Persistent Genital Arousal Disorder: Current Conceptualizations and Etiologic Mechanisms
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Purpose of review
Persistent genital arousal disorder (PGAD), characterized in 2001, persists as a distressing malady that is not well appreciated, understood, or treated by healthcare providers. This review describes the characteristics of PGAD, hypotheses regarding its etiology, therapies, and recent findings that provide evidence of PGAD as a genital sensory neuropathy.
PGAD can result from (a) Tarlov cysts, which contain aberrant sensory nerve fibers and form on the genital sensory nerves where they abrade on the entrance to the sacrum, and/or (b) herniated intervertebral disc-produced irritation of the roots of those genital sensory nerves as they course through the cauda equina within the spinal canal.
Local genital anesthesia or peripheral nerve block often fails to alleviate PGAD symptoms. In that case, the possibility that genital sensory nerve root irritation (i.e., radiculopathy) “upstream” at the entrance to, or within, the spinal canal should be suspected and assessed, optimally by lumbo-sacral-oriented MRI. Imaging can reveal the presence of Tarlov cysts and/or herniated intervertebral disc impingement on the cauda equina, which could provoke PGAD symptoms in women and men and may be treatable. Chronic irritative radiculopathy could eventually affect nerve conduction deleteriously and thereby attenuate genital afferent and/or efferent activity, leading to genital paresthesias, anorgasmia, or anejaculation.
KeywordsPersistent genital arousal disorder PGAD Tarlov cyst Cauda equina syndrome Genital nerve Anorgasmia
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Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article contains no studies with human or animal subjects performed by any of the authors.
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