Persistent genital arousal disorder: a review of the literature and recommendations for management. BASHH special interest group for sexual dysfunction

Female sexual arousal can be classified into subjective and genital arousal. Until recently the term sexual arousal disorder had been used to denote absent or diminished response of genital or subjective sexual arousal which evokes distress in the woman. In 2001 Leiblum and Nathan published details of five women who rather than having low or absent genital arousal appeared to complain of persisting heightened genital arousal. They described the condition as persistent sexual arousal syndrome (PSAS). In fact Riley in the UK had published details of a woman with a similar clinical picture some years earlier, and it is possible that Soranus of Ephesus alluded to the condition in the text ‘Midwifery and diseases of women’ in the second century AD. In 2004, PSAS was recognized as a clinical entity by an International Definitions Committee. Leiblum subsequently renamed it as the persistent genital arousal disorder (PDAD) (see below). PGAD had until recently been rarely reported, implying it is a rare condition. However, a recent study of its prevalence in young women would suggest that as many as 1% of young women have the full-blown syndrome (L Garvey, personal communication). Sexual dysfunction is a sensitive issue and one that may be difficult to talk about. Recent population studies have highlighted low rates of women seeking medical or psychological help for sexual dysfunction despite reporting a high prevalence. This may well be for sociocultural and economic reasons. Women suffering from PGAD may have feared being labelled as ‘mad’ by clinicians unfamiliar with the condition and thus not have sought help. In this light, we wish to present here the data published to date on PGAD and give recommendations as to how such women may be best clinically managed.