2 “Other women wonder how to have an orgasm … I wonder how to stop mine"
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
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):365-80
5 What is arousal in women?? Engorgement of sexual tissues such as nipples, vulva, clitoris, vaginal walls with vaginal lubricationIt is the counterpart of erection in menتم إزالة الصورة بواسطة الرقابة على المصنفات العلمية
7 Genital swelling &sensitivity± NippleswellingPersist for hours or days and do not subside completely on their own
8 2. Arousal is unrelatedto any sense of desireDifference from mania
9 3. arousal is triggered by sexual & non-sexual stimuliRiding a car or a trainUsing a washing machineVibrations of mobile phonesOr by no apparent stimulus
10 4. Symptoms return sudden ly, unpredictable and unwanted
11 5. The symptoms cause, at least, a moderate degree of distress 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 suicideTragedy as woman with debilitating sexual arousal disorder ... commits suicide, The Daily Mail, 4 Dec Retrieved Dec 2012
13 Ninety six randomly chosen women completed a questionnaire regarding spontaneous and persistent GA How frequent ?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 It may be experienced as mildly pleasurable or mildly annoying Awareness of sensations of genital arousal is quite normal for some womenIt may be experienced as mildly pleasurable or mildly annoyingLeiblum SR. Persistent Genital Arousal Disorder: What It Is and What It Isn’t. Contemporary Sexuality- Update. 2006, Vol. 40, No. 10
16 MEDICATIONS Trazodone (Trittico) SSRI Discontinuation 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): 3Goldmeier 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 restlesslegs syndromeRestless bladdersyndromeWaldinger MD, Schweitzer DH. Persistent genital arousal disorder in 18 Dutch. women. J Sex Med Feb;6(2):482-97AND
18 PGAD was linked with pudendal nerve entrapment during pregnancy Symptoms disappeared after physiotherapyRosenbaum 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 arteriesGoldstein 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; 2006:674-85Thorne C, Stuckey B. Pelvic congestion syndrome presenting as persistent genital arousal: a case report.J Sex Med (2):504-
20 “And where does this woman live?” ÷In many casesThe etiologyIs idiopathic“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
21 Leiblum published 3 papers about etiology of PGAD using web questionnaires(# 491)
32 Since the etiology is not established, No satisfactory treatment is available The following treatments were used in case reports
33 General measures Avoiding factors that induce PGAD Masturbation can lead to temporaryrelief of mild forms
34 In severe forms, orgasms only perpetuate symptoms Simple procedures such asusing ice packs on the areamay be helpfulGoldmeier et al. Persistent genital arousal disorder: a review of the literature and recommendations for management. Int J STD AIDS, 2009;20(6):373-7.
35 AnticonvulsantsPregabalin (Painica®) 75 mg in the morning and 100 mg in the eveningSymptoms disappeared for a 14 months follow up periodPhilippsohn 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®) 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 Varenicline (Champix®) symptoms relieved within 2 weeks but returned after 2weeksKorda 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):
38 Repeated ECT 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.
39 Surgeryy Surgical release of pudendal nerve entrapment has resulted in PGAD symptom improvementIrwin Goldstein. PGAD: Treatment.
40 The proposed treatments do not completely eliminate the condition They may help reduce the pain, stress and discomfortMariana A. PGAD in elderly women:A case study. J IMAB - Annual Proceeding (Scientific Papers) 2012, vol. 18, book 3