symptoms. In that case, the possibility that genital sensory nerve root irritation (i.e., radiculopathy) “upstream” at the entrance to, or within, the spinal canal should be suspected and assessed, optimally by lumbo-sacral-oriented MRI. Imaging can reveal the presence of Tarlov cysts and/or herniated intervertebral disc impingement on the cauda equina, which could provoke PGAD symptoms in women and men and may be treatable. Chronic irritative radiculopathy could eventually affect nerve conduction deleteriously and thereby attenuate genital afferent and/or efferent activity, leading to genital paresthesias, anorgasmia, or anejaculation.