Medical and Surgical Treatments of PGAD

NPWH/ISSWSH Women's Sexual Health Course for NPs (16-03)

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Irwin Goldstein, MD, IF

Objectives
• Name the various disorders that cause excess peripheral sensory information that might result in
PGAD, and potential treatments for them
• List non-hormonal treatment strategies to raise inhibition and lower inhibition in the central
sexual reflex center

Session Description
Persistent Genital Arousal Disorder (PGAD) is characterized by persistent or recurrent, unwanted or
intrusive, bothersome or distressing feelings of genital arousal or being in the verge of orgasm (genital
dysesthesia) not associated with concomitant sexual interest, thoughts, or fantasies. PGAD may be
associated with the following: i) Limited resolution, no resolution, or aggravation of symptoms by sexual
activity with or without aversive and/or compromised orgasm in terms of impaired orgasm frequency,
intensity, timing, and/or pleasure; ii) Aggravation of genital symptoms by certain circumstances (sitting,
driving in a car, listening to music, general anxiety, stress or nervousness; iii) Despair, emotional liability,
catastrophization and/or suicidality; iv) Inconsistent evidence of genital arousal on physical examination
during symptoms (lubrication, swelling of clitoris or labia). Pathophysiologies associated with PGAD
include exacerbation by psychological factors; pharmacologic factors; musculo-skeletal factors;
peripheral neurologic factors; central neurologic factors; and vascular factors.

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