Persistent Genital Arousal Disorder (PGAD): Difference between revisions
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There are different hypotheses for causes of PGAD that may be multifacorial; vascular factors, central and peripheral nervous system factors, pharmacological factors, psychosocial factors''',''' dietary''',''' or even idiopathetic factors. | There are different hypotheses for causes of PGAD that may be multifacorial; vascular factors, central and peripheral nervous system factors, pharmacological factors, psychosocial factors''',''' dietary''',''' or even idiopathetic factors. | ||
'''Pharmacological factors''', it was reported in a few case report studies that drugs that contain serotonergic such as antidepressant medication (SSRIs /SNRIs) may induce or worsen PGAD symptoms <ref>Leiblum SR, Goldmeier D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. Journal of Sex & Marital Therapy. 2008 Feb 21;34(2):150-9.</ref>even at initiation or withdrawal of drug, however, there were cases in which there was a fundamental improvement of PGAD symptoms anticonvulsant or SNRI<ref>Kruger TH, Schippert C, Meyer B. The [https://link.springer.com/article/10.1007/s11930-020-00240-0#Sec5 pharmacotherapy of persistent genital arousal disorder]. Current Sexual Health Reports. 2020 Mar;12:34-9. | '''Pharmacological factors''', it was reported in a few case report studies that drugs that contain serotonergic such as antidepressant medication (SSRIs /SNRIs) may induce or worsen PGAD symptoms <ref>Leiblum SR, Goldmeier D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. Journal of Sex & Marital Therapy. 2008 Feb 21;34(2):150-9.</ref>even at initiation or withdrawal of drug, however, there were cases in which there was a fundamental improvement of PGAD symptoms anticonvulsant or SNRI<ref name=":0">Kruger TH, Schippert C, Meyer B. The [https://link.springer.com/article/10.1007/s11930-020-00240-0#Sec5 pharmacotherapy of persistent genital arousal disorder]. Current Sexual Health Reports. 2020 Mar;12:34-9. | ||
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BibTeXEndNoteRefManRefWorks</ref>. | BibTeXEndNoteRefManRefWorks</ref>. | ||
'''Psychosocial factors,''' assessment of psychological factors of patient sis important for diagnoses of PGAD<ref>· Aswath M, Pandit LV, Kashyap K, Ramnath R. [https://www.ncbi.nlm.nih.gov/ Persistent genital arousal disorder. Indian journal of psychological medicine]. 2016 Jul;38(4):341-3. </ref>. | |||
== Clinical Presentation == | == Clinical Presentation == | ||
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Pelvic MRI in cases with suspected pudendal nerve entrapment. | |||
Lumbosacral MRI for exclusion of cauda equina syndrome. | |||
== Management / Interventions == | |||
There is a guidelines for PGAD/ GD and all we have depend on case studies, the intervention for PGAD treatment need collaboration of multidisciplinary team for diagnosis and treatment. | |||
<u>Pharmacological intervention</u> in case studies research there was an improvement in PGAD symptoms with the intervention of antidepressant and anticonvulsant<ref name=":0" /> and there was a successful treatment for female patient with leuprolide<ref>Deka K, Dua N, Kakoty M, Ahmed R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623662/ Persistent genital arousal disorder: Successful treatment with leuprolide (antiandrogen).] Indian journal of psychiatry. 2015 Jul 1;57(3):326-8.</ref>. | |||
<u>Neurolysis of dorsal nerve to clitoris</u> in cases with nerve compression there was complete relief of symptoms after surgery an bilateral neurolysis had better outcomes than unilateral. The dorsal nerve to clitoris is compressed mainly at the exit of the canal of Alcock and the site of compression can be detected during physical examination it will be tender and painful with palpation<ref>Klifto K, Dellon AL. [https://onlinelibrary.wiley.com/doi/10.1002/micr.30464 Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve.] Microsurgery. 2020 Feb;40(2):160-6. </ref>. | |||
== Differential Diagnosis == | |||
'''[https://www.choosingtherapy.com/hypersexuality/ Hypersexuality],''' unlike PGAD it is associated with a desire to have sex and was defined as the desire and urge to engage in sexual activity. | |||
[[Urinary Tract Infection|Urinary tract infection]] if there was symptoms like burning and itching. | |||
== Resources == | == Resources == | ||
Revision as of 02:27, 27 March 2023
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Introduction[edit | edit source]
Persistent genital arousal disorder (PGAD), restless genital syndrome (ReGS), or genitopelvic dysesthesia (GD) a rare disorder defined as persistatant, unpleasant , distressing sensation of unwanted, uncontrollable genital arousal, happens in the absence of any arousal or sexual stimulus, dose not resolve by orgasm or masturbation, may last for hours or days, and usually has a negative impact on individual's life. Symptoms may be triggered by sexual cues, non-sexual cues, or it may be idiopathic. Persistent genital arousal disorder (PGAD) was described for the first time in 2001 by Sandra Leiblum and Sharon Nathan[1]. It is relating mainly to women but it was presented in men also[2].
