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Martín-Vivar M, Villena-Moya A, Mestre-Bach G, Hurtado-Murillo F, Chiclana-Actis C. Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review. J Sex Med 2022; 19:961-974. [PMID: 35396171 DOI: 10.1016/j.jsxm.2022.03.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Persistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. AIM To perform a scoping review of the proposed treatments for PGAD and their efficacy. METHODS A scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. OUTCOMES Three different effective treatments were found (Physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). RESULTS Thirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive-behavioral strategies with pharmacological treatment. CLINICAL IMPLICATIONS Pharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. STRENGTHS AND LIMITATIONS This study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. CONCLUSIONS To date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD. Martín-Vivar M, Villena-Moya A, Mestre-Bach G, et al. Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review. J Sex Med 2022;19:961-974.
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Affiliation(s)
- María Martín-Vivar
- Unidad de Sexología Clínica y Salud Sexual, Consulta Dr. Carlos Chiclana, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | - Felipe Hurtado-Murillo
- Doctor Peset University Hospital, Center for Sexual and Reproductive Health, Valencia, Spain
| | - Carlos Chiclana-Actis
- Unidad de Sexología Clínica y Salud Sexual, Consulta Dr. Carlos Chiclana, Madrid, Spain; Universidad Internacional de la Rioja, La Rioja, Spain; University CEU San Pablo, Madrid, Spain
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Pease ER, Ziegelmann M, Vencill JA, Kok SN, Collins CS, Betcher HK. Persistent Genital Arousal Disorder (PGAD): A Clinical Review and Case Series in Support of Multidisciplinary Management. Sex Med Rev 2021; 10:53-70. [PMID: 34362711 DOI: 10.1016/j.sxmr.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Persistent genital arousal disorder (PGAD) is an uncommon condition resulting in intrusive, unwanted and distressing symptoms of genital arousal. Presentation can vary and most cases do not have an immediately identifiable etiology. OBJECTIVES To present evaluation and treatment recommendations for PGAD from a multidisciplinary perspective and provide case examples. METHODS A focused review of the literature on diagnosis, workup, and treatment of PGAD was completed. A case series of 3 varying presentations of PGAD is offered. RESULTS PGAD results in high levels of patient distress and is best managed with a multidisciplinary treatment approach. Identification and management of co-occurring symptoms or disease states is imperative, particularly psychologic and psychiatric comorbidities. With appropriate intervention, patients may achieve improvement of their physical symptoms and a decrease in associated psychological distress. CONCLUSION PGAD is an uncommon and highly distressing condition that requires thoughtful evaluation for appropriate diagnosis and treatment. Multidisciplinary treatment approaches provide the best opportunity to address the needs of patients and optimizing treatment response. Pease ER, Ziegelmann M, Vencill JA, et al. Persistent Genital Arousal Disorder (PGAD): A Clinical Review and Case Series in Support of Multidisciplinary Management. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Eric R Pease
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer A Vencill
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Susan N Kok
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Scott Collins
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hannah K Betcher
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Cankardas S, Schenck CH. Sexual Behaviors and Sexual Health of Sexsomnia Individuals Aged 18-58. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 33:29-39. [PMID: 38596470 PMCID: PMC10807804 DOI: 10.1080/19317611.2020.1850597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 04/11/2024]
Abstract
Objective: The objective of this study was to address the relationships between demographics and sexsomnia episodes, and sexual health issues in affected individuals. This study is the first sexsomnia survey conducted in Turkey. Sexsomnia comprises involuntary, unconscious sexual behavior during sleep, observed by a bed partner. Method:To reach people with and without sexsomnia, an online survey method was used. Among 274 participants, 42 of them reported having sexsomnia. Results: Women who do not have sexsomnia have more sexual problems than women who have sexsomnia episodes. The sexsomnia experiences of men and women also differed. Additionally, there were gender differences with difficulties caused by the sexsomnia. Conclusions: There is a need for further studies on sexsomnia that address socio-cultural, gender, and biological factors (including sleep disorders).
