Persistent Genital Arousal Disorder (PGAD)

Persistent genital arousal disorder (PGAD), is associated with unrelenting, unwanted, persistent, intrusive, and spontaneous sensations such as pressure, discomfort, engorgement, pulsating, pounding and/or throbbing sensations in the clitoris, vulva, perineum and/or anus in the absence of conscious thoughts of sexual desire or sexual interest. PGAD ranges from being mildly distracting to severely disruptive of a woman’s ability to live her life normally.

The evaluation of PGAD requires careful and thoughtful consideration of the patient and a multitude of factors. PGAD may be associated with neurological, vascular, physiological, pharmacological and psychological etiologies. Neurologic causes may be secondary to epilepsy, trauma, or post-surgical interventions. Other causes include pudendal nerve entrapment (similar to pudendal neuralgia), a Tarlov cyst in the spine, a bulging disc in the spine, dilated pelvic blood vessels, Tourette’s syndrome, Restless Leg syndrome, Ehlers-Danlos syndrome, or a periclitoral mass.  Pharmacologic causes may be secondary to the use of certain antidepressants, such as trazodone, or secondary to the sudden withdrawal of selective serotonin reuptake inhibitors (SSRIs). Some cases of PGAD arise spontaneously with no known cause.

Treatment

As PGAD is not one disease, optimal treatment is based on identifying the cause. Dr. Goldstein’s diagnostic algorithm has recently been presented in a PGAD Process Of Care developed by the International Society for the Study of Women’s Sexual Health. Once a diagnosis has been made  appropriate pharmacologic treatments include varenicline, zolpidem, tricyclic or SSRI antidepressants, prolactin-elevating agents, and anti-seizure medications. If there is pudendal nerve involvement, pudendal nerve blocks and/or the surgical release of pudendal nerve entrapment or Tarlov cyst removal may result in resolution of PGAD symptoms. Pelvic floor physical therapy and psychological counseling and support can also be very helpful. 

Conditions we treat