DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201369

Persistent genital arousal disorder it’s etiology, treatment guideline and management strategy

Preksha T. Singh, Shreyans D. Singhvi

Abstract


Persistent genital arousal disorder is a recently recognized disorder. Its first case was reported in 2001, since then many cases have been diagnosed and treated with various methods, yet no FDA approved treatment guidelines have been proposed. Although it is a cause of not only sexual, but also psychological impairment to the patients of the disorder, Persistent genital arousal disorder is not well recognized currently due to the social stigma attached to it  This study is important for the physicians treating a case of PGAD, as it has all the published data about the disorder.

The review of literature was done by using all the research articles and case reports of PGAD using keywords like ‘persistent’, ‘genital’, ‘arousal’, ‘disorder’ on platforms like google scholar and pubmed. Various research articles and case reports were reviewed and grouped into different levels of intervention; at the female genital system, at the spinal cord and the brain. This study has evaluated all the possible etiologies and suggested the possible treatments and management strategies for the disorder. This study has thrown striking limelight on all the potential causes leading to PGAD, its potential line of treatment, and the management strategy. This study is based on the case reports found till date, but there is still a paucity in data, the number of reported cases is less due to a possible social stigma associated with the disease. The present investigation demands extensive research in the topic as this is a cause of social concern leading to psychological, emotional and nervous breakdown.


Keywords


Arousal, Disorder, Genital, Persistent

Full Text:

PDF

References


Nazik H, Api M, Aytan H, Narin R. A new medical treatment with botulinum toxin in persistent genital arousal disorder: successful treatment of two cases. J sex Marit Ther. 2014;40(3):170-4.

Leiblum R, Sharon G, Nathan S. Persistent sexual arousal syndrome: A newly discovered pattern of female sexuality. J Sex Marit Ther. 2001;27(4):365-80.

Leiblum S, Seehuus M, Goldmeier D, Brown C. Psychological, medical, and pharmacological correlates of persistent genital arousal disorder. J Sexual Med. 2007;4(5):1358-66.

Nazik H, Api M, Aytan H, Narin R. A new medical treatment with botulinum toxin in persistent genital arousal disorder: successful treatment of two cases. J Sex Marit Ther. 2014;40(3):170-4.

Gaines N, Odom BD, Killinger KA, Peters KM. Pudendal neuromodulation as a treatment for persistent genital arousal disorder-A case series. Fem Pelvic Med Reconstr Surg. 2018;24(4):e1-5.

Klifto K, Dellon AL. Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve. Microsurgery 2019:1-7.

Thorne C, Stuckey B. Case Report: Pelvic Congestion Syndrome Presenting as Persistent Genital Arousal: A Case Report. J Sexual Med. 2008;5(2):504-8.

Bedell S, Goldstein AT, Burrows L. A periclitoral mass as a cause of persistent genital arousal disorder. J Sexual Med. 2014;11(1):136-9.

Goldstein I, Goldstein S, Hartzell-Cushanick R. 071 Biopsychosocial Assessment of Persistent Genital Arousal Disorder (PGAD) in Young Girls. J Sexual Med. 2019;16(6):S26.

Aerts L. "P-03-068 Successful management of PGAD and clitorodynia caused by a closed compartment syndrome. J Sexual Med. 2016;13(5):S205-6.

Krapf JM, Goldstein AT. Two case presentations of profound labial edema as a presenting symptom of hypermobility-type Ehlers–Danlos syndrome. J Sex Med. 2013;10:2347-50.

Rosenbaum, Yehuda T. Physical therapy treatment of persistent genital arousal disorder during pregnancy: A case report. J Sexual Med. 2010;7(3):1306-10.

Feigenbaum F, Boone K. Persistent genital arousal disorder caused by spinal meningeal cysts in the sacrum: successful neurosurgical treatment. Obs Gynecol. 2015 Oct 1;126(4):839-43.

Komisaruk, Barry R., and Huey‐Jen Lee. "Prevalence of sacral spinal (Tarlov) cysts in persistent genital arousal disorder. J Sexual Med. 2012;9(8):2047-56.

Kim C, Blevins J, Goldstein S, Komisaruk B, Goldstein I. 004 Neurogenic Persistent Genital Arousal Disorder (PGAD) Secondary to Radiculopathy of Sacral Spinal Nerve Roots (SSNR): Treatment Outcomes Following Minimally Invasive Spine Surgery (MISS). J Sex Med. 2020 Jan 1;17(1):S2.

