Genito-pelvic dysestheia (GPD), also known as persistent genital arousal disorder (PGAD), is associated with unrelenting, unwanted, persistent, intrusive, and spontaneous sensations such as pressure/discomfort, engorgement, pulsating, pounding and/or throbbing, in the genitalia and/or in the perineum and/or anus in the absence of conscious thoughts of sexual desire or sexual interest. Genito-pelvic dysesthesia / persistent genital arousal disorder is often associated with significant personal bother and distress.
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) may be classified into primary, lifelong if the PGAD/GPD is present throughout the person’s life or into secondary, acquired if the PGAD/GPD develops variably in later life. Persistent genital arousal disorder is associated with spontaneous orgasms or feelings that orgasm is imminent or feelings that orgasmic release is needed to reduce the feelings of persistent arousal, but where symptoms are not consistently diminished by achieving orgasmic release. Persistent genital arousal disorder is an uncommonly reported men’s sexual health concern.
PGAD/GPD symptoms include unrelenting, unwanted, persistent, intrusive, and spontaneous sensations such as pressure/discomfort, engorgement, pulsating, pounding and/or throbbing, in the genitalia and/or in the perineum and/or anus.
Little is known about what causes persistent genital arousal disorder/genito-pelvic dysesthesia. PGAD/GPD may be associated with psychological-related pathophysiologies, including depression and anxiety. Men with GPD/ PGAD have described that stress worsens PGAD/GPD symptoms, whereas distraction and relaxation strategies lower PGAD/GPD symptoms.
PGAD/GPD may be associated with biologic-related pathophysiologies including neurologic, and pharmacologic etiologies. Central neurologic causes may be secondary to Tourette’s Syndrome, epilepsy, post-blunt CNS trauma, post-neurosurgical intervention of central arteriovenous malformation, or to cervical and lumbosacral surgical interventions. Peripheral neurologic causes may be secondary to pudendal nerve entrapment or hypersensitivity. Pharmacologic causes may be secondary to use of certain antidepressants, such as ttrazodone, or secondary to sudden withdrawal of selective serotonin re-uptake inhibitors (SSRIs) as occurs in sudden SSRI discontinuation syndrome. Some cases of PGAD/GPD are idiopathic.
Therapeutic strategies have developed for men who seek management because of distress from PGAD/GPD. Psychologic-based treatments engage management of the depression, or focus on efforts to maximize relaxation, through strategies such as distraction, and/or hypnosis. Biologic-based treatments include ice or topical anesthetic agents. Discontinuing trazodone may provide relief. Surgical release of pudendal nerve entrapment may result in PGAD/GPD symptom improvement. Pharmacologic strategies have included use of tricyclic or SSRI antidepressants (e.g. clomipramine, paroxetine), prolactin-elevating agents (e.g. olanzapine, risperidone), anti-seizure medications (e.g. carbamazepine), use of the opioid agonist tramadol, use of the varenicline (a partial agonist at the nicotinic receptor subtype that decreases the ability of nicotine to stimulate the release of mesolimbic dopamine).
With the recent determination that a small defect in the sacral spinal nerve roots may be misread in the brain as persistent genital arousal, or persistent itching, minimally invasive spine surgery may cure PGAD/GPD in certain individuals. San Diego Sexual Medicine has a unique relationship with the Spine Institute of San Diego to diagnosis and treat women and men with PGAD/GPD from radiculopathy of the sacral spinal nerve roots. Click to learn more.
The International Society for the Study of Women's Sexual Health recently published a guideline regarding the diagnosis and treatment of PGAD/GPD. While it is focused on women, the results can be extrapolated for men. This is published in The Journal of Sexual Medicine and is a free downloadable pdf.
For those people with PGAD/GPD suffering who would like to connect with others in a safe way, please consider joining the moderated PGAD Support Group. You will be interviewed before being allowed to join to protect other members from potential predators. The founder of this page is our patient.