Persistent Genital Arousal Disorder

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.

PGAD occurs in women. It has been compared to priapism in men. PGAD is rare and is not well understood. The literature is inconsistent with the nomenclature. It is distinguished from hypersexuality, which is characterized as heightened sexual desire.

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. 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.

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

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

Signs and symptoms

Physical arousal caused by PGAD can be very intense and persist for extended periods, days or weeks at a time. Symptoms include pressure, pain, irritation, clitoral tingling, throbbing, vaginal congestion, vaginal contractions, and sometimes spontaneous orgasms. Pressure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris, labia, vagina, perineum, or the anus. The symptoms may result from sexual activity or from no identified stimulus, and are not relieved by orgasm except for cases where multiple orgasms over hours or days allow for relief. The symptoms can impede on home or work life. Women may feel embarrassment or shame, and avoid sexual relationships, because of the disorder. Stress can make the symptoms worse.

Cause

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

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

Diagnosis

Treatment

Because PGAD has only been researched since 2001, there is little documenting what may cure or remedy the disorder. Treatment may include extensive psychotherapy, psycho-education, and pelvic floor physical therapy. In one case, serendipitous relief of symptoms was concluded from treatment with varenicline, a treatment for nicotine addiction.

Epidemiology

PGAD is very rare. Although online surveys have indicated that hundreds of women may have PGAD, documented case studies have been limited to about 22. No population data on the disorder exists.

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. While PGAD involves the absence of sexual desire, hypersexuality is characterized as heightened sexual desire.

The term persistent sexual arousal syndrome was coined by researchers Leiblum and Nathan in 2001. 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. The rename was also considered to give the condition a better chance of being classified as a dysfunction.

See also

• Vaginismus