What to assess for persistent genital arousal disorder?

Assessment for Persistent Genital Arousal Disorder (PGAD)

A comprehensive evaluation for persistent genital arousal disorder requires a detailed medical, sexual, and psychosocial history, physical examination, and selective laboratory testing to identify potential etiologies and guide appropriate treatment.

Initial Assessment

Medical History

• Duration, onset, and pattern of unwanted genital arousal symptoms
• Presence of distress associated with symptoms
• Whether symptoms remit after orgasm
• Relationship to sexual stimulation or desire (typically absent in PGAD)
• Precipitating factors or events
• Comorbid conditions:
  • Neurological disorders (especially those affecting sacral nerves)
  • Vascular conditions
  • Pelvic floor dysfunction
  • Restless leg syndrome
  • Overactive bladder 1

Medication Review

• Current medications that may contribute to symptoms
• Recent medication changes, especially:
  • SSRIs or discontinuation of SSRIs
  • Hormonal treatments
  • Recreational drugs 1, 2

Sexual History

• Impact on sexual function and relationships
• Differentiation from other sexual disorders
• Prior sexual function
• Level of distress and interference with daily activities 3

Psychosocial Assessment

• Psychological comorbidities:
  • Anxiety
  • Depression
  • Obsessive-compulsive tendencies
  • History of sexual trauma
  • Relationship difficulties 4

Physical Examination

Genital Examination

• Assessment for pelvic floor muscle hypertonicity
• Evaluation for pudendal neuralgia
• Examination for vascular abnormalities
• Assessment for Tarlov cysts or other spinal/pelvic abnormalities 3, 5

Neurological Examination

• Evaluation of sacral dermatomes
• Assessment of pelvic floor reflexes
• Testing for peripheral neuropathy 4

Diagnostic Testing

Laboratory Tests

• Hormonal profile (including testosterone levels in women)
• Glucose/HbA1c to rule out diabetes-related neuropathy
• Thyroid function tests 3

Imaging Studies (as indicated)

• Pelvic MRI to evaluate for:
  • Tarlov cysts
  • Spinal lesions
  • Pelvic masses
  • Vascular abnormalities 4, 6

Specialized Testing

• Pudendal nerve conduction studies (if pudendal neuralgia is suspected)
• Pelvic floor EMG to assess muscle tension
• Doppler ultrasound to evaluate pelvic blood flow 1, 4

Validated Assessment Tools

• Use of validated questionnaires to document severity and track treatment response
• Consider the Brief Sexual Symptom Checklist as a screening tool 3

Multidisciplinary Approach

PGAD often requires assessment from multiple specialists:

• Gynecologist/urologist
• Neurologist
• Physical therapist with pelvic floor expertise
• Psychologist/psychiatrist with sexual health expertise 4

Common Pitfalls to Avoid

• Dismissing symptoms as purely psychological
• Failing to consider multiple potential etiologies
• Not addressing the significant psychological distress associated with the condition
• Missing comorbid conditions that may contribute to symptoms 6

PGAD is a complex condition that often has overlapping physical and psychological components. A thorough assessment is essential to identify potential contributing factors and develop an effective treatment plan. The condition causes significant distress and impacts quality of life, making prompt and comprehensive evaluation crucial 1, 2.