Persistent Genital Arousal Disorder
Also Known As: Persistent Genital Arousal Disorder, Persistent Sexual Arousal Syndrome, Restless Genital Syndrome
Persistent Genital Arousal Disorder (PGAD), originally called Persistent Sexual Arousal Syndrome (PSAS) and also known as Restless Genital Syndrome (ReGS or RGS), results in a spontaneous, persistent, and uncontrollable genital arousal in women, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. It was first documented by Dr. Sandra Leiblum and Dr. Daniel DeCleats in 2001, only recently characterized as a distinct syndrome in medical literature with a comparable counterpart increasingly reported by men.
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. Priapism is a recognized diagnosable medical condition by the Diagnostic and Statistical Manual of Mental Disorders IV, whereas PGAD is not. The disorder has been newly included in DSM-5, which was released in May 2013.
In particular, it is not related to hypersexuality, sometimes known as nymphomania or satyriasis. (Hypersexuality, nymphomania, and satyriasis are also not recognized diagnosable medical conditions by the DSM-IV.) In addition to being very rare, PGAD is also frequently unreported by sufferers who may consider it shameful or embarrassing. A lack of seriousness in society regarding the human reproductive system downplays the intense pain of the sufferer.
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 return of symptoms, with the exception of known triggers, is sudden and unpredictable. Failure or refusal to relieve the symptoms often results in waves of spontaneous orgasms in women and ejaculation in men. The symptoms can be debilitating, preventing concentration on mundane tasks. Some situations, such as riding in anautomobile or train, vibrations from mobile phones, and even going to the toilet can aggravate the syndrome unbearably causing the discomfort to verge on pain. It is not uncommon for sufferers to lose some or all sense of pleasure over the course of time as release becomes associated with relief from pain rather than the experience of pleasure. Some sufferers have said that they shun sexual relations, which they may find to be a painful experience. The condition may last for many years and can be so severe that it has been known to lead to depression and even suicide.
The prevalence of PGADis unknown but based on a Dutch study there are at least 7000 cases worldwide.
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, or those who have undergone hormonal treatment.
Some drugs such as trazodone may cause priapism (which is a recognized medical condition, unlike PGAD) as a side effect, in which case discontinuing the medication may give relief. Additionally, the condition can sometimes start only after the discontinuation ofSSRIs. In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the penis or clitoris; surgical treatment was effective in this case.
In other situations where the cause is unknown or less easily treatable, the symptoms can sometimes be reduced by the use ofantidepressants, 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. There is, however, no evidence for the long-term efficacy of surgical intervention.