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 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.
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.
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.
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 is sometimes considered to be the same as 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.
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.
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.
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.
- Richard Balon, Robert Taylor Segraves (2009). Clinical Manual of Sexual Disorders. American Psychiatric Pub. p. 193. ISBN 1585629057. Retrieved February 8, 2018.
- Gerald L. Andriole (2013). Year Book of Urology 2013, E-Book. Elsevier Health Sciences. p. 160. ISBN 1455773166. Retrieved February 8, 2018.
- David A. Gordon, Mark R. Katlic (2017). Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly: An Integrated Approach. Springer. p. 259. ISBN 1493965549. Retrieved February 8, 2018.
- Brian A. Sharpless (2016). Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research. Oxford University Press. pp. 110–120. ISBN 0190245867. Retrieved February 8, 2018.
- Komisaruk, Barry R. (April 2015). "Re: Puppo V, Puppo G. 2014. anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists". Clinical Anatomy (New York, N.Y.). 28 (3): 290. doi:10.1002/ca.22488. ISSN 1098-2353. PMID 25511419.
- Anna Padoa, Talli Y. Rosenbaum (2009). The Overactive Pelvic Floor. Springer. p. 25. ISBN 3319221507. Retrieved February 8, 2018.
- Stetka, Bret S.; De Aquino, Camila Henriques (March 3, 2015). "What Is Restless Genital Syndrome?". Medscape. Retrieved February 8, 2018.
- Kevan R. Wylie (2015). ABC of Sexual Health. John Wiley & Sons. p. 39. ISBN 1118665562. Retrieved February 8, 2018.
- Helen Carcio, MS, MEd, ANP-BC, R. Mimi Secor, MS, MEd, FNP-BC, NCMP, FAANP (2014). Advanced Health Assessment of Women, Third Edition: Clinical Skills and Procedures. Springer Publishing Company. p. 85. ISBN 0826123090. Retrieved February 8, 2018.
- Kevan R. Wylie (2015). ABC of Sexual Health. John Wiley & Sons. p. 52. ISBN 1118665562. Retrieved February 8, 2018.
- Goldstein, Irwin (1 March 2004). "Persistent Sexual Arousal Syndrome". Boston University Medical Campus Institute for Sexual Medicine. Retrieved 2007-05-04.
- Leiblum, Sandra (September–October 1999). "Sexual problems and dysfunction: epidemiology, classification and risk factors". Journal of Gender-Specific Medicine. 2 (5): 41–45.
- Markos, A. R.; Dinsmore, Wallace (November 2013). "Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia?". International journal of STD & AIDS. 24 (11): 852–858. doi:10.1177/0956462413489276. ISSN 1758-1052. PMID 23970620.