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Affiliation(s)
- Sinem Cankardas
- Department of Psychology, Izmir Democracy University, Izmir, Turkey
| | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Wang XX, Zhu XY, Wang Z, Dong JW, Ondo WG, Wu YC. Restless abdomen: a spectrum or a phenotype variant of restless legs syndrome? BMC Neurol 2020; 20:298. [PMID: 32787789 PMCID: PMC7425072 DOI: 10.1186/s12883-020-01875-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background With the growing awareness of restless legs syndrome (RLS), sensory disorders similar to RLS but initially confined to the arms, abdomen, and perineum have been reported. One of them is restless abdomen, which refers to a restless sensation in abdomen. Our study is designed to evaluate the clinical phenotype of restless abdomen and investigate its relationship with RLS. Methods We enrolled 10 patients with restless abdomen according to RLS diagnostic criteria, excluding the requiring of leg involvement. Laboratory examinations were performed to exclude mimics and notable comorbidities. Results All 10 patients had RLS like symptoms in the abdomen and otherwise satisfied all other RLS diagnostic criteria, and responded to dopaminergic therapy. Conclusions Neurologists and gastroenterologists should be aware that RLS-related restlessness can occur in extra-leg anatomy in the absence of episodes of worsening or augmentation of restlessness.
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Affiliation(s)
- Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China.,Shanghai General Hospital of Nanjing Medical University, Nanjing, 210029, P.R. China
| | - Xiao-Ying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China
| | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021, P.R. China
| | - Jian-Wei Dong
- Department of Neurology, Changchun Central Hospital, Changchun, P.R. China
| | - William G Ondo
- Department of Neurology, Methodist Hospital, Weill Cornell Medical School, Houston, TX, USA
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China.
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Abstract
Abstract
Purpose of Review
Persistent genital arousal disorder (PGAD) is a rare, yet debilitating, disease, which was first described at the beginning of this century and has not yet been considered by the ICD-10 or DSM-5. Since affected subjects usually suffer tremendously, this review aims at offering an overview of pharmacological approaches to treat this disorder.
Recent Findings
Until now, no randomised placebo-controlled clinical trials have been conducted on PGAD, and the international registries have not recorded any ongoing trials. Current knowledge on pharmacological options for the treatment of PGAD relies mainly on case reports/case series. Most importantly, there is evidence that some drugs such as SSRIs and SNRIs might induce or worsen PGAD.
Summary
Knowledge on pharmacological treatment options for PGAD is not yet evidence-based, while some reports even assume an induction of PGAD by serotonergic antidepressants. Nevertheless, practitioners should be aware of PGAD and carefully discuss with the patient an individual treatment trial by considering the experience up to now.
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Lakshmi M, Khan SD. Female Sexual Dysfunction. Sex Med 2019. [DOI: 10.1007/978-981-13-1226-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kruger TH. Can pharmacotherapy help persistent genital arousal disorder? Expert Opin Pharmacother 2018; 19:1705-1709. [DOI: 10.1080/14656566.2018.1525359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Tillmann H.C. Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
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Matsubara T, Suzuki K, Okamura M, Shiina T, Miyamoto M, Nakamura T, Hirata K. [A 70-year-old woman presenting with restless shoulder following posterior internal capsule infarction]. Rinsho Shinkeigaku 2017; 57:711-715. [PMID: 29070754 DOI: 10.5692/clinicalneurol.cn-001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 70-year-old woman noticed difficulty in speech and weakness of the left upper and lower limb upon awakening. Neurological examination showed dysarthria and left hemiparesis. No sensory disturbance was observed. Brain MRI revealed acute infarction in the right posterior limb of the internal capsule. On the hospital day 1, she developed the abnormal sensations restricted to the bilateral shoulders, resulting in difficulty initiating sleep. On laboratory data, renal function and serum hemoglobin and ferritin levels were normal. When four essential features of restless legs syndrome (RLS) were applied to her shoulders, the patient met RLS criteria. Following low dose pramipexole treatment, the abnormal sensation of the shoulders and insomnia significantly improved. We should be aware of the possibility of RLS or its variant, including "restless shoulder" of our patient, for the cause of insomnia following acute ischemic infarction.
