Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias?

Pukall, Caroline F.; Jackowich, Robyn A.; Mooney, Kayla M.; Chamberlain, Susan

doi:10.1016/j.sxmr.2018.08.001

Cited by 30 publications

(16 citation statements)

References 25 publications

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“…19 However, as PGAD is not a named sexual dysfunction category, no diagnostic criteria are listed in the ICD-11 classification. 42 At the ISSWSH PGAD consensus meeting in 2019, experts discussed a possible name change for the following reasons: (1) the term PGAD was descriptive rather than medical; (2) Pukall et al recommended that PGAD be considered a genito-pelvic dysesthesia characterized by distressing arousal, that is classified according to its primary sensation (eg, arousal) and that this overarching framework could include other distinct (but often overlapping) sensations (ie, pain, vulvodynia, itch) 43 ; and (3) there are patients who have a distressing genital itch and/or pain symptoms 10,14,43 with or without genital symptoms of arousal, and a change in terminology would acknowledge the overlap among these dysesthesia symptoms. Further supporting the change in nomenclature is that common neural pathways (spinothalamic and/or spinoreticular tracts) convey genital sensations of arousal and orgasm, as well as dysesthesias such as itch and pain.…”

Section: Nomenclature Historical Perspectivementioning

confidence: 99%

“…40 Early symptoms of PGAD/GPD may include genital awareness that is noticed but non-aversive. More intense dysesthesia symptoms (eg, genital/perineal pain, 10,15,22,55 itch, 43 clitorodynia, 66,67 vulvodynia, 51,68,69 vestibulodynia, 70 dyspareunia, 68 interstitial cystitis, 71 bladder/bowel dysfunction, 22,48,71,72 rectal, 72 leg, and/or back pain, 22 or restless legs), 48,73,74 with possible spontaneous orgasms/ejaculations, may represent a progression of the condition. Protracted neuropathy could result in damage to the nerves or nerve roots, changing the symptoms from "hyperfunction" (eg, genital arousal, pain, and/or itch) to "hypofunction" (eg, genital numbness, anorgasmia, and/or anejaculation).…”

Section: Documenting Symptom Characteristics and Psychosocial And Medical History Takingmentioning

confidence: 99%

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International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Goldstein

Komisaruk

Pukall

et al. 2021

The Journal of Sexual Medicine

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Background: Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim: To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods: A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes: The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. Results: The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. Clinical Implications: The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and Limitations: Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the

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Section: Nomenclature Historical Perspectivementioning

confidence: 99%

Section: Documenting Symptom Characteristics and Psychosocial And Medical History Takingmentioning

confidence: 99%

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Goldstein

Komisaruk

Pukall

et al. 2021

The Journal of Sexual Medicine

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“…More recent proposed criteria (eg, 11 ) not only maintain these core features of PGAD but also contain additional associated features, such as difficulties in psychosocial wellbeing and the possible presence of unwanted/spontaneous orgasms (reported by a third of individuals with PGAD 2 ). These newer proposed criteria are similarly based on expert opinion (for a comparison of proposed PGAD criteria, see 12 ).…”

Section: Pgadmentioning

confidence: 99%

“…21 Given these consequences, efforts to educate the public and members of the healthcare system (eg, #PGADFacts social media campaign) should be undertaken to increase its recognition, and screening questions about health history in clinical settings should include those about distressing genital sensations. It has been observed that PGAD shares a number of similarities with other forms of genitopelvic discomfort, 3,12,22 and may be best described as a genitopelvic dysesthesia (defined as an unpleasant sensation 12 ). Screening questions about distressing genitopelvic sensations, which include sensations of arousal as well as pain, should be incorporated into medical history-taking.…”

