Abstract

Persistent genital arousal disorder (PGAD), originally called persistent sexual arousal syndrome (PSAS), Weiss Disease, and also known as restless genital syndrome (ReGS or RGS), results in a spontaneous, persistent, and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. It was only recently characterized as a distinct syndrome in medical literature with a comparable counterpart increasingly reported by men. It was studied as far back as 1986 and in the 90s was researched by the Dutch.

Some physicians use the term "persistent sexual arousal syndrome" to refer to the condition in women; others consider the syndrome of priapism in men to be the same disorder. Priapism was a recognized, diagnosable medical condition in the "Diagnostic and Statistical Manual of Mental Disorders" IV, whereas PGAD was not. With the release of the DSM-5 in 2013, PGAD was again not included as a listed condition.

In particular, it is not related to hypersexuality, sometimes known as nymphomania or satyriasis. (Hypersexuality, nymphomania, and satyriasis are also not recognized diagnosable medical conditions by the DSM-IV).

Signs and symptoms

Physical arousal caused by this syndrome can be very intense and persist for extended periods, days or weeks at a time. Orgasm can sometimes provide temporary relief, but within hours the symptoms return. The return of symptoms, with the exception of known triggers, is sudden and unpredictable. Failure or refusal to relieve the symptoms often results in waves of spontaneous orgasms in women and ejaculation in men. The symptoms can be debilitating, preventing concentration on mundane tasks. Some situations, such as riding in an automobile or train, vibrations from mobile phones, and even going to the toilet can aggravate the syndrome unbearably causing the discomfort to verge on pain. It is not uncommon for sufferers to lose some or all sense of pleasure over the course of time as release becomes associated with relief from pain rather than the experience of pleasure. Some sufferers have said that they shun sexual relations, which they may find to be a painful experience. The condition may last for many years and can be so severe that it has been known to lead to depression and even suicide.

A Dutch study has connected PGAD with restless legs syndrome.

Cause

There is not enough known about persistent genital arousal disorder to definitively pinpoint a cause. Medical professionals think it is caused by an irregularity in sensory nerves, and note that the disorder has a tendency to strike post-menopausal women, or those who have undergone hormonal treatment.

Treatment

Some drugs such as trazodone may cause priapism as a side effect, in which case discontinuing the medication may give relief. Additionally, the condition can sometimes start only after the discontinuation of SSRIs. In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the penis or clitoris; surgical treatment was effective in this case.

In other situations where the cause is unknown or less easily treatable, the symptoms can sometimes be reduced by the use of antidepressants, antiandrogenic agents, and anaesthetising gels. Psychotherapy with cognitive reframing of the arousal as a healthy response may also be used.

More recently, the symptoms of the condition have also been linked with pudendal nerve entrapment. Regional nerve blocks and less common surgical intervention have demonstrated varying degrees of success in most cases. There is, however, no evidence for the long-term efficacy of surgical intervention.

In one recent case, serendipitous relief of symptoms was noted from treatment with varenicline, a treatment for nicotine addiction.