Persistent genital arousal disorder

Template:Short description Template:Infobox medical condition Persistent genital arousal disorder (PGAD), originally called persistent sexual arousal syndrome (PSAS),<ref name="Balon">Template:Cite book</ref> is spontaneous, persistent, unwanted and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire,<ref name="Andriole">Template:Cite book</ref><ref name="Gordon">Template:Cite book</ref> and is typically not relieved by orgasm.<ref name="Gordon"/><ref name="Sharpless">Template:Cite book</ref> Instead, multiple orgasms over hours or days may be required for relief.<ref name="Sharpless"/>

PGAD occurs in people of both sexes.<ref name=":5"/><ref name="Sharpless"/><ref name="Wylie">Template:Cite book</ref> It has been compared to priapism in male and female genitalia.<ref name="Wylie"/><ref name="Leiblum">Template:Cite book</ref> PGAD is rare and is not well understood.<ref name="Andriole"/><ref name="Sharpless"/> The literature is inconsistent with the nomenclature. It is distinguished from hypersexuality, which is characterized as heightened sexual desire.<ref name="Balon"/><ref name="Sharpless"/>

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.<ref name="Sharpless"/> 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.<ref name="Sharpless"/>

The condition has been characterized by a researcher as being a term with no scientific basis.<ref name=":0">Template:Cite journal</ref> There is concern that the title may be misleading because, since the genital arousal is unwanted, it is dubious to characterize it as arousal.<ref name=":0" />

Other researchers have suggested that the disorder be renamed "persistent genital vasocongestion disorder (PGVD)"<ref name="Padoa"/> or "restless genital syndrome (ReGS)".<ref name="Padoa"/><ref name="Stetka">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Signs and symptoms

Physical arousal caused by PGAD can be very intense and persist for extended periods, days, weeks or years at a time.<ref name="Gordon"/><ref name="Sharpless"/> Symptoms may include pressure, pain, vibrating, pleasure, irritation, clitoral or penile<ref name=":5"/> tingling, throbbing, vaginal congestion, vaginal contractions, penile spasms, arousal, clitoral or penile erections, and prolonged spontaneous orgasms.<ref name="Gordon"/> Pressure, pleasure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris, penis, labia, vagina, perineum, or the anus.<ref name="Wylie2">Template:Cite book</ref> The symptoms may result from sexual activity or from no identified stimulus, and are not relieved by a single orgasm; instead, multiple strong orgasms over hours, days, or weeks are needed for short term relief.<ref name="Sharpless"/> The symptoms can impede home or work life.<ref name="Gordon"/><ref name="Padoa">Template:Cite book</ref> Women and men<ref name=":5"/> may feel embarrassment or shame, and avoid sexual relationships, because of the disorder.<ref name="Gordon"/><ref name="Sharpless"/> Stress can make the symptoms worse.<ref name="Padoa"/><ref name="Wylie2"/>

Cause

Researchers do not know the cause of PGAD, but assume that it has neurological, vascular, pharmacological, and psychological causes.<ref name="Balon"/><ref name="Sharpless"/> Tarlov cysts have been speculated as a cause.<ref name="Gordon"/><ref name="Wylie2"/> PGAD has been associated with clitoral priapism,<ref name="Carcio">Template:Cite book</ref> and has been compared to priapism in men.<ref name="Wylie"/><ref name="Leiblum"/> 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.<ref name="Gordon"/> It has been additionally associated with restless legs syndrome (RLS), but only in a minority of women,<ref name="Padoa"/> as well as men.

In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the clitoris.<ref name="Wylie2"/><ref name="Boston">Template:Cite news</ref> Surgical treatment was effective in this instance.<ref name="Boston"/> There is evidence that some drugs such as SSRIs and SNRIs might induce or worsen PGAD.<ref>Template:Cite journal</ref>

Diagnosis

The following five criteria must be met by patients in order to be diagnosed with PGAD:<ref name=":02">Template:Cite journal</ref><ref name=":1">Template:Cite journal</ref>

1. Typical physiological responses from sexual arousal persist for an extended amount of time and do not cease on their own
2. Feelings of arousal remain even after orgasm or multiple orgasms are needed to lessen the arousal
3. Arousal is experienced without desire or sexual excitement
4. Arousal occurs with both sexual and non-sexual stimuli or with no stimuli
5. Symptoms are intrusive, unwanted, and cause distress

