Sexual Health
CMECNE

Next Steps For The Patient With Persistent Genital Arousal Disorder

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Learning Objectives and CME/Disclosure Information

CLINICAL ACTIONS:

Persistent Genital Arousal Disorder is characterized by significant unwanted feelings of arousal that are not associated with sexual desire and are not resolved with multiple orgasms. It is important to determine that the patient does indeed meet the diagnosis of Persistent Genital Arousal Disorder (PGAD). The history and patient’s description is critical.

  • Ask and elicit the following
    • Is the arousal related in any way to sexual stimulus or thoughts?
    • Can the patient alleviate the symptoms by inducing and experiencing four or fewer orgasms?
    • In what way is the patient experiencing distress?
  • Provide support for the patient, acknowledging the severity of the condition. PGAD patients can often feel dismissed or frustrated by how debilitating this condition can be

SYNOPSIS:

Patients with PGAD complain of intense feelings of genital arousal which are spontaneous, unconnected to sexual desire or activity and persistent, lasting hours, days or weeks. This condition is often accompanied by severe anxiety or depression as the symptom can be disruptive and debilitating. Treatment generally involves managing symptoms to allow normal day to day activity.

KEY POINTS:

PGAD is a fairly new diagnosis and while there are numerous treatments for the condition, there is currently no one absolute way of resolving the symptoms. The following are treatments that are used to minimize PGAD symptoms and allow for continuation of a relatively normal routine:

  • If PGAD onset began with the prescription of Selective Serotonin Reuptake Inhibitors (SSRIs), patient may consider discontinuing them, if possible, under the guidance of the prescribing physician
  • Similarly, if the condition began when the patient stopped taking an SSRI, they can consider restarting them under the guidance of the prescribing physician
  • Valium suppositories if the condition is accompanied by vaginal spasm
  • TENS unit used one or more times during the day on the vulva
  • Gabapentin
  • Varenicline
  • Pudendal nerve blocks
  • Short term treatment of alprazolam can be helpful in alleviating symptoms while more long term solutions are found
  • This condition is often relapsing/remitting, that is patient have “flare ups” and then the condition can quiet down for long periods of time
  • Encourage patients to get psychological support
    • Cognitive behavioral therapy (e.g., mindfulness meditation) has been reported as a potential treatment modality
  • A general therapist who deals with chronic pain or sex therapist would be suitable for patients during times when the condition manifests symptoms and while they are looking for appropriate treatment
  • DIAGNOSIS CODES: ICD 10 –  F 53.22

Learn More – Primary Sources:

Persistent genital arousal in women with pelvic and genital pain

Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia?

Persistent genital arousal disorder: a clinical challenge

Take a post-test and get CME credits

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Related ObG Topics:

Persistent Genital Arousal Disorder- What is it?
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