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Persistent Genital Arousal Disorder (PGAD)
Persistent genital arousal syndrome (PGAD) is spontaneous, persistent, unwanted, and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire. The arousal symptoms of PGAD can be experienced all or most of the time, and in some cases, intermittently. This is typically not relieved by orgasm. 40% of people with PGAD describe their sensations as painful. PGAD was previously called persistent sexual arousal syndrome.
Five Criteria That Can be Used to Diagnose Symptoms of PGAD:
- Spontaneous and persistent.
- Unwanted and intrusive.
- Provoked by non-sexual factors and unrelated to desire.
- Not dissipating following orgasm.
- Distressing to the patient.
PGAD can severely affect a person’s quality of life.
Psychological Symptoms that Impact Someone Suffering From PGAD:
- Panic attacks
The causes of PGAD are often unknown.
Theories of the Causes of PGAD:
- Restless leg syndrome/vascular insufficiency/neurovascular dysfunction causing clitoral congestion.
- Neurological hypersensitivity.
- Tarlov Cysts: Sacs filled with spinal fluid that appear on the sacral nerve root.
- Endocrinal PGAD: If cyclical, may be estrogen or progesterone dominant.
- Changes in hormones or medications.
- Trauma to the central nervous system.
- Tourette’s syndrome.
- High tone or overactivity of the pelvic floor muscles.
When physiotherapists use a biopsychosocial approach, there is an acknowledgment that there is can be a blend of tissue dysfunction and psychosocial factors that contribute to symptoms. This thorough assessment will help target the right ‘driver’ of a patient’s symptoms.
Pelvic health physiotherapy can be an integral part of a multidisciplinary approach in the treatment of symptoms associated with PGAD.
Treatments May Include:
- Improving pelvic floor proprioception/awareness sense.
- Deep breathing and relaxation.
- Vulvar skin health education.
- Address bowel and bladder function.
- Treatment of the nervous system.
- Body mapping.
- Therapeutic exercise.
- External myofascial techniques, including connective tissue dysfunction.
- Internal myofascial techniques (gentle, pain-free internal work to help decrease pelvic floor over-activity/tension).
- Pain education.
Persistent pain education is an important part of treating pelvic floor dysfunction since the pelvic floor is an area that we often hold tension. Anxiety, stress and our thoughts, attitudes, and beliefs can perpetuate the pain in our pelvis. Understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor dysfunction.