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Persistent Genital Arousal Disorder – Symptoms, Treatment

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

Persistent genital arousal disorder (PGAD) is characterized by sensations of physiological genital arousal that occur in the absence of psychological sexual desire. The primary symptom characteristic of PGAD is the presence of persistent, intrusive, and unwanted sensations of genital arousal. The genital arousal is typically localized to the labia minora and/or major, the clitoris, and the region above the pubic bone. The presence of distress is a necessary criterion for the diagnosis of PGAD, and it is often what leads individuals to seek treatment. Individuals with PGAD often experience a high degree of associated psychosocial impairment.

Persistent genital arousal disorder (PGAD) is a phenomenon relating mainly to women’s sexual health, in which afflicted women complain of sudden and frequent genital arousal that is qualitatively different from the kind of sexual arousal that is associated with desire, or subjective arousal. Masturbation and orgasms offer little or no relief. It is important not to confuse persistent sexual arousal syndrome (PSAS) with hypersexuality. Hypersexuality manifests as excessive desire with or without persistent genital arousal. The key difference between the two is that PSAS manifests as persistent genital arousal in the absence of desire.[rx] It is a very rare condition, and it is possible that the sufferers do not report the condition because of shame and embarrassment.[rx]

Persistent genital arousal disorder (PGAD), also known as persistent sexual arousal syndrome (PSAS) or restless genital syndrome (ReGS), is recently recognized as a sexual health problem in western countries although it is not been considered as a physical or psychiatric disorder by DSM IV or ICD 10. PGAD is associated with constant, spontaneous, and intrusive feelings of genital arousal in the absence of conscious sexual thoughts or stimuli.

Causes of Persistent Genital Arousal Disorder

Central neurological changes (e.g., postinjury, specific brain lesion/anomaly) peripheral neurological changes (e.g., pelvic nerve hypersensitivity or entrapment) vascular changes (e.g., pelvic congestion), mechanical pressure against genital structures, medication-induced changes, psychological changes (stress), initiation or cessation of treatment with antidepressant medication and other mood stabilizers, the onset of menopause, physical inactivity, association with an overactive bladder have been implicated as being causal.[rx,rx,rx] One theory suggests that these women may be more vigilant in monitoring small changes in their physical well-being.[rx]

Researchers do not know the cause of PGAD but assume that it has neurological, vascular, pharmacological, and psychological causes.^[rx]^[rx] Tarlov cysts have been speculated as a cause.^[rx]^[rx] PGAD has been associated with clitoral priapism,^[rx] and has been compared to priapism in men.^[rx]^[rx] 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.^[rx] It has been additionally associated with restless legs syndrome (RLS), but a minority of women with PGAD have restless legs syndrome.^[rx]

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In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the clitoris.^[rx]^[rx] Surgical treatment was effective in this instance.^[rx]

Symptoms of Persistent Genital Arousal Disorder

In 2001 Leiblum and Nathan described what they termed persistent sexual arousal syndrome in five women [rx]. Since that time, the syndrome has been renamed persistent genital arousal disorder [rx] to emphasize that the prominent feature of this disorder is physiologic arousal that is unrelated to and different from normal sexual desire and subjective arousal. This is distinctly different from disorders of hypersexuality which present as excessive sexual desire and compulsive sexual behavior, sometimes referred to as Don Juanism or nymphomania [rx]. For a diagnosis of PGAD to be made Goldmeier et al. suggested that the following will be present [rx]:

Symptoms characteristics of sexual arousal (genital fullness/swelling and sensitivity with or without nipple fullness/swelling) that persist for an extended period of time (hours or days) and do not subside completely on their own;
Symptoms of physiological arousal that do not resolve with ordinary orgasmic experience and may require multiple orgasms over hours or days to remit;
Symptoms of arousal that are usually experienced as unrelated to any subjective sense of sexual excitement or desire;
The persistent genital arousal that may be triggered not only by sexual activity but seemingly also by nonsexual stimuli or by no apparent stimulus at all;
Symptoms that are experienced as unbidden, intrusive, and unwanted;
The symptoms that cause the woman at least a moderate degree of distress.

The primary symptom of PGAD is a series of ongoing and uncomfortable sensations in and around the genital tissues, including the clitoris, labia, vagina, perineum, and anus.

