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Persistent Genital Arousal Disorder ( P.G.AD.)

Persistent Genital Arousal Disorder ( P.G.AD.)

Persistent Genital Arousal Disorder  ( P.G.AD.)

Introduction

If you have never heard of this condition, you are not alone.

Persistent Genital Arousal Disorder (PGAD) – a condition in which genitals are unnecessarily aroused for hours to days at a time – was only first described in 2001 with a review of 5 patients.

Since then, there is now published research on more than 500 patients and since 2013 it has been accepted and recognized in the Diagnosis and Statistics Manual of Mental Disorders (DSM – 5)

It is a condition about which our knowledge and treatment are still very much evolving – but let us see what we know so far.

Causes

Although the cause for PGAD is still being understood, the dominant theory is the main nerve for the genitals (pudendal nerve) gets trapped somewhere along its course in the pelvis.

Anxiety is considered to also be part of the cause – 30% of those with PGAD have had panic attacks and 60% have had depression in the year before symptoms begin.

Symptoms

The symptoms of PGAD are genital are spontaneous, uncontrollable and persistently aroused with engorgement and even orgasm. Unlike usual arousal, induced orgasm brings only temporary relief at best.

PGAD is defined and diagnosed by the presence of six core features to differentiate it from normal or hypersexuality:

1. Continues for hours to days (or even weeks)

2. Not relieved by orgasms

3. Unrelated to the desire of sex and sexual excitement

4. Unrelated to sexual stimulation of the genitalia

5. Unwanted

6. Distressful

Although PGAD occurs in both sexes, it is much more commonly reported in females, where it can affect any or all of the clitoris, vagina, and labia with symptoms of congestion, pain, and tingling.

PGAD

Investigations

Assessment is mainly through symptom history. However, a physical examination is important to exclude other causes.

Additionally, in certain cases, an MRI scan of the pelvis looks for evidence of nerve entrapment and physiotherapists test pelvic floor muscle control.

Treatment

Currently, treatment involves a combination of medications and psychological support to minimise discomfort from symptoms.

Many types of medications have been used. For symptoms relief, different types of painkillers ranging from nerve painkillers like gabapentin to regular painkillers like opiates to nerve stimulation machines called TENS have been used. For the psychological element, antidepressants and antipsychotic medications have been used. The choice of medication very much depends upon the individual’s symptoms.

Psychological Therapies

Recommended psychological therapies include CBT with or without mindfulness (a type of meditation practice). CBT aims at changing response and behavior to pain and other symptoms from PGAD, while Mindfulness helps to become aware of body sensations without associating them with any judgment.

Further treatments offered to depend upon the individual case- relationship counseling may be of value where changes in sex life significantly impact the relationship and pelvic floor strengthening exercises may help where weak muscle control is a contributing factor.

Source: Principles and Practice of Sex Therapy, Fifth Edition by M. Yitzchak et al.