Persistent genital arousal disorder

Persistent genital arousal disorder (PGAD), previously called persistent sexual arousal syndrome,<ref name="Balon">,

 Clinical Manual of Sexual Disorders. online version, 
  
 American Psychiatric Pub, 
 2009, 
  
  
 ISBN 978-1585629053,</ref> is spontaneous, persistent, unwanted and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire,<ref name="Andriole">, 
  
 Year Book of Urology 2013, E-Book. online version, 
  
 Elsevier Health Sciences, 
 2013, 
  
  
 ISBN 978-1455773169,</ref><ref name="Gordon">, 
  
 Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly: An Integrated Approach. online version, 
  
 Springer, 
 2017, 
  
  
 ISBN 978-1493965540,</ref> and is typically not relieved by orgasm.<ref name="Gordon"/><ref name="Sharpless">{{{last}}}, 
 Brian A. Sharpless, 
  
 Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research. online version, 
  
 Oxford University Press, 
 2016, 
  
  
 ISBN 978-0190245863, 
  
  
  
 Pages: 110–120,</ref> Instead, multiple orgasms over hours or days may be required for relief.<ref name="Sharpless"/>

PGAD occurs in women.<ref name="Sharpless"/><ref name="Wylie">{{{last}}},

 Kevan R. Wylie, 
  
 ABC of Sexual Health. online version, 
  
 John Wiley & Sons, 
 2015, 
  
  
 ISBN 978-1118665565,</ref> It has been compared to priapism in men.<ref name="Wylie"/><ref name="Leiblum">{{{last}}}, 
 Sandra R. Leiblum, 
  
 Principles and Practice of Sex Therapy, Fourth Edition. online version, 
  
 Guilford Press, 
 2006, 
  
  
 ISBN 1606238272,</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">Komisaruk, Barry R.,

 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.), 
 
 Vol. 28(Issue: 3),
 pp. 290,
 DOI: 10.1002/ca.22488,
 PMID: 25511419,</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">

What Is Restless Genital Syndrome?(link). {{{website}}}.

March 3, 2015.

</ref>

Signs and symptoms

Physical arousal caused by PGAD can be very intense and persist for extended periods, days or weeks at a time.<ref name="Gordon"/><ref name="Sharpless"/> Symptoms include pressure, pain, irritation, clitoral tingling, throbbing, vaginal congestion, vaginal contractions, and sometimes spontaneous orgasms.<ref name="Gordon"/> Pressure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris, labia, vagina, perineum, or the anus.<ref name="Wylie2">{{{last}}},

 Kevan R. Wylie, 
  
 ABC of Sexual Health. online version, 
  
 John Wiley & Sons, 
 2015, 
  
  
 ISBN 978-1118665565,</ref> 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.<ref name="Sharpless"/>  The symptoms can impede on home or work life.<ref name="Gordon"/><ref name="Padoa">, 
  
 The Overactive Pelvic Floor. online version, 
  
 Springer, 
 2009, 
  
  
 ISBN 978-3319221502,</ref>  Women 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">,

 Advanced Health Assessment of Women, Third Edition: Clinical Skills and Procedures. online version, 
  
 Springer Publishing Company, 
 2014, 
  
  
 ISBN 978-0826123091,</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 a minority of women with PGAD have restless legs syndrome.<ref name="Padoa"/>

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"> Goldstein, Irwin,

 Persistent Sexual Arousal Syndrome Full text, 
 , 
 Boston University Medical Campus Institute for Sexual Medicine, 
 1 March 2004,

</ref> Surgical treatment was effective in this instance.<ref name="Boston"/>

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"/>

Epidemiology

PGAD is very rare. Although online surveys have indicated that hundreds of women may have PGAD,<ref name="Sharpless"/> documented case studies have been limited to about 22.<ref>,

 Persistent Sexual Arousal Syndrome: A Newly Discovered Pattern of Female Sexuality, 
 Journal of Sex & Marital Therapy, 
 2001,
 Vol. 27(Issue: 4),
 pp. 365–380,
 DOI: 10.1080/009262301317081115,
 PMID: 11441520,</ref><ref name="SL">Leiblum, Sandra, 
 Sexual problems and dysfunction: epidemiology, classification and risk factors, 
 Journal of Gender-Specific Medicine, 
 
 Vol. 2(Issue: 5),
 pp. 41–45,</ref><ref>Markos, A. R., 
 Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia?, 
 International Journal of STD & AIDS, 
 
 Vol. 24(Issue: 11),
 pp. 852–858,
 DOI: 10.1177/0956462413489276,
 PMID: 23970620,</ref> No population data on the disorder exists.<ref name="Sharpless"/>

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"/>

See also

• 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