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

Abstract

We conducted a literature review of patients' conditions described under persistent genital arousal disorder and restless genital syndrome, vulvodynia and male genital skin pain of unknown aetiology (penoscrotodynia). Our aim is to improve the understanding of the condition, unify nomenclature and promote evidence-based practice. The most prominent symptom in persistent genital arousal disorder and restless genital syndrome is a spontaneous, unwelcomed, intrusive and distressing vulval sensation. There are similarities between the clinical presentation of vulvodynia, penoscrotodynia, persistent genital arousal disorder and restless genital syndrome patients. The aetiology of persistent genital arousal disorder and restless genital syndrome, similar to vulvodynia, could be better explained in terms of neuro-vascular dysfunction, genital peripheral neuropathy and/or dysfunctional micro-vascular arterio-venous shunting. Erythromelalgia lends itself to explain some cases of restless genital syndrome, who have concurrent restless legs syndrome; and therefore draw parallels with the red scrotum syndrome. The published literature supports the concept of classifying restless genital syndrome as a sub-type of vulvodynia rather than sexual dysfunction.

Pain Experienced During Vaginal and Anal Intercourse with Other-Sex Partners: Findings from a Nationally Representative Probability Study in the United States

“…Health and Behavior indicate that about 5% of men and about 30% of women in the United States report some degree of pain during their most recent sexual experience [1]. Women's experiences of genital pain during sexual activities appear to be a common outcome of multiple etiologic pathways related to hormonal status (e.g., menopause, lactation), vulvar dermatoses (e.g., lichen sclerosus), gynecological health (e.g., endometrioisis), infections (e.g., bacterial vaginosis or candidiasis), medications (e.g., reduced vaginal lubrication from hormonal contraception), and mechanical issues (e.g., tight genital fit between partners, vaginal penetration despite insufficient vaginal lubrication, etc), or may have unclear origins, perhaps resulting in a diagnosis of vulvodynia [2][3][4][5][6][7][8][9][10][11][12][13]. Vulvodynia, dyspareunia, and other types of genital pain can create substantial personal distress to patients and relationship partners and have been linked with lower scores on measures of sexual satisfaction [2][3][4][5][6][7][8][9][10][11][12][13].…”

022 Predictors and Moderators of Sexual Distress in Women with Persistent Genital Arousal Disorder

“…They further reported a "clustering" of these symptoms and theorized they could be lumped into a condition they deemed restless genital syndrome (RGS), a more complex syndrome that encompasses RLS, PGAD, overactive bladder and urethra hypersensitivity. Markos and Dinsmore (2013) concurred with the notation of similarities between PGAD and RGS and went on to suggest that these similarities can also be found in vulvodynia, a condition involving chronic pain of the external genital region. In their 2013 manuscript, Markos and Dinsmore suggested that PGAD and RGS be considered subtypes of vulvodynia and argued that it should be reclassified as a pain disorder as opposed to a sexual dysfunction, which appears to be based upon their interpretation of the similarity in symptoms and the evolving definition of vulvodynia over the past few decades.…”

“…Because these women were bathing multiple times per day due to their persistent arousal and orgasms, and were hesitant to discuss their concerns due to fear of being seen as hypersexual, they were instead treated for OCD and subsequently received no relief. Fear, guilt, shame, and embarrassment have been cited across the literature as the potential reasons behind low reporting levels of PGAD (Markos & Dinsmore, 2013;Leiblum, 2008;Mahoney & Zarate, 2007).…”

Restless Genital Syndrome in Parkinson Disease

“…Her symptoms were very similar to those previously described in RGS and her dramatic response to pramipexole supports this diagnosis. 3,6,7 The intrusive genital symptoms in RGS may be perceived as a discomfort, irritation, tingling, itching, congestion, and pain. Although most patients have difficulty describing their symptoms, 3 the account is very similar among patients, reinforcing the organic nature of this disorder.…”