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Affiliation(s)
| | | | | | | | - Masayuki Miyamoto
- Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing
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Suzuki K, Miyamoto M, Uchiyama T, Miyamoto T, Matsubara T, Hirata K. Restless Bladder in an Elderly Woman: An Unusual Feature or a Variant of Restless Legs Syndrome? Intern Med 2016; 55:2713-6. [PMID: 27629973 DOI: 10.2169/internalmedicine.55.6815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an elderly patient with a history of restless legs syndrome (RLS) who developed unpleasant sensations in the lower abdomen and perineum. The patient' s symptoms occurred during the evening and at rest and forced the patient to void, resulting in some symptom relief. Urological examinations and spinal magnetic resonance imaging findings were unremarkable. The adjunctive use of rotigotine resolved her symptoms. The symptoms were considered to be "restless bladder". Further studies are required to elucidate whether restless bladder is an identical condition to the clinical entities of other RLS variants or whether it represents an unusual feature of RLS.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Japan
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Suzuki K, Miyamoto T, Hirata K, Miyamoto M. [Pathophysiological similarity between restless genital syndrome and restless legs syndrome in Parkinson's disease]. Rinsho Shinkeigaku 2015; 55:848-9. [PMID: 26447096 DOI: 10.5692/clinicalneurol.cn-000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Sawamura M, Toma K, Udaka F. [Pathophysiological similarity between restless genital syndrome and restless legs syndrome in Parkinson's disease]. Rinsho Shinkeigaku 2015; 55:850. [PMID: 26447097 DOI: 10.5692/clinicalneurol.cn-000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Persistent genital arousal disorder following selective serotonin reuptake inhibitor cessation. J Clin Psychopharmacol 2015; 35:352-4. [PMID: 25928703 DOI: 10.1097/jcp.0000000000000318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erős E, Brockhauser I, Pólyán E. [Symptomatology and treatment of persistent genital arousal disorder. Case report]. Orv Hetil 2015; 156:614-8. [PMID: 25845321 DOI: 10.1556/oh.2015.30131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Persistent genital arousal disorder is a rare condition among women characterized by unwanted and intrusive sexual arousal that can persist for an extended period of time and unrelated to sexual desire or sexual stimuli. Since its first documentation in 2001, numerous studies have been dedicated to investigate its specifics. The persistent genital arousal occurs in the absence of sexual interest and fantasies and it causes excessive psychological suffering. Masturbation, spontaneous orgasm or sexual intercourse can offer only a temporary relief. Researches provide a limited insight into the characteristics of persistent genital arousal disorder. This paper presents a case and summarizes the scientific findings on prevalence, etiology and treatment perspectives.
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Affiliation(s)
- Erika Erős
- Országos Gyermekegészségügyi Intézet Családtervezési, Koragyermekkori és Ifjúsági Osztály Budapest Bolgárkerék u. 3. 1148
| | - Ildikó Brockhauser
- Országos Gyermekegészségügyi Intézet Családtervezési, Koragyermekkori és Ifjúsági Osztály Budapest Bolgárkerék u. 3. 1148
| | - Edina Pólyán
- Országos Gyermekegészségügyi Intézet Családtervezési, Koragyermekkori és Ifjúsági Osztály Budapest Bolgárkerék u. 3. 1148
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Abstract
Persistent genital arousal disorder (PGAD) is characterized by intrusive sexual arousal that is unresolvable via sexual activity and persists for an extended period of time. PGAD's etiology is unknown, and it has no established treatments. This case study reports on a 71-year-old female patient diagnosed with PGAD who received 9 sessions of hypnotherapy. The following measures were administered at baseline and follow-up: Hospital Anxiety and Depression Scale, Center for Epidemiologic Studies Depression Scale, Pittsburgh Sleep Quality Index, and visual analogue measurements of quality of life, intensity of symptoms, and marital interference. At follow-up, there were significant improvements in all measures. Given the currently limited alternatives for treatment, this case study suggests that hypnotherapy may be beneficial for some patients with PGAD.
