Persistent Genital Arousal Disorder.pptx

Persistent genital arousal disorder which is not included in DSM-5.

1. Persistent Genital Arousal Disorder DR MIRZA NASRIN LINJA R-14 PHASE A RESIDENT DEPT OF PSYCHIATRY

2. CONTENT: DEFINITION EPIDEMIOLOGY ETIOLOGY CLINICAL FEATURES ASSESSMENT SEXUAL RESPONSE CYCLE RELATION WITH OTHER DISEASE INVESTIGATION TREATMENT 2

3. DEFINITION: Spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing) when sexual interest or desire is absent. Awareness of subjective arousal is infrequent but mostly unpleasant. The arousal is unrelieved by orgasms, and the feelings persist for hours or days. 3

4. EPIDEMIOLOGY: ~ It is very rare disease. ~ Affects only 1% of women. ~ More rare in male than women. ~ There is diverse in presentation— they may be young or old, heterosexual or homosexual, married or single, premenopausal, perimenopausal, or postmenopausal. 4

5. ETIOLOGY: Mostly unknown. Antidepressant discontinuation Cesarean section surgery Pressure on the genitals Increases and decreases in hormonal therapies Past sexual abuse Pelvic or pudendal nerve hypersensitivity. 5

6. CONTI… Excessive masturbation as a child Neurological damage Head injuries Seizure disorders. 6

7. FEATURES OF PGAD: • The physiological responses characteristic of sexual arousal (genital and breast Vaso congestion and sensitivity) persist for an extended period (hours to days), and do not subside completely on their own. • The signs of physiological arousal do not resolve with ordinary orgasmic experience, and may require multiple orgasms over hours or days to remit. 7

8. CONTINU… • These physiological signs of arousal are usually experienced as unrelated to any subjective sense of sexual excitement or desire. • The persistent sexual arousal may be triggered not only by sexual activity, but also by seemingly nonsexual stimuli or no apparent stimulus at all. 8

9. CONTINU… • The physiological signs of persistent arousal are experienced as uninvited, intrusive, and unwanted. 9

10. ASSESSMENT : 10

11. ASSESSMENT : 11

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13. KEY POINTS OF BASSON’S MODDEL: ~ Sexual desire is not prerequisite for the sexual response to be initiated. ~ Desire may be initiated after receiving pleasurable sexual stimuli. ~ According to this model sexual activity for women is personal satisfaction rather orgasm only. # Personal satisfaction for women are a) Physical satisfaction. (orgasm). b) Emotional satisfaction. (connection, feeling of intimacy). 13

14. MEDICATION AFFECTING SEXUAL RESPONSE : 14

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16. HYPERSEXUALITY AND PGAD: ~ Hypersexuality refers to excessive feelings of sexual desire with or without persistent genital arousal. ~ It is occasional symptom. ~ Patient feels satisfied after orgasm. 16

17. VULVODYNIA: Vulvodynia is  a chronic pain and discomfort in vaginal region  without evidence of infectious, inflammatory, or neoplastic causes. ~ It is a pain disorder. CAUSE: I diopathic, Chronic vaginal infections, Irritation, Trauma ~ Persists weeks to years. 17

18. The pain often is described as: Burning. Irritation. Stinging. Rawness. Soreness. Sharp or knife-like pain. A ching, throbbing and swelling. 18

19. PRIAPISM IN MEN: Priapism refers to a pathological condition of peripheral genital arousal that persists beyond or is unrelated to sexual stimulation. TYPES: 1. Low-flow priapism (Ischemic). 2. High-flow priapism (non ischemic). 3. Stuttering / recurrent priapism. 19

20. SSRIs AND PGAD: ~ SSRIs cause sexual dysfunction in 30-40%. ~ SSRIs such as paroxetine, Citalopram , Fluvoxamine , Fluoxetine and SNRIs such as Venlafaxine or Duloxetine has relation with PGAD symptoms. ~ Symptoms is associated with both start and discontinuation of these drugs. 20

21. PUDENDAL NERVE ENTRAPMENT AND PGAD: Pelvic nerve hypersensitivity plays important role. These are ~ The pudendal nerve , ilioinguinal nerve, genitofemoral nerve, and iliohypogastic nerve. M/A : B lood becomes trapped in the genital area ➤ hypertonicity of the pelvic muscles ➤ tremors or feelings of pressure in the genital area ➤ feelings of sexual arousal. 21

22. CONTI… Persistent engorgement of the pelvic erectile and vascular tissues may lead to chronic stimulation of the pelvic nerve endings and result in low-grade continuous symptoms of sexual arousal. This occurs in: Multiple childbirth Deliveries over 7 pounds Pelvic relaxation syndrome 22

23. CONTI… Cystocele or rectocele Urinary stress incontinence Uterine prolapse Pelvic varicosities on broad ligament. 23

24. INVESTIGATION: ~ Diagnosis is based on clinical history. ~ Some investigations can be helpful. Eg - Routing investigation. EEG, MRI. Hormonal test – Estrogen, Testosterone, Prolactin. Nitric oxide (NO). Vasoactive intestinal polypeptide (VIP). 24

25. TREATMENT: 1. Social Support. 2. Pelvic Massage. 3. S tretching exercise. 4. Cognitive-Behavioral Interventions. 5. Medication : ~ Anesthetizing agents. ~ Mood stabiliser.. Valporic acid. ~ SNRI. 25

26. Reference : 1. Clinical Manual of Sexual Disorders Edited by Richard Balon , M.D. Robert Taylor Segraves , M.D., Ph.D. 2. PRINCIPLES AND PRACTICE OF SEX THERAPY Fourth Edition . Edited by SANDRA R. LEIBLUM 26

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