Persistent genital arousal disorder

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.)

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 an automobile 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.

A Dutch study has connected PGAD with restless legs syndrome.The prevalence of PGAD is 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 of SSRIs. 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 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. There is, however, no evidence for the long-term efficacy of surgical intervention.

In one recent case, serendipitous relief of symptoms was noted from treatment with varenicline, a treatment for nicotine addiction.otes

Restless Genital Syndrome
“Persistent Sexual Arousal Syndrome Renamed As Restless Genital Syndrome”. RxPG News: Sexual Medicine Channel. December 28, 2008.
Leiblum, Sandra; Nathan, Sharon. “Persistent Sexual Arousal Syndrome in Women”. Quadrant HealthCom Inc. Retrieved 2009-06-19.
Leiblum, S.R. & Nathan, S.G. (July 1, 2001). “Persistent Sexual Arousal Syndrome: A Newly Discovered Pattern of Female Sexuality”. Journal of Sex & Marital Therapy 27 (4): 365–380. doi:10.1080/009262301317081115.
Goldstein, Irwin (1 March 2004). “Persistent Sexual Arousal Syndrome”. Boston University Medical Campus Institute for Sexual Medicine. Retrieved 2007-05-04.
“DSM”. American Psychiatric Association. Retrieved 11 December 2012.
Leiblum, Sandra (September–October 1999). “Sexual problems and dysfunction: epidemiology, classification and risk factors”. Journal of Gender-Specific Medicine 2 (5): 41–45.
Berczuk, Carol; Quinones, John (2008-02-21). “Medical Mystery: Persistent Sexual Arousal Syndrome”. 20/20. p. 2. Retrieved 2009-06-20.
Persistent genital arousal disorder brings woman agony, not ecstasy, Tampa Bay Times, 30 Nov 2012. Retrieved Dec 2012.
Tragedy as woman with debilitating sexual arousal disorder … commits suicide, The Daily Mail, 4 Dec 2012. Retrieved Dec 2012.
Waldinger (2008-12-17). “Persistent Imminent Orgasms in Women are Associated with Restless Legs”. Science Daily (ScienceDaily LLC). Retrieved 2009-06-20.
Finger, William W., Lund, Margaret and Slagel, Mark A. (Jan 1997). “Medications that may contribute to sexual disorders: a guide to assessment and treatment in family practice”. Journal of Family Practice 44 (1): 33–43.
Goldmeier D, Leiblum SR. Persistent genital arousal in women – a new syndrome entity Int J STD & AIDS 2006; 17:215-6. PMID 16595040.
Joanna B. Korda, MD et al. (2009-02-18). “Persistent Genital Arousal Disorder: A Case Report in a Woman with Lifelong PGAD Where Serendipitous Administration of Varenicline Tartrate Resulted in Symptomatic Improvement”. Journal of Sexual Medicine 6 (5): 1479–1486. doi:10.1111/j.1743-6109.2008.01210.x.
The patient from the preceding study was featured in a televised documentary, Strange Sex, aired on TLC 2010-01-27

Journal of Sex & Marital Therapy

Journal of Sex & Marital Therapy (Photo credit: Wikipedia)

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