Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review

Abstract

Background Persistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. Aim To perform a scoping review of the proposed treatments for PGAD and their efficacy. Methods A scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. Outcomes Three different effective treatments were found (physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). Results Thirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive–behavioral strategies with pharmacological treatment. Clinical implications Pharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. Strengths and limitations This study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. Conclusions To date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD.

Persistent genital arousal disorder: clinical, differential diagnostic and care aspects (clinical report)

“…Some studies indicate a correlation between the onset of PGAD symptoms and taking or stopping antidepressants including SSRIs [10,11]. In the case we described, the correlation between discontinuation of an antidepressant and the beginning of symptoms and their disappearance when the drugs of this class are re-prescribed is clearly observed.…”

“…The PGAD studies point to the need to exclude organic pathology of the external genitalia [8,9]. Our patient was under constant observation by a gynecologist for polycystic ovarian syndrome and the gynecologist also excluded pathology of the external genitalia.…”

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach

“…However, current evidence suggests that psychological, pharmacological, and physiological treatment approaches may be appropriate and effective (Goldstein et al, 2021 ; Martín-Vivar et al, 2022 ; Pease et al, 2022 ; Pukall et al, 2022 ). A scoping review of proposed treatments for PGAD/GPD (Martín-Vivar et al, 2022 ) identified 38 studies and found evidence for physical treatments such as surgery, neuromodulation, and pelvic floor physiotherapy; pharmacological approaches such as the use of paroxetine, duloxetine, and clonazepam; and psychotherapy approaches such as cognitive-behavior therapy (CBT), couples therapy, mindfulness, and hypnotherapy. Notably, the scoping review only identified seven studies which examined psychological interventions, all of which were case studies.…”