Section: Prevalence Of Pgad Criteriamentioning

confidence: 99%

Prevalence of Persistent Genital Arousal Disorder in 2 North American Samples

Jackowich

Pukall

2020

The Journal of Sexual Medicine

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Background: Persistent genital arousal disorder (PGAD) is a highly distressing, understudied condition characterized by persistent genital arousal (eg, genital sensations, sensitivity) in the absence of sexual desire. Currently, there is limited information about the prevalence of PGAD based on its proposed diagnostic criteria ("PGAD criteria"). Aim: This study sought to assess the prevalence of PGAD criteria in 2 North American samples: a large, nonclinical sample of Canadian undergraduate students (Study 1), and a nationally representative sample from the U.S. (Study 2). Methods: The incoming class of undergraduate students (N ¼ 1,634) enrolled in the Introduction to Psychology course at a Canadian university and a nationally representative sample of U.S. participants (N ¼ 1,026) responded to questions about each PGAD criterion, and distress associated with these experiences. Outcomes: 5 self-report questions were developed based on each of the Leiblum and Nathan 2001 PGAD criteria, and a measure of associated distress was included. The U.S. sample (Study 2) also responded to questions about medical comorbidities and their knowledge of the term "PGAD." Results: 1.1% (n ¼ 4; Study 1) to 4.3% (n ¼ 22; Study 2) of men and 0.6% (n ¼ 7; Study 1) to 2.7% (n ¼ 14; Study 2) of women reported experiencing all 5 PGAD criteria at a moderate to high frequency. Even greater proportions of participants reported experiencing all 5 criteria at any frequency (6.8e18.8%). Although ratings of associated distress varied, participants who were distressed by these symptoms most frequently endorsed the first PGAD criterion: physiological genital arousal in the absence of sexual excitement or desire. These results are similar to previously reported rates of PGAD. Clinical Implications: A non-trivial number of individuals may experience PGAD, and it should be screened for by healthcare practitioners. Strengths & Limitations: This study is the first to use 2 large, non-clinical samples to assess the prevalence of PGAD symptoms. However, barriers to reporting symptoms, such as shame or embarrassment, may have resulted in underestimates of prevalence in the present sample. Conclusion: The prevalence of the 5 PGAD criteria in 2 large non-clinical samples ranged from similar to higher than rates reported in previous research. However, distress ratings associated with the 5 criteria varied, with most respondents describing them primarily as neutral or non-distressing.

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“…Other forms of genito-pelvic discomfort, such as vulvar pain, may serve as a useful framework for studying PGAD/GPD HC experiences, as similarities between these conditions have been previously noted. 11 , 12 The patient-HCP relationship and communication between a patient and HCP have been associated with treatment satisfaction in women with provoked vestibulodynia (PVD; vulvodynia subtype characterized by provoked pain at the vulvar vestibule). In 1 study, almost half the participants with PVD reported that finding a trustworthy HCP was the most important aspect of their diagnostic experience.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Experiences of Individuals With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia

et al. 2021

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Introduction: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent, unwanted sensations of genital arousal (eg, feelings of being on the verge of orgasm, and of lubrication, swelling, tingling, throbbing) that occur in the absence of sexual desire. Although PGAD/GPD is associated with significant impairments in psychosocial functioning, the healthcare (HC) experiences of affected individuals are not well understood. Aim: The aims of this study were to examine the barriers to HC, the costs of HC, and the associations among HC experiences, symptoms, and psychosocial outcomes in those with PGAD/GPD symptoms. Methods: One hundred and thirteen individuals with PGAD/GPD symptoms completed an online, cross-sectional self-report questionnaire about their HC history and experiences. Main Outcome Measures: Self-reported HC barriers, and financial costs associated with PGAD/GPD HC. Validated measures of HC experiences (eg, comfort communicating with HC practitioners [HCPs]), and psychosocial (eg, depression, anxiety) and PGAD/GPD symptom outcomes. Results: The majority of participants (56.6%) reported waiting at least 6 months to seek HC for PGAD/GPD symptoms. Those who sought HC approached many HCPs (46.0% approached 6+ HCPs). Several barriers to HC were identified (eg, lack of HCP knowledge of PGAD/GPD), and high costs were reported. A series of multiple linear regression analyses found an association between HC experiences, psychosocial, and symptom outcomes. Specifically, decreased comfort communicating with one's HCP was associated with greater depressive and anxiety symptoms. Conclusion: High costs and numerous barriers to seeking HC for PGAD/GPD symptoms were identified, and discomfort communicating with an HCP about PGAD/GPD was associated with increased symptoms of depression and anxiety. These results highlight the need for more awareness of this condition in order to improve care for this population.

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Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias?

Cited by 30 publications

References 25 publications

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Prevalence of Persistent Genital Arousal Disorder in 2 North American Samples

Healthcare Experiences of Individuals With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia

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