Persistent

Genital Arousal Disorder

Photo
(compulsory)
Mitchell B. Berger, MD, PhD

Department of Obstetrics and Gynecology,
University of Michigan Healh System, Ann Arbor, Michigan, USA

No disclosures or conicts of interest
A student undergoing a word associaCon test
was asked why a snowstorm put him in mind of
sex. He replied frankly: Because everything
does.
-- Honor Tracy
quickmeme.com
Persistent Genital Arousal Disorder (PGAD)

Involuntary genital arousal for extended Cme

Persistent Genital Arousal Disorder (PGAD)

Involuntary genital arousal for extended Cme

Physical arousal not relieved by orgasm
Persistent Genital Arousal Disorder (PGAD)

Involuntary genital arousal for extended Cme

Physical arousal not relieved by orgasm
Arousal not related to sexual desire
Persistent Genital Arousal Disorder (PGAD)

Involuntary genital arousal for extended Cme

Physical arousal not relieved by orgasm
Arousal not related to sexual desire
Arousal is intrusive and unwanted
Persistent Genital Arousal Disorder (PGAD)

Involuntary genital arousal for extended Cme

Physical arousal not relieved by orgasm
Arousal not related to sexual desire
Arousal is intrusive and unwanted
Arousal is at least moderately distressing
 PGAD - History

First described by Leiblum and Nathan

(2001) as Persistent Sexual Arousal
Syndrome (PSAS)
Renamed in 2006 by Goldmeier and
Leiblum
May have been described as far back as 2nd
Century AD (text from Soranus of Ephesus
in Midwifery and Diseases of Women)
 Prevalence

Dicult to assess, may be as high as 1%

Up to 1/3 may have symptoms
MulCple surveys (online or in clinics):
Wide range of ages
Majority menopausal
Majority married
Generally healthy
Some college educaCon
OPQRST
 Onset

MulCple eCological factors noted in literature

Psychological
Dietary
MedicaCons
Illnesses
 O - Psychological

ConicCng reports about history of sexual

abuse
Depression
Anxiety
Stress
SomaCzaCon
Panic acacks
Obsessive-Compulsive Disorder
 O - Dietary

Soy products
 O - MedicaCons

SSRI/SNRI
- Most common: Venlafaxine (Eexor)
- IniCaCon or withdrawal
- ParoxeCne (Paxil), Sertraline (Zolog)
and FluoxeCne (Prozac) also reported
Tricyclics
Estrogens
 O - Illnesses

Neurologic
Seizures/Epilepsy
Pudendal Neuralgia
Tarlov (sacral spinal) cysts
Restless leg syndrome
OveracCve bladder
 O - Illnesses

Vascular
Pelvic congesCon syndrome
Pelvic varices
 O - Illnesses

Miscellaneous
Pelvic masses
Clitoral priapism
Pelvic organ prolapse
Lichen sclerosus
 ProvocaCon

Triggers
EroCc images (60%)
Intercourse (50%)
MasturbaCon (35%)
Stress/Anxiety (30-45%)



 PalliaCon

Triggers
EroCc images (60%)
Intercourse (50%)
MasturbaCon (35%)
Stress/Anxiety (30-45%)
AlleviaCng Factors
MasturbaCon (51%)
Orgasm (50%)
 Quality

Tingling (78.6%)
Wetness (75.7%)
CongesCon (74.8%)
Throbbing (72.2%)
Genital ContracCons (70.9%)

Regions
Regions

Clitoris 78%
 Regions

Vagina 55%
Regions

Labia 28%
 Regions

Clitoris

Labia
Vagina

CombinaCon of all 3:
44%
Severity

Leiblum, et al., J Sex Med 4:680-689 (2007)

Severity

Leiblum, et al., J Sex Med 4:680-689 (2007)

 Timing

Symptom Occurrence
ConCnuously 8.1%
Occasionally 52.7%
Regularly 29.7%
Rarely 9.5%
OPQRST
 Comorbid Pain

Pain frequently reported

Spontaneous (28.6%)
Provoked via penetraCon (45.7%)
 Pain Syndromes

Commonly reported by women with pain

syndromes
Pelvic/genital pain (60%)
Bladder symptoms (53.3%)
Pudendal neuralgia (40%)
Fibromyalgia (20%)
Irritable bowel syndrome (20%)
Screening

Garvey, et al., Int J STD AIDS 20:519-521 (2009)

Screening

Garvey, et al., Int J STD AIDS 20:519-521 (2009)

 Assessment

Pelvic ExaminaCon
Visual inspecCon of vulva
Q-Cp tesCng
Single digit pelvic oor myofascial exam/
TacCle mapping
Prolapse exam (POP-Q)
Bimanual exam
 Assessment

Imaging
Pelvic ultrasound (with Doppler)
MRI (Pelvis, Spine, Brain)
Pudendal Nerves
 Tarlov Cysts

Komisaruk & Lee, J Sex Med 9:2047-2056 (2012)

 Assessment

Miscellaneous
EEG
Blood count
Serum hormone levels
Urinalysis and Culture
 Treatment

Counseling
Acceptance Therapy
CogniCve-Behavioral Therapy
Psychotherapy
Couples Therapy
 Treatment

MedicaCons
CessaCon of oending agents
Benzodiazepines (Clonazepam)
AnCdepressants (TCA, SSRIs)
Analgesics (Tramadol)
AnCpsychoCcs (Risperidone)
AnCdopaminergics (Varenicline)
AnCepilepCcs (GabapenCn)
 Treatment

Physical Treatments
TENS unit
ECT
Pelvic oor physical therapy
Adrenergic injecCon?
Clitoral Priapism

Arntzen & de Boer, BJOG 113:742-743 (2006)

 Trial and Error

Reassurance
Open dialogue
Team approach
Address psychological, emoConal, and
physical components
 Persistent Genital Arousal Disorder

Photo
(compulsory)
Mitchell B. Berger, MD, PhD

Department of Obstetrics and Gynecology,
University of Michigan Healh System, Ann Arbor, Michigan, USA

No conicts of interest to report