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A HUNDRED ORGASMS A DAY: PGAD PROF IHAB YOUNIS www.redsulfur.net 1.

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Presentation on theme: "A HUNDRED ORGASMS A DAY: PGAD PROF IHAB YOUNIS www.redsulfur.net 1."— Presentation transcript:

1 A HUNDRED ORGASMS A DAY: PGAD PROF IHAB YOUNIS 1

2 “Other women wonder how to have an orgasm … I wonder how to stop mine" 2

3 “When I describe it to men, I tell them, ‘Imagine having an erection that does not go down, all day, all night, no matter how many times, no matter how much you’ve destroyed the skin on your penis” Gretchen Molannen (39), who suffered from PGAD for 16 years, was found dead of a suicide in her Spring Hill, Fla., home the day after a story she had participated in with the Tampa Bay Times appeared online 3

4 The disorder was first described by Leiblum &Nathan in 2001 They reported five cases and named it ”persistent sexual arousal syndrome (PSAS)” Leiblum SR, Nathan SG: Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality. J Sex Marital Ther Jul-Sep;27(4):

5 What is arousal in women? ? Engorgement of sexual tissues such as nipples, vulva, clitoris, vaginal walls with vaginal lubrication It is the counterpart of erection in men 5 تم إزالة الصورة بواسطة الرقابة على المصنفات العلمية

6 COMPONENTS 6

7 7 Genital swelling & sensitivity ± Nipple swelling Persist for hours or days and do not subside completely on their own

8 Difference from mania 8 2. AROUSAL IS UNRELATED TO ANY SENSE OF DESIRE

9 Riding a car or a train Using a washing machine Vibrations of mobile phones Or by no apparent stimulus 9

10 10

11 11 Goldmeier D et al:Persistent genital arousal disorder: a review of the literature and recommendations for management. Internat J STD & AIDS 2009; 00: 1–5

12 Some sufferers avoid sexual relations, because they find it a painful experience The condition may last for many years and can be so severe leading to depression & even suicide 12 Tragedy as woman with debilitating sexual arousal disorder... commits suicide, The Daily Mail, 4 Dec Retrieved Dec 2012

13 How frequent ? 13 Ninety six randomly chosen women completed a questionnaire regarding spontaneous and persistent GA Garvey LJ, West C, Latch N, Leiblum S, Goldmeier D. Report of spontaneous and persistent genital arousal in women attending a sexual health clinic. Int J STD AIDS Aug;20(8):

14 14 Awareness of sensations of genital arousal is quite normal for some women It may be experienced as mildly pleasurable or mildly annoying Leiblum SR. Persistent Genital Arousal Disorder: What It Is and What It Isn’t. Contemporary Sexuality- Update. 2006, Vol. 40, No. 10

15 CLOUDY ETIOLOGY 15

16 MEDICATIONS Trazodone ( Trittico) SSRI Discontinuation 16 Finger, William W., Lund, Margaret and Slagel, Mark A. "Medications that may contribute to sexual disorders: a guide to assessment and treatment in family practice". J Fam Pract, 1997, 44 (1): 3 Goldmeier D, Leiblum SR. Persistent genital arousal in women - a new syndrome entity. Int J STD & AIDS, 2006; 17:215-6.

17 NEUROLOGICAL DYSFUNCTIONS Associated with restless legs syndrome Restless bladder syndrome Waldinger MD, Schweitzer DH. Persistent genital arousal disorder in 18 Dutch. women. J Sex Med Feb;6(2): AND

18 18 PGAD was linked with pudendal nerve entrapment during pregnancy Symptoms disappeared after physiotherapy Rosenbaum T Y.Physical Therapy Treatment of Persistent Genital Arousal Disorder During Pregnancy: A Case Report. J Sex Med 2010;7:1306–1310

19 VASCULAR CAUSES Varices in the pelvis,vagina & nearby structures Arteriovenous malformations in clitorial arteries 19 Thorne C, Stuckey B. Pelvic congestion syndrome presenting as persistent genital arousal: a case report.J Sex Med (2):504- Goldstein I, De EJB, Johnson J. Persistent sexual arousal syndrome and clitoral priapism. In: Goldsein I, Meston C, Davis S, Traish A, eds. Women’s sexual function and dysfunction: study, diagnosis and treatment. London: Taylor and Francis; 2006:674-85

