Next Steps For The Patient With Persistent Genital Arousal Disorder

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Utilize the appropriate questions to determine the diagnosis of PGAD
2. List potential treatment options for PGAD

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

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

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