Persistent Genital Arousal Disorder

Persistent Genital Arousal Disorder

Recently I saw a patient with an interesting and peculiar complaint: she felt constant clitoral arousal that lead to pressure that she could not relieve. It was leading to anxiety and disrupting her life and activities. Even after achieving orgasm from masturbation, she would still sense the clitoris to be stimulated.

It was fortuitous that I read about this condition about 3 months before I saw the patient in the office. It is a little known condition that was first described in 2001. It is a problem of genital arousal, not sexual arousal. Patients will experience tingling, pressure, irritation, congestion, throbbing, pain or vaginal contractions. Only sometimes can sexual intercourse or masturbating alleviate the sensation. In a recent Dutch study, there appears to be a correlation between PGAD, overactive bladder and anxiety.

In my patient?s case, as is described for PGAD, the patient felt genital/clitoral arousal the entire day; it was unwanted and intrusive to her life; it was triggered by non-sexual activity (she had a UTI that preceded it); it lead to distress; it was not associated with a psychological condition.

PGAD: Persistent Genital Arousal Disorder

Recently I saw a patient with an interesting and peculiar complaint: she felt constant clitoral arousal that lead to pressure that she could not relieve. It was leading to anxiety and disrupting her life and activities. Even after achieving orgasm from masturbation, she would still sense the clitoris to be stimulated.

It was fortuitous that I read about this condition about 3 months before I saw the patient in the office. It is a little known condition that was first described in 2001. It is a problem of genital arousal, not sexual arousal. Patients will experience tingling, pressure, irritation, congestion, throbbing, pain or vaginal contractions. Only sometimes can sexual intercourse or masturbating alleviate the sensation. In a recent Dutch study, there appears to be a correlation between PGAD, overactive bladder and anxiety.

Persistent genital arousal disorder
From Wikipedia, the free encyclopedia

Persistent genital arousal disorder (also known as persistent sexual arousal syndrome or PSAS) results in a spontaneous and persistent genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. It was first documented by Dr. Sandra Leiblum in 2001,[1] only recently characterized as a distinct syndrome in medical literature.[2] Some physicians use the term Persistent Sexual Arousal Syndrome to refer to the condition in women; others consider the syndrome of priapism in men to be the same disorder.[2][3] In particular, it is not related to hypersexuality, sometimes known as nymphomania or satyriasis. In addition to being very rare, the condition is also frequently unreported by sufferers who may consider it shameful or embarrassing.[4]

Physical arousal caused by this syndrome can be very intense and persist for extended periods, days or weeks at a time. Orgasm can sometimes provide temporary relief, but within hours the symptoms return. The symptoms can be debilitating, preventing concentration on mundane tasks. Some situations, such as riding in an automobile or train, vibrations from mobile phones, and even going to the toilet can aggravate the syndrome unbearably.
A Dutch study has connected PSAS with restless legs syndrome.

Possible causes and treatment

There is not enough known about persistent genital arousal disorder to definitively pinpoint a cause. Medical professionals think it is caused by an irregularity in sensory nerves, and note that the disorder has a tendency to strike post-menopausal women in their 40s and 50s, or those who?ve undergone hormonal treatment. It can affect a person at any age.

Some drugs such as trazodone may cause it as a side effect,[8] in which case discontinuing the medication may give relief. Additionally, the condition can sometimes start only after the discontinuation of SSRIs.[9] In some recorded cases, the syndrome was caused by a pelvic arterial-venous malformation with arterial branches to the penis or clitoris; surgical treatment was effective in this case.[3]

In other situations where the cause is unknown or less easily treatable, the symptoms can sometimes be reduced by the use of antidepressants, antiandrogenic agents and anaesthetising gels. Psychotherapy with cognitive reframing of the arousal as a healthy response may also be used.

More recently, the symptoms of the condition have also been linked with pudendal nerve entrapment. Regional nerve blocks and less common surgical intervention have demonstrated varying degrees of success in most cases.