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Suzuki K, Miyamoto M, Miyamoto T, Hirata K. Restless "lower back" in a patient with Parkinson's disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 24255803 PMCID: PMC3822403 DOI: 10.7916/d8348j3b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/12/2013] [Indexed: 12/20/2022]
Abstract
Background In restless legs syndrome (RLS), the isolated involvement of other body parts in the absence of leg involvement is rare. Case report We report an 82-year-old male with a 1-year history of Parkinson’s disease (PD) who developed an abnormal sensation limited to his “lower back.” He fulfilled the four essential RLS criteria, with the major caveat that the criteria were applied in a modified manner to his lower back rather than his legs. The administration of a dopamine agonist completely eliminated his symptoms. Discussion Our patient’s “restless lower back” may be a variant of RLS. Clinicians should pay attention to restlessness in other body parts in addition to the legs.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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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. JOURNAL OF SEX & MARITAL THERAPY 2013; 40:170-174. [PMID: 24168013 DOI: 10.1080/0092623x.2013.788109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Persistent genital arousal disorder is described in a spontaneous, persistent, and uncontrollable genital arousal in women, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. This study aimed to argue that application of Botulinum toxin in the periclitoral region in order to block the dorsal nerve of the clitoris might decrease symptoms of persistent genital arousal disorder. The authors presented 2 cases, in which application of Botulinum toxin resulted in improvement of the symptoms of persistent genital arousal disorder. Botulinum toxin type A treatment protocol is seen as a promising application for the persistent genital arousal disorder. However, further controlled studies in large samples are needed.
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Affiliation(s)
- Hakan Nazik
- a Adana Numune Education and Research Hospital , Department of Obstetrics and Gynecology , Adana , Turkey
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Markos AR, Dinsmore W. Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia? Int J STD AIDS 2013; 24:852-8. [PMID: 23970620 DOI: 10.1177/0956462413489276] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a literature review of patients' conditions described under persistent genital arousal disorder and restless genital syndrome, vulvodynia and male genital skin pain of unknown aetiology (penoscrotodynia). Our aim is to improve the understanding of the condition, unify nomenclature and promote evidence-based practice. The most prominent symptom in persistent genital arousal disorder and restless genital syndrome is a spontaneous, unwelcomed, intrusive and distressing vulval sensation. There are similarities between the clinical presentation of vulvodynia, penoscrotodynia, persistent genital arousal disorder and restless genital syndrome patients. The aetiology of persistent genital arousal disorder and restless genital syndrome, similar to vulvodynia, could be better explained in terms of neuro-vascular dysfunction, genital peripheral neuropathy and/or dysfunctional micro-vascular arterio-venous shunting. Erythromelalgia lends itself to explain some cases of restless genital syndrome, who have concurrent restless legs syndrome; and therefore draw parallels with the red scrotum syndrome. The published literature supports the concept of classifying restless genital syndrome as a sub-type of vulvodynia rather than sexual dysfunction.
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Affiliation(s)
- A R Markos
- HIV and Sexual Medicine, Mid Staffordshire NHS Foundation Trust, Stafford Hospital, Stafford, UK
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Facelle TM, Sadeghi-Nejad H, Goldmeier D. Persistent genital arousal disorder: characterization, etiology, and management. J Sex Med 2012; 10:439-50. [PMID: 23157369 DOI: 10.1111/j.1743-6109.2012.02990.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Persistent genital arousal disorder (PGAD) is a potentially debilitating disorder of unwanted genital sensation and arousal that is generally spontaneous and unrelenting. Since its first description in 2001, many potential etiologies and management strategies have been suggested. AIM To review the literature on PGAD, identify possible causes of the disorder, and provide approaches to the assessment and treatment of the disorder based on the authors' experience and recent literature. METHODS PubMed searches through July 2012 were conducted to identify articles relevant to persistent sexual arousal syndrome and PGAD. MAIN OUTCOME MEASURES Expert opinion was based on review of the medical literature related to this subject matter. RESULTS PGAD is characterized by persistent sensations of genital arousal in the absence of sexual stimulation or emotion, which are considered unwanted and cause the patient at least moderate distress. The proposed etiologies of PGAD are plentiful and may involve a range of psychologic, pharmacologic, neurologic, and vascular causes. PGAD has been associated with other conditions including overactive bladder and restless leg syndrome. Assessment should include a through history and physical exam and tailored radiologic studies. Treatment should be aimed at reversible causes, whether physiologic or pharmacologic. All patients should be considered for cognitive therapy including mindfullness meditation and acceptance therapy. CONCLUSIONS PGAD likely represents a range of conditions manifesting in unwanted genital sensations. Successful treatment requires a multidisciplinary approach and consideration of all reversible causes as well as cognitive therapy.
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Affiliation(s)
- Thomas M Facelle
- UMDNJ New Jersey Medical School-Surgery-Urology, Newark, NJ 07103, USA.
