Abstract
Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.
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Notes
All healthcare treatment occurred in British Columbia, Canada, which has a publicly funded universal health care system.
Existing literature has suggested that the nervous system, including the autonomic nervous system, may be involved in the etiology and/or maintenance of PGAD/GPD (Goldstein et al., 2021; Jackowich et al., 2016; Leiblum et al., 2007). Additionally, factors such as stress have been linked to the onset of PGAD/GPD symptoms (Goldstein et al., 2021). Since the autonomic nervous system responses to stress can include physiological changes such as increased blood pressure, nausea, and vomiting (Ziegler, 2012), it is possible that some of her symptoms which seem unusual with PGAD/GPD are better explained by her response to the stress of the COVID-19 pandemic. Further, several other studies mention similar symptoms (e.g., nausea, vomiting, weight loss, hypertension) being present in PGAD/GPD patients (Goldmeier & Leiblum, 2008; Kamatchi & Ashley-Smith, 2013; Oaklander et al., 2020; Scantlebury & Lucas, 2023).
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Acknowledgements
We would like to express our gratitude to the patient for her openness, willingness, and bravery; thank you for trusting us to tell your story. We would also like to acknowledge Dr. Melanie Altas for her guidance and support.
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Merwin, K.E., Brotto, L.A. Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach. Arch Sex Behav 52, 2249–2260 (2023). https://doi.org/10.1007/s10508-023-02617-3
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DOI: https://doi.org/10.1007/s10508-023-02617-3