International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

BackgroundPersistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations arousal, is associated with significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood.AimTo characterize this complex more accurately, review the epidemiology pathophysiology, provide new nomenclature guidance for evidence-based management.MethodsA panel experts reviewed pertinent literature, discussed research clinical experience, used modified Delphi method to reach consensus concerning nomenclature, etiology, factors. Levels evidence grades recommendation were assigned diagnosis treatment.OutcomesThe was broadened genito-pelvic dysesthesia (GPD), biopsychosocial diagnostic treatment algorithm PGAD/GPD developed.ResultsThe recognized term does not fully constellation GPD symptoms experienced by patients. Therefore, inclusive adopted, which maintains primacy distressing acknowledges bothersome GPD. While there are diverse contributors, common underlying neurologic basis attributable spontaneous intense activity region represented somatosensory cortex its projections. A process care strategy developed guide clinician, whenever possible, localizing as originating any five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, (v) brain. Psychological strategies considered critical should be performed conjunction medical strategies. Pharmaceutical interventions based on their site mechanism action reduce patients’ bother distress.Clinical ImplicationsThe uses personalized, approach treatment.Strengths LimitationsStrengths Limitations: Strengths characterization consensus, analysis, rational treatment. Future investigations into etiology outcomes recommended. The main limitations dearth knowledge current literature consists primarily case reports expert opinion.ConclusionWe provide, time, an pathophysiology development management extremely sexual health prevalent than previously recognized.Goldstein I, Komisaruk BR, Pukall CF, et al. International Society Study Women’s Sexual Health (ISSWSH) Review Epidemiology Pathophysiology, Consensus Nomenclature Process Care Management Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665–697.