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Levin RJ, Wylie KR. Persistent genital arousal disorder: a review of the literature and recommendations for management. Int J STD AIDS 2010; 21:379-80; author reply 380. [DOI: 10.1258/ijsa.2010.010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R J Levin
- Sexual Physiology Laboratory, Porterbrook Clinic, Sheffield Health & Social Care Foundation Trust, Sheffield S11 9BF, UK
| | - K R Wylie
- Sexual Physiology Laboratory, Porterbrook Clinic, Sheffield Health & Social Care Foundation Trust, Sheffield S11 9BF, UK
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22
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Rosenbaum TY. Physical therapy treatment of persistent genital arousal disorder during pregnancy: a case report. J Sex Med 2010; 7:1306-10. [PMID: 20059652 DOI: 10.1111/j.1743-6109.2009.01654.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Persistent genital arousal disorder (PGAD) is described as the spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. Whether the etiology of this disorder is essentially central or peripheral is unclear; however, a presenting symptom may be persistent engorgement of genital erectile and vascular tissue. AIM To describe a case of a distressed 27 year old pregnant woman with symptoms consistent with PGAD, and the intervention leading to the resolution of symptoms. METHODS A patient with symptoms of PGAD was assessed. Information regarding this condition was offered. A manual therapy treatment was provided to decrease muscle hypertonus near the pudendal nerve, and a home intervention was suggested. RESULTS Complete resolution of symptoms per patient's report 1 week later. CONCLUSION Treatment with pelvic floor manual therapy directed at the pudendal nerve may provide safe and significant relief from PGAD symptoms in a pregnant woman patient.
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Pereira VM, Silva ACDOE, Nardi AE. Transtorno da excitação genital persistente: uma revisão da literatura. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000300009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Realizar uma revisão da literatura sobre o transtorno da excitação genital persistente (TEGP), um quadro clínico que acomete somente mulheres, recentemente descrito na literatura, caracterizado por sinais fisiológicos de excitação sexual sem a presença de desejos ou estímulos sexuais. MÉTODOS: Foi realizada revisão sistemática com busca nas bases científicas PubMed, ISI, SciELO e PsycInfo. Do total de artigos encontrados, 27 foram selecionados para integrar esta revisão. RESULTADOS: Os artigos, em sua maioria, são relatos de casos. Apesar de algumas hipóteses diagnósticas terem sido propostas, ainda não existe consenso sobre etiologia, fatores de risco e epidemiologia desse transtorno. A literatura aponta para uma correlação positiva entre a presença do transtorno e quadros depressivos, ansiosos e sintomas obsessivo-compulsivos. CONCLUSÃO: Há necessidade de estudos mais amplos para o melhor entendimento desse quadro clínico. É possível que muitos casos passem despercebidos pelos profissionais de saúde por desconhecimento dos critérios diagnósticos.
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Waldinger MD, Venema PL, Van Gils AP, Schweitzer DH. New Insights into Restless Genital Syndrome: Static Mechanical Hyperesthesia and Neuropathy of the Nervus Dorsalis Clitoridis. J Sex Med 2009; 6:2778-87. [DOI: 10.1111/j.1743-6109.2009.01435.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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; 6:2901-9. [DOI: 10.1111/j.1743-6109.2009.01421.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goldmeier D, Mears A, Hiller J, Crowley T. Persistent genital arousal disorder: a review of the literature and recommendations for management. Int J STD AIDS 2009; 20:373-7. [PMID: 19451319 DOI: 10.1258/ijsa.2009.009087] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been. This article aims to draw together current literature on this topic and provide readers with guidance on the management of this condition. This includes a working definition, an exploration of possible aetiologies within the confines of current knowledge, practical advice regarding assessment, management and auditable outcomes of practice.
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Affiliation(s)
- D Goldmeier
- Jefferiss Wing, Imperial College NHS Trust, London.
