WHAT IS IT?

Persistent Genital Arousal Disorder PGAD (formerly Persistent Sexual Arousal Syndrome) is a condition characterized by significant, spontaneous, intrusive and distressing vulvar sensation. It is generally described by patients as unpleasant, unwanted intense feelings of genital arousal (swelling and tingling) that are not associated with sexual fantasy, sexual desire or sexual activity. It is persistent, lasting hours, days or weeks. It cannot be diminished with multiple orgasms. This condition is often accompanied by severe anxiety or depression, as the symptoms can be unsettling and disruptive to day to day activity.

KEY POINTS:

• As PGAD is a fairly new diagnosis, many providers are not familiar with the condition and dismiss patients as malingering. It is not unusual to confuse the condition with nymphomania. It is imperative that providers appreciate this is a potentially debilitating condition and treatment is available  
• If unwanted arousal can be dissipated with 1-3 orgasms, PGAD can be ruled out
• Causes of PGAD are, as yet, unclear. Potential contributors, not proven to be causative, include:
  • The start of Selective Serotonin Reuptake Inhibitors (SSRIs)
  • The termination of SSRIs
  • An injury or surgery: cases have been reported after a broken hip, a hysterectomy or any trauma to the pelvic region
• The course of PGAD tends to be intermittent, that is there are “flares” that come and go inexplicably
• Most PGAD patients report times of the day when their symptoms are worse than others or activities that exacerbate their condition but most of these activities, such as driving in a car, standing on their feet, cannot be avoided
• When a patient is experiencing a flare, the condition can be extremely debilitating, necessitating change of daily routine, employment, child care or school schedules
• PGAD seems to be connected to Restless Leg Syndrome
  • It has been suggested that both are caused by pudendal neuropathy and both may be alleviated with dopamine agonists. However, correlation is still unclear
• Various treatments that have been reported include
  • Psychological treatment
  • Clonazepam
  • Transcutaneous electrical nerve stimulation
  • Cognitive behavioral therapy (e.g., mindfulness meditation)
  • Use of estrogen, lubricants and vibrators
  • ECT has resulted in improvement in cases with concomitant depression
• Treatment of PGAD is aimed at alleviating the symptoms and allowing the patient to manage them with as little disruption as possible
  • There is no specific therapy for PGAD

Learn More – Primary Sources:

Persistent Genital Arousal in Women with Pelvic and Genital Pain

Persistent Genital Arousal and Restless Genitalia: Sexual Dysfunction or Subtype of Vulvodynia?

Persistent Genital Arousal Disorder: A Clinical Challenge 

An Online Cross-Sectional Comparison of Women With Symptoms of Persistent Genital Arousal, Painful Persistent Genital Arousal, and Chronic Vulvar Pain

Related ObG Topics:

Next Steps For The Patient With Persistent Genital Arousal Disorder