Persistent genital arousal disorder

Persistent genital arousal disorder is a condition of sexual dysfunction whereby the genitals suffer unprovoked arousal, quite outside of the person’s wishes.

The cause of persistent genital arousal is unknown, however pelvic muscle tightness impacting nerves is the primary suspect at this point.

Symptoms of persistent genital arousal disorder

  • Spontaneous genital arousal (tingling or throbbing)
  • Not experienced during any sexual desire or subjective sexual arousal (i.e. nothing is sexually exciting at all)
  • May persist for hours or days
  • Causes distress and embarrassment
  • Can cause pain

Treatment of persistent genital arousal disorder

  • Stimulation to orgasm can provide relief at least at first, but this ‘treatment’ ceases to be effective over time. Masturbating to orgasm can be really distressing to partake in considering the circumstances.
  • Biofeedback has been suggested as a treatment option, targeting the pelvic muscles/nerves.
  • Mindfulness, combined with biofeedback therapy, can help.
  • High-dose SSRI antidepressants may help.
  • Reassurance that this condition actually exists and is likely to spontaneously disappear can be very soothing, and in fact, in some cases has relieved the patient of the condition spontaneously.
  • Pelvic physiotherapy
  • Osteopathy/chiropractic
  • Musculoskeletal treatments
  • Sex therapy (adjunct)

Theoretical causes of PGAD

Reported, suspected causes of PGAD include vascular, neurological, pharmacological and psychological. Understanding the neurophysiology of this condition starts with an understanding of the biomechanics of the pudendal nerve and female sexual response.

If a nerve is trapped, it can result in the nerve constantly firing, with the consequence being continuous arousal.

Diagnosing and treating PGAD

Pelvic 3-tesla magnetic resonance imaging (MRI) is recommended for those with suspected nerve entrapment. If a Tarlov cyst or herniated disc are suspected, lumbosacral 3-tesla MRI is recommended.

When the peripheral nerve is the source of the problem, surgical intervention may be recommended.

The care team for people with PGAD should include a doctor, pelvic floor physiotherapist and a sex therapist. There are no existing FDA approved treatments for PGAD.

References

Klifto KM, Dellon AL. Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves. Sex Med Rev. 2019 Nov 5. pii: S2050-0521(19)30100-3. doi: 10.1016/j.sxmr.2019.10.001.




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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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