Treatment

Because PGAD has only been researched since 2001, there is little documenting what may cure or remedy the disorder.<ref name="Sharpless"/> Treatment may include extensive psychotherapy, psycho-education, and pelvic floor physical therapy.<ref name="Sharpless"/><ref name="Padoa"/> In one case, serendipitous relief of symptoms was concluded from treatment with varenicline, a treatment for nicotine addiction.<ref name="Sharpless"/> It was reported in a study that repeated masturbation (51%), strong or prolonged orgasms (50%), distraction (39%), intercourse (36%), exercise (25%), and cold compresses (13%) were the most relieving treatments that could be done without the help of a professional.<ref name=":2">Template:Cite journal</ref>

Having a team of professionals such as a medical provider, a pelvic floor physical therapist, massage therapist and sex therapist has been shown to aid patients. One study found that, after working with professionals, patients felt validated, listened to, and that their sexual function had improved.<ref name=":02" /> Many patients felt practicing mindfulness allowed them to adjust to living with PGAD by recognizing thoughts and emotions corresponding to the symptoms and avoiding brooding over them.<ref name=":2" /> This treatment method focuses on reducing the anxiety that is caused by the condition and pushes the patient to develop effective distraction and relaxation techniques.<ref name=":1" />

Epidemiology

PGAD is very rare and is believed to affect about 1% of women;<ref name=":02" /> it is considered even rarer in men.<ref name=":5">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Although online surveys have indicated that hundreds of women and men<ref name=":5" /> may have PGAD,<ref name="Sharpless"/> documented case studies have been limited.<ref>Template:Cite journal</ref><ref name="SL">Template:Cite journal</ref><ref>Template:Cite journal</ref>

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.<ref name="Sharpless"/> While PGAD involves the absence of sexual desire, hypersexuality is characterized as heightened sexual desire.<ref name="Balon"/><ref name="Sharpless"/>

The term persistent sexual arousal syndrome was coined by researchers Leiblum and Nathan in 2001.<ref name="Balon"/><ref name="Gordon"/> 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.<ref name="Balon"/> The rename was also considered to give the condition a better chance of being classified as a dysfunction.<ref name="Balon"/> Now PGAD is often called or termed Genito-Pelvic Dysesthesia.<ref name=":6">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Impact on mental health

Women and men<ref name=":6" /> with PGAD report having unstable mental health with thoughts of suicide and difficulty completing daily activities.<ref name=":3">Template:Cite journal</ref><ref name=":4">Template:Cite journal</ref> Most people that suffer from PGAD report having to masturbate 6, 20 or even more times a day and may have to use many types of sexual devices to experience any type of relief from symptoms.<ref name=":7">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Many people are afraid to leave their homes due to fears that PGAD symptoms may flare up while in public and they will not be able to wait until they are able to relieve themselves.<ref name=":7" /> This disorder can become so debilitating and devastating that at least one female patient is known to have commited suicide in 2012.<ref>Template:Cite news</ref>

Before the start of their PGAD, many women were seen to have higher stress scores as well as symptoms of depression and anxiety.<ref name=":4" /> Panic attacks (31.6%) and major depression (57.9%) were reported commonalities between patients occurring at least one year prior to the onset of PGAD symptoms. Up to 45% of women and men with the disorder have reported having a history with antidepressants.<ref name=":2" /><ref name=":6" />

A small study found that several women and men began to see symptoms of PGAD after discontinuing the use of their selective serotonin reuptake inhibitors.<ref name=":6" /> It is not known whether reintroduction of the SSRIs would improve PGAD symptoms.<ref name=":3" />

See also

• Delayed ejaculation
• Female sexual arousal disorder
• List of causes of genital pain
• Postorgasmic illness syndrome
• Sexual dysfunction
• Vaginismus

External links

• PSAS, information about PSAS in Dutch and English
• A Hundred Orgasms A Day, Channel 5 (UK) 2004 documentary film about PSAS
• Car crash leaves woman constantly aroused, Ninemsn, 16 December 2009