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Garvey LJ, West C, Latch N, Leiblum S, Goldmeier D. Report of spontaneous and persistent genital arousal in women attending a sexual health clinic. Int J STD AIDS 2009; 20:519-21. [DOI: 10.1258/ijsa.2008.008492] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The frequency of spontaneous genital arousal (GA) and persistent genital arousal disorder (PGAD) in women is unknown. The aim of this study was to conduct an anonymous survey to assess the frequency and nature of spontaneous GA and PGAD in women attending a walk-in sexual health clinic in London. Female patients completed a questionnaire, which included demographic information, medical, psychiatric and gynaecology history, the hospital anxiety and depression scale, and a somatization scale. Patients were then asked to complete three questions regarding spontaneous and persistent GA. Any patient with one or more symptoms then answered questions about the distress, intensity and duration of sensations. Ninety-six subjects participated. The mean age was 28.97 years. Thirty-two women (33.3%) answered ‘yes’ to at least one question regarding spontaneous or persistent GA and six women (6.3%) women answered ‘yes’ to all three questions. Only one subject fulfilled all five diagnostic criteria for PGAD. In conclusion, women report a high rate of spontaneous GA in the absence of desire or excitement. This has not been well described previously. A small proportion of women report multiple features of spontaneous and persistent GA, with chronicity over years, but without distress in most cases. Larger studies are needed.
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Affiliation(s)
- L J Garvey
- Jefferiss Wing, Imperial College NHS Healthcare Trust
- Division of Medicine, Imperial College London, UK
| | - C West
- Jefferiss Wing, Imperial College NHS Healthcare Trust
| | - N Latch
- Division of Medicine, Imperial College London, UK
| | | | - D Goldmeier
- Jefferiss Wing, Imperial College NHS Healthcare Trust
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Korda JB, Pfaus JG, Goldstein I. CASE REPORTS: Persistent Genital Arousal Disorder: 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. [DOI: 10.1111/j.1743-6109.2008.01210.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Waldinger MD, Schweitzer DH. Persistent Genital Arousal Disorder in 18 Dutch Women: Part II—A Syndrome Clustered with Restless Legs and Overactive Bladder. J Sex Med 2009; 6:482-97. [DOI: 10.1111/j.1743-6109.2008.01114.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Waldinger MD, Van Gils AP, Pauline Ottervanger H, Vandenbroucke WV, Tavy DL. Persistent Genital Arousal Disorder in 18 Dutch Women: Part I. MRI, EEG, and Transvaginal Ultrasonography Investigations. J Sex Med 2009; 6:474-81. [DOI: 10.1111/j.1743-6109.2008.01113.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goldmeier D, Leiblum S. Interaction of organic and psychological factors in persistent genital arousal disorder in women: a report of six cases. Int J STD AIDS 2008; 19:488-90. [DOI: 10.1258/ijsa.2007.007298] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary There have been a number of case reports published recently describing women who complain of persistent genital arousal. Most of these papers do not report medical data or observations from genital examination. We report in such detail on six cases of persistent genital arousal disorder (PGAD) in women. We further advance the hypothesis that in many cases the objective genital component may be induced by a variety of psychophysiological and pathological factors such as anxiety, genital prolapses and dermatoses. Genital engorgement so produced may not be continuous but when present may be enhanced and perpetuated by both anxiety focussed on the genitals and masturbation used in an attempt to relieve the sensations. Premorbid affective psychological illness negatively colours the subjective perception of this genital engorgement, leading to either elicitation or maintenance of PGAD. We discuss this hypothesis in relation to our six cases.