The sensations experienced are known as dysesthesias.

They can include:

wetness
itching
pressure
burning
pounding
pins and needles

These can lead the person with PGAD to feel consistent like they are about to experience orgasm, or they may experience waves of spontaneous orgasms.

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However, these symptoms happen in the absence of sexual desire. Climaxing may temporarily alleviate symptoms, but they may return suddenly within a few hours. Episodes of intense arousal may occur several times a day for weeks, months, or even years. The condition can lead to psychological symptoms due to the persistent discomfort and impact on day-to-day living.

These may include:

anxiety
panic attacks
depression
distress
frustration
guilt
insomnia

People with chronic, or incurable, persistent genital arousal disorder may eventually lose their notion of sexual pleasure because the orgasm becomes associated with relief from pain rather than an enjoyable experience.

Priapism, PSAS, and PGAD: What is the difference?

Some doctors class priapism in men as a type of persistent genital arousal disorder. Priapism is a persistent and unrelenting penile erection without sexual desire.

PGAD is not associated with hypersexuality or an elevated need for sexual gratification, otherwise known as satyriasis in males or nymphomania in females.

The condition was formerly known as Persistent Sexual Arousal Syndrome (PSAS), but the name was changed to PGAD as PSAS suggests active sexual desire.

Diagnosis of Persistent Genital Arousal Disorder

It was not possible until recent years to formally diagnose PGAD.

Medical literature has only recently classed PGAD as a distinct syndrome. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) did not recognize PGAD as a diagnosable medical condition.

However, it was added to DSM-V, so that PGAD may now be formally diagnosed.

Prof. Sandra R. Leiblum, a Professor of Clinical Psychiatry at The University of Medicine and Dentistry’s Robert Wood Johnson Medical School, first documented the disease in 2001. She listed 5 criteria for an accurate diagnosis of PGAD.

The 5 criteria are:

involuntary genital and clitoral arousal that continues for an extended period of hours, days, or months
no cause for the persistent genital arousal can be identified
the genital arousal is not associated with feelings of sexual desire
the persistent sensations of genital arousal feel intrusive and unwanted
after one or more orgasms, the physical genital arousal does not go away

They are considered to be the only valid criteria established to date for a PGAD diagnosis.

Treatment of Persistent Genital Arousal Disorder

Current medications include the following: (1) escitalopram, 20 mg/d, which has improved her overall anxiety but not improved her arousal and urgency symptoms; pregabalin (started 2 months ago)—she is currently taking 300 mg/d, titrating up toward 600 mg/d—which has provided mild improvement in symptoms. She discontinued gabapentin because it provided no improvement in her symptoms.

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In some cases, masturbation to orgasm may reduce some of the symptoms of arousal. But this method doesn’t always provide long-term relief. It may only provide temporary relief before symptoms return. In some cases, frequent masturbation to relieve PGAD may make symptoms worse or last longer.

Some other common treatments for PGAD include:

numbing gels
electroconvulsive therapy, which is used if a mental disorder such as bipolar I or severe anxiety is linked to the condition
transcutaneous electrical nerve stimulation (TENS), which uses electrical currents to help relieve nerve pain

A case study trusted Source about a woman diagnosed with depression showed that treatment with medications reduced symptoms of PGAD and helped her manage the condition. Some possible medications used to treat PGAD include:

clomipramine, an antidepressant often used to treat obsessive-compulsive disorder (OCD)
fluoxetine, a selective serotonin reuptake inhibitor (SSRI) usually prescribed to treat the major depressive disorder, panic disorder, and bulimia
lignocaine (also called lidocaine) gel, which numbs the areas on your body it’s applied to

Therapy options

Some psychological methods, such as therapy or counseling, may help relieve symptoms. This may help if a condition like anxiety or depression is causing your symptoms or making them worse. These methods may be especially helpful if are experiencing feelings of guilt or shame about issues in your relationships or personal life.

Cognitive-behavioral therapy (CBT) can also help. CBT will help you to learn to articulate and control your negative emotions and reactions. It can often help you address situations that may exacerbate the symptoms of PGAD.

Talking to a therapist might help you discover emotional triggers that could be causing PGAD. Meditation can also help reduce symptoms by reducing your anxiety and relaxing your muscles.

References