Persistent genital arousal disorder: A neurodevelopmental hypothesis

Abstract

Persistent Genital Arousal Disorder (PGAD) is characterized by sensations of genital arousal, unrelated to any subjective sense of sexual desire. These symptoms, which affect mainly women, are described as intrusive, very painful, associated with feelings of shame, and often lead to severe anxiety disorders, depression, self-harm, suicidal ideation and even suicide. Several organic etiologies have been proposed and various treatments attempted, generally introduced by iterative trial and error, some invasive or dangerous. However, several studies mention the high frequency of past sexual abuse among these patients (about 50%). As their clinical presentations often include several psychological symptoms, these patients may have received different psychiatric diagnoses, mainly borderline personality disorder or bipolar disorder. In these cases, however, PGAD is best considered a dissociative disorder: this bodily experience is a form of depersonalization and the sensations can be considered as a somatoform dissociative symptom. Dissociative disorders are clearly associated with interpersonal violence, especially childhood abuse or neglect (Dutra, Bureau, Holmes, Lyubchik, & Lyons-Ruth, 2009). The purpose of this article is twofold: first, it summarizes the main studies published in English on this subject, second, it draws on our clinical experience and on the various publications on post-traumatic somatoform dissociative disorders to describe the neurodevelopmental hypothesis and the type of treatment that results from them, which are rarely mentioned in the literature on PGAD.