20 “And where does this woman live?” ÷ Nappi R, Salenia A, Traish AM et al. Clinical biologic pathophysiologies of women’s sexual dysfunction. J Sex Med 2005;2:4-25 Inn 20 In many cases The etiologyIs idiopathic

21 Leiblum published 3 papers about etiology of PGAD using web questionnaires(# 491) 21

22 Some findings in the 3 studies 22

23 23 The average age was ±12.5

24 Arousal PGAD Non-PGAD Unrelated to desire 100% 62.5% Does not resolve by orgasm 100% 66.7% Intrusive 100% 66.7% Cause at least mod.distress 100% 58.3% 24

25 The longest period without symptoms PGAD Non-PGAD < 24 hours 41.2% 22.2% < one week 26.5% 31.1% 25

26 Physical health Back pain Thyroid problems Hypo and Hypertension Neurological problems Diabetes Chronic fatigue syndrom* *Significant difference between PGAD & Non-PGAD 26

27 Psychiatric health PGAD Non-PGAD Depression 57.9% 39.6% Anxiety 42.1% 27.1% 27

28 Sexual abuse PGAD Non-PGAD As a child 52.6% 43.8% As an adult 35.5% 22.9% Did it contribute to your persistent arousal 11.8% 16.7% 28

29 Negative feelings about PGAD PGAD Non-PGAD Frustrated 85.5% 56.3% Distracted 76.3% 58.3% Worried 56.6% 35.4% Depressed 44.7% 27.1% 29

30 Positive feelings about PGAD PGAD Non-PGAD Sexy 17.1% 41.7% Pleased 14.5% 31.3% 30

31 TREATMENT 31

32 Since the etiology is not established, No satisfactory treatment is available The following treatments were used in case reports 32

33 General measures Avoiding factors that induce PGAD Masturbation can lead to temporary relief of mild forms 33

34 In severe forms, orgasms only perpetuate symptoms Simple procedures such as using ice packs on the area may be helpful Goldmeier et al. Persistent genital arousal disorder: a review of the literature and recommendations for management. Int J STD AIDS, 2009;20(6):

35 Anticonvulsants Pregabalin (Painica ® ) 75 mg in the morning and 100 mg in the evening Symptoms disappeared for a 14 months follow up period 35 Philippsohn S & Kruger T H, PGAD:Successful treatment with Duloxtine&Pregabalin in two cases. J Sex Med, 2012;9(1):213-7.

36 Antipsychotics Olanzapine (Zyprexa®) Risperidone (Risperdal®) 36 Wylie K, Levin R, Hallam-Jones R, Goddard A. Sleep exacerbation of persistent sexual arousal syndrome in a post menopausal woman.J Sex Med 2006;3:296–302.

37 Smoking cessation drug Korda JB, Pfaus JG, Goldstein I.Persistent Genital Arousal Disorder: ACase Report in a Woman with Lifelong PGAD Where Serendipitous Administration of Varenicline TartrateResulted in Symptomatic Improvement.J Sex Med. 2009;6(5): Varenicline (Champix®) symptoms relieved within 2 weeks but returned after 2weeks

38 ECT Repeated ECT Produced +ve outcome Yero SA, et al. Successful use of electroconvulsivetherapy in 2 cases of persistent sexual arousal syndrome and bipolar disorder. J ECT 2006;22:274–5. 38

39 Surgery y 39 Surgical release of pudendal nerve entrapment Irwin Goldstein. PGAD: Treatment. women/treatment/2010 has resulted in PGAD symptom improvement

40 They may help reduce the pain, stress and discomfort 40 The proposed treatments do not completely eliminate the condition M ARIANA A. PGAD in elderly women:A case study. J IMAB - Annual Proceeding (Scientific Papers) 2012, vol. 18, book 3

41 A HUNDRED ORGASMS A DAY: PGAD THANK YOU 41


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