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Levin RJ, Wylie K. Vaginal Vasomotion—Its Appearance, Measurement, and Usefulness in Assessing the Mechanisms of Vasodilatation. J Sex Med 2008; 5:377-86. [DOI: 10.1111/j.1743-6109.2007.00669.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Leiblum S, Seehuus M, Goldmeier D, Brown C. Psychological, medical, and pharmacological correlates of persistent genital arousal disorder. J Sex Med 2007; 4:1358-66. [PMID: 17680784 DOI: 10.1111/j.1743-6109.2007.00575.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Little is known about the etiology or medical/psychological correlates of persistent genital arousal disorder (PGAD). AIM The aims of this article were (i) to replicate the findings of earlier research identifying two subtypes of women with persistent arousal-those who meet all features of the condition and are at least moderately distressed, and those who meet only some features and are less distressed; and (ii) to identify the medical, psychological and/or pharmacological correlates of the condition. METHOD A comprehensive web-based survey of persistent genital arousal (PGA) was posted on several Internet websites. Of the 156 women who completed the survey, 76 met all five features qualifying for a persistent genital arousal disorder (PGAD) group, and 48 met only some features (non-PGAD group). MAIN OUTCOME MEASURES The main outcome measures were endorsement of diagnostic signs of depression, anxiety, obsessive-compulsive disorder, and panic attack as well as medical illnesses and pharmacological preparations. RESULTS Compared to non-PGA subjects, women with PGA were significantly more likely to be depressed (55% vs. 38%) and to report panic attacks (31.6% vs. 14.6%). They were more anxious and more likely to monitor their physical sensations. Both groups reported high rates of childhood and adult sexual abuse, although the PGA women reported a higher prevalence of sexual victimization. They were significantly more likely to endorse negative feelings about their genital sensations and also more likely to complain of chronic fatigue syndrome than women without the condition (10% vs. 0%). There were no significant relationships with pharmacologic agents and symptoms. CONCLUSIONS Women who met all the criteria of PGAD were more likely than women who only met some of the criteria to report depression, anxiety, panic attacks, and certain obsessive-compulsive symptoms such as monitoring their physical sensations. It is hypothesized that for a subset of women, psychological factors, namely anxiety, reinforce exacerbate and maintain PGAD.
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Affiliation(s)
- Sandra Leiblum
- UNDNJ-Robert Wood Johnson Medical School-Psychiatry, Piscataway, NJ 08854, USA.
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Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 2007; 30:683-702. [PMID: 17580590 PMCID: PMC1978350 DOI: 10.1093/sleep/30.6.683] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences. DESIGN A computerized literature search was conducted, and other sources, such as textbooks, were searched. RESULTS Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of "sleepsex" ("sexsomnia") in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy. CONCLUSIONS A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, USA.
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Leiblum S, Seehuus M, Brown C. ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Persistent Genital Arousal: Disordered or Normative Aspect of Female Sexual Response? J Sex Med 2007; 4:680-689. [PMID: 17498105 DOI: 10.1111/j.1743-6109.2007.00495.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Persistent genital arousal disorder (PGAD), previously known as persistent sexual arousal syndrome, is a serious and extremely distressing condition. Clinical experience suggests that there may be a subset of women who experience persistent genital arousal as a normative and not especially distressing part of their sexuality. AIM To determine whether there are women who report unprovoked genital arousal and view it as normative, and to identify differences between women who endorse all five features of PGAD vs. those who endorse only some of features. MAIN OUTCOME MEASURES Respondents were asked about the nature, onset, duration, and severity of their arousal, and their feelings about PGAD. Overall sexual and relationship satisfaction was assessed, as were scores on the Female Sexual Function Index (FSFI). METHODS An on-line, anonymous survey on persistent genital arousal was conducted. Of the 388 respondents, 206 women endorsed all five features of PGAD (PGAD group) and 176 endorsed some, but not all, criteria (non-PGAD group). RESULTS The two groups were similar in age, relationship status, and duration. More PGAD than non-PGAD women reported current symptoms and greater symptom severity. Distress ratings were significantly greater for PGAD than non-PGAD women (7.9 vs. 4.7 on a 10-point scale). Forty-eight percent of PGAD vs. 27% of non-PGAD women reported continuous feelings of arousal. Significantly more PGAD women than non-PGAD women endorsed negative feelings about their genital arousal. Women with PGAD reported lower desire, less sexual satisfaction, greater pain, and lower overall scores on the FSFI. CONCLUSIONS There is a cohort of women who regularly, if intermittently, experience unprovoked and persistent genital arousal and find it mildly pleasurable. Their genital arousal differs from that of women who meet all five criteria for a diagnosis of PGAD. Possible explanations and etiologies for these differing reactions are discussed.
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Affiliation(s)
- Sandra Leiblum
- UNDMJ-Robert Wood Johnson Medical School-Psychiatry, Piscataway, NJ, USA;.
| | | | - Candace Brown
- University of Tennessee Health Science Center-Pharmacy, Obstetrics and Gynecology, and Psychiatry, Memphis, TN, USA
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Hiller J, Hekster B. Couple therapy with cognitive behavioural techniques for persistent sexual arousal syndrome. SEXUAL AND RELATIONSHIP THERAPY 2007. [DOI: 10.1080/14681990600815285] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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