1. A HUNDRED ORGASMS A DAY: PGAD
Prof ihab younis

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 lubrication
It is the counterpart of erection in men
تم إزالة الصورة بواسطة الرقابة على المصنفات العلمية

6. components

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

8. 2. Arousal is unrelated
to any sense of desire
Difference from mania

9. 3. arousal is triggered by sexual
& non-sexual stimuli
Riding a car or a train
Using a washing machine
Vibrations of mobile phones
Or 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 suicide
Tragedy 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 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

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): 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):482-97
AND

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
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
Thorne 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 cases
The etiology
Is 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)

22. Some findings in the 3 studies

23. The
average
age was
40.05 ±12.5

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

25. The longest period without symptoms
PGAD Non-PGAD
< 24 hours % %
< one week % %

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

27. Psychiatric health PGAD Non-PGAD Depression 57.9% 39.6%
Anxiety % %

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

29. Negative feelings about PGAD
PGAD Non-PGAD
Frustrated % %
Distracted % %
Worried % %
Depressed % %
Negative feelings about PGAD

30. Positive feelings about PGAD
PGAD Non-PGAD
Sexy % %
Pleased % %

31. TREATMENT

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 temporary
relief of mild forms

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):373-7.

35. Anticonvulsants
Pregabalin (Painica®) 75 mg in the morning and 100 mg in the evening
Symptoms disappeared for a 14 months follow up period
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®)
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 2weeks
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):

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 improvement
Irwin Goldstein. PGAD: Treatment.

40. The proposed treatments do not completely eliminate the condition
They may help reduce the pain, stress and discomfort
Mariana 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