Elkins GR, Ramsey D, Yu Y. Hypnotherapy for persistent genital arousal disorder: a case study. Int J Clin Experimental Hypnosis. 2014 Apr 3;62(2):215-23.

Hiller J, Hekster B. Couple therapy with cognitive behavioural techniques for persistent sexual arousal syndrome. Sex Relat Ther. 2007 Feb 1;22(1):91-6.

Leiblum SR, Goldmeier D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. J Sex Marit Ther. 2008 ;34(2):150-9.

de Magalhães, Frederico José Coelho MMed; Kumar, Manoj Therayil :Persistent Genital Arousal Disorder Following Selective Serotonin Reuptake Inhibitor Cessation. J Clin Psychopharmacol: 2015;35(3):352-4.

Philippsohn S, Kruger TH. Persistent genital arousal disorder: successful treatment with duloxetine and pregabalin in two cases. J Sexual Med. 2012;9(1):213-7.

Korda JB, Pfaus JG, Goldstein I. Persistent Genital Arousal Disorder (PGAD): A case report in a woman with lifelong PGAD where serendipitous administration of varenicline tartrate resulted in symptomatic improvement. J Sex Med. 2009;6:1479-86.

Camila CA, Mestre T, Anthony E. Lang. "Restless genital syndrome in Parkinson disease. JAMA Neurol. 2014;71(12):1559-61.

Battaglia C, Venturoli S. Persistent genital arousal disorder and trazodone. Morphometric and vascular modifications of the clitoris. A case report. J Sex Med. 2009;6(10):2896-9000.

Deka K, Dua N, Kakoty M, Ahmed R. Persistent genital arousal disorder: Successful treatment with leuprolide (antiandrogen). Ind J Psychiat. 2015; 57(3):326-8.

Yildirim EA, Hacioglu Yildirim M, Carpar E, Sarac I. Clomipramine trial for treatment-resistant persistent genital arousal disorder: a case series. J Psych Obs Gynecol. 2017 Oct 2;38(4):260-7.

King SA, Goldstein I, Pfaus J. 020 Mechanism of Action and Preliminary Clinical Experience with Zolpidem, a Non-Benzodiazepine Indirect GABA A Receptor Agonist, for Symptomatic Treatment of Persistent Genital Arousal Disorder (PGAD). J Sex Med. 2016 Jun 1;13(6):S247-8.

Wylie K, Levin R, Hallam‐Jones R, Goddard A. Sleep exacerbation of persistent sexual arousal syndrome in a postmenopausal woman. J Sex Med. 2006 Mar;3(2):296-302.

Mahoney S, Zarate Jr C. Persistent sexual arousal syndrome: A case report and review of the literature. J Sex Marit Ther. 2007 Jan 1;33(1):65-71.

Korda JB, Pfaus JG, Kellner CH, Goldstein I. Persistent genital arousal disorder (PGAD): case report of long-term symptomatic management with electroconvulsive therapy. J Sex Med. 2009 Oct 1;6(10):2901-9.

Anzellotti F, Franciotti R, Bonanni L, Tamburro G, Perrucci MG, Thomas A, et al. Persistent genital arousal disorder associated with functional hyperconnectivity of an epileptic focus. Neuroscience. 2010;167(1):88-96.

McMullen R, Agarwal S. Persistent genital arousal disorder Case report of symptomatic relief of symptoms with transcranial magnetic stimulation. J ECT. 2016 1;32(3):e9-10.

Amsterdam A, Abu‐Rustum N, Carter J, Krychman M. Persistent sexual arousal syndrome associated with increased soy intake. J Sex Med. 2005 ;2(3):338-40.

Waldinger, Marcel D., and Dave H. Schweitzer. Persistent genital arousal disorder in 18 Dutch women: Part II. A syndrome clustered with restless legs and overactive bladder. J Sex Med. 2009;6(2): 482-97.

Waldinger MD, De Lint GJ, Venema PL, Van Gils AP, Schweitzer DH. WOMEN'S SEXUAL HEALTH: Successful Transcutaneous Electrical Nerve Stimulation in Two Women with Restless Genital Syndrome: The Role of Aδ-and C-Nerve Fibers. J Sex Med. 2010 Mar 1;7(3):1190-9.

Waldinger, Marcel D. Successful Transcutaneous Electrical Nerve Stimulation in Two Women with Restless Genital Syndrome: The Role of Ad-and C-Nerve Fibers. 2009;1-11.