Mechanism of Injury / Pathological Process[edit | edit source]
As it was described for first time 20 years ago and it difficult to know its prevalence there is limited studies about PGAD that are individual case studies till now there is not RCT or SR studies about PGAD how to diagnose, assess, or treat.
There are different hypotheses for causes of PGAD that may be multifacorial; vascular factors, central and peripheral nervous system factors, pharmacological factors, psychosocial factors, dietary, or even idiopathetic factors.
Pharmacological factors, it was reported in a few case report studies that drugs that contain serotonergic such as antidepressant medication (SSRIs /SNRIs) may induce or worsen PGAD symptoms [3]even at initiation or withdrawal of drug, however, there were cases in which there was a fundamental improvement of PGAD symptoms anticonvulsant or SNRI[4].
Nervous system factors, nerve roots compression at the level of cauda equina (roots of genetalia) this compression may be because of tarlov cysts that cause cauda equina syndrome. In a study on an online support group for patients with with PGAD(18) their MRI was collected, (12/18) there was Tarlov cysts[5]. Compression of dorsal nerve of clitoris is another possible factor for PGAD[6].
Psychosocial factors, assessment of psychological factors of patient sis important for diagnoses of PGAD[7].
Clinical Presentation[edit | edit source]
- Uncontrollable genital arousal dos not affected by orgasm or masturbation.
- Lasts for hours or days in absence of sexual desire or objective stimulus.
- Pain or discomfort in the genetalia
- Tingling around clitoris.
- Genital engorgement.
- Lubrication or discharges
- Throbbing response[8].
Diagnostic Procedures[edit | edit source]
Pelvic MRI in cases with suspected pudendal nerve entrapment.
Lumbosacral MRI for exclusion of cauda equina syndrome.
Management / Interventions[edit | edit source]
There is a guidelines for PGAD/ GD and all we have depend on case studies, the intervention for PGAD treatment need collaboration of multidisciplinary team for diagnosis and treatment.
Pharmacological intervention in case studies research there was an improvement in PGAD symptoms with the intervention of antidepressant and anticonvulsant[4] and there was a successful treatment for female patient with leuprolide[9].
Neurolysis of dorsal nerve to clitoris in cases with nerve compression there was complete relief of symptoms after surgery an bilateral neurolysis had better outcomes than unilateral. The dorsal nerve to clitoris is compressed mainly at the exit of the canal of Alcock and the site of compression can be detected during physical examination it will be tender and painful with palpation[10].
Differential Diagnosis[edit | edit source]
Hypersexuality, unlike PGAD it is associated with a desire to have sex and was defined as the desire and urge to engage in sexual activity.
Urinary tract infection if there was symptoms like burning and itching.
Resources[edit | edit source]
References[edit | edit source]
- ↑ Jackowich RA, Pukall CF. Persistent genital arousal disorder: a biopsychosocial framework. Current Sexual Health Reports. 2020 Sep;12:127-35.
- ↑ Stevenson BJ, Köhler TS. First reported case of isolated persistent genital arousal disorder in a male. Case Reports in Urology. 2015 Feb 12;2015.
- ↑ Leiblum SR, Goldmeier D. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. Journal of Sex & Marital Therapy. 2008 Feb 21;34(2):150-9.
- ↑ 4.0 4.1 Kruger TH, Schippert C, Meyer B. The pharmacotherapy of persistent genital arousal disorder. Current Sexual Health Reports. 2020 Mar;12:34-9.
- ↑ Komisaruk BR, Lee HJ. Prevalence of sacral spinal (Tarlov) cysts in persistent genital arousal disorder. The Journal of Sexual Medicine. 2012 Aug;9(8):2047-56.
- ↑ Klifto KM, Dellon AL. Persistent genital arousal disorder: review of pertinent peripheral nerves. Sexual Medicine Reviews. 2020 Apr 1;8(2):265-73. BibTeXEndNoteRefManRefWorks
- ↑ · Aswath M, Pandit LV, Kashyap K, Ramnath R. Persistent genital arousal disorder. Indian journal of psychological medicine. 2016 Jul;38(4):341-3.
- ↑ Deka K, Dua N, Kakoty M, Ahmed R. Persistent genital arousal disorder: Successful treatment with leuprolide (antiandrogen). Indian journal of psychiatry. 2015 Jul 1;57(3):326-8.
- ↑ Deka K, Dua N, Kakoty M, Ahmed R. Persistent genital arousal disorder: Successful treatment with leuprolide (antiandrogen). Indian journal of psychiatry. 2015 Jul 1;57(3):326-8.
- ↑ Klifto K, Dellon AL. Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve. Microsurgery. 2020 Feb;40(2):160-6.
