Clinical characterization and management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD): a registry study

TL;DR

This study describes the clinical features and management of a rare condition called persistent genital arousal disorder, highlighting its complex nature and the need for interdisciplinary treatment.

Contribution

The study provides a detailed clinical characterization of PGAD/GPD through a registry of 92 patients, identifying symptom patterns and comorbidities.

Findings

PGAD/GPD symptoms are often tingling sensations, frequently localized in the clitoris or glans penis, with high rates of swelling and spontaneous orgasms.

Most patients reported mental stress and tight clothing as triggers, while distraction and warmth were common relieving factors.

High rates of psychiatric comorbidities, especially depression, were observed, often developing after symptom onset.

Abstract

Persistent genital arousal disorder (PGAD)/genito-pelvic dysesthesia (GPD) is a disabling disease, where patients perceive prolonged genital arousal without sexual desire. The condition mainly occurs in women. Etiopathological considerations reach from peripheral to central nervous system mechanisms.

To clinically and anamnestically characterize patients with PGAD/GPD using data from a dedicated patient registry.

This study comprises a detailed description of 92 patients with PGAD/GPD from a registry data bank. Investigations included clinical characterization of PGAD/GPD-symptoms, assessment of sexual, urogynecological, somatic, and psychiatric history as well as clinical examination and treatments.

The primary outcome was to identify common clinical features, symptom patterns, trigger and relieving factors, comorbidities, and therapeutic strategies.

Persistent genital arousal disorder symptoms were mostly characterized as tingling and were almost permanently present. In over 80%, PGAD symptoms were located in the clitoris (women) or in the glans penis (men); 50% reported extragenital manifestations. Thirty-four percent described symptoms such as GPD. PGAD presented with high rates of swelling of the genitals (46%), spontaneous orgasms (30%), and extraordinary lubrication (27%). Most frequent trigger factors were mental stress, sitting, wearing tight clothes, and vibration. Relieving factors were mainly distraction, physical exercise, and warmth. Half of the patients stated increased urinary urge. More than 40% stated symptoms of overactive bladder syndrome. About one third reported restless legs symptoms. Almost 70% had comorbid psychiatric diseases, mainly depressive disorders. In most cases, those occurred after the onset of PGAD/GPD symptoms. Further diagnostic procedures covered urogynecological and neurological examinations as well as magnetic resonance imaging of brain, spinal cord, and pelvis. Non-pharmacological therapeutic approaches included among others physiotherapy, psychotherapy, transcutaneous electrical nerve stimulation, neurosurgical procedures, or pudendal block. In the majority, a clear somatic correlate for PGAD/GPD was not found.

The findings highlight the complex and multifactorial nature of PGAD/GPD, advocating interdisciplinary diagnostics and individualized treatments due to high psychiatric comorbidity and the absence of consistent somatic findings.

The study’s strength lies in its large sample size and comprehensive clinical profiling of PGAD/GPD patients; however, its retrospective registry-based design and the absence of a control group represent significant limitations.

This first registry-based study of PGAD/GPD in a larger cohort highlights the need for future controlled studies with larger sample sizes and more specified clinical assessments according to consensus statements for a better understanding of the clinical appearance and the etiopathology of PGAD/GPD.

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