Challenges in the Treatment of Persistent Genital Arousal Disorder: a Case Report

Abstract

Background Persistent genital arousal disorder (PGAD), or persistent sexual arousal syndrome (PSAS), causes spontaneous genital arousal without sexual stimuli, typically not relieved by orgasm. It affects 1-4% of the population, mostly women. The etiology can be of various mechanisms, therefore complicating the treatment process. Management primarily focuses on self-help measures to reduce neuromuscular hypersensitivity. Case Report A 42-year-old woman complained of clitoral spasms and discomfort, pelvic pain, and spontaneous orgasms several times a day and night, with sporadic flare-ups worsened by sitting or exercise lasting daily for 7 months. Painful intercourse was indicated in previous history, yet she did not sought medical help. Amitriptyline provided slight relief. She previously had lower back pain, that resolved after rehabilitation. MRI showed moderate lumbar degeneration and an ovarian cyst, for which she underwent surgery, providing no relief on her symptoms. Examination revealed hyperactive pelvic floor muscles (PFM), vestibular hypersensitivity and mild overactive bladder symptoms. The patient underwent twelve 1-hour curative sessions, including manual vaginal trigger point release, vestibular desensitization, circulation stimulation via vibration (3-5 min), dilator use (5 min), and twelve 14-minute sessions of external High-Intensity Laser Therapy (HILT) (120J/cm2, 12W, continuous wave). She was also thought self-help techniques, such as internal myofascial release for perineal and PFM desensitizing using digital feedback, though she found the internal method unpleasant and mainly was consistent with external self-help. Additionally, she performed daily TENS for posterior tibial nerve stimulation (10Hz, 250µsec), reverse Kegels, superficial heat therapy (20min/day), bladder training, and muscle stretching exercises, continuing Amitriptyline. After the last visit, her symptoms resolved and remained in remission for 5-6 months. Later an intestinal infection and stress likely triggered PFM tension resulting in relapse. She was advised to intensify self-help, stretching and TENS. Within two weeks her symptoms resolved completely, with no further relapses to date. Conclusions This case emphasizes the complexity of PGAD, where multiple factors play a role in symptom persistence and relapse. A structured multimodal treatment approach should be personalized and adapted for specific patients, therefore enhancing the chances of recovery.