Predictors of Psychosocial and Functional Outcomes in Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Application of the Fear-Avoidance Model

Abstract

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD), which affects up to 4.3% of individuals, is a distressing and poorly understood condition characterized by persistent, unwanted, and often painful sensations of genito-pelvic arousal (eg, throbbing) in the absence of sexual desire. PGAD/GPD is associated with significant negative impacts on psychosocial well-being and daily functioning. Recent research has indicated that PGAD/GPD shares many similarities with other forms of chronic genito-pelvic pain. This study applied the fear-avoidance model of chronic pain to PGAD/GPD to identify cognitive and behavioral factors associated with psychosocial and functional outcomes. A total of 263 individuals with PGAD/GPD symptoms completed a cross-sectional online survey of symptom intensity, cognitive and behavioral predictors (symptom catastrophizing, hypervigilance to symptoms, symptom fear and avoidance, self-efficacy), depression symptoms, and role functioning. Symptom catastrophizing, fear of symptoms, avoidance of symptoms, and hypervigilance to PGAD/GPD symptoms were significantly correlated with poorer psychosocial and functional outcomes, whereas higher self-efficacy was significantly associated with lower depression and better role functioning. Two serial parallel mediation models examined the fear-avoidance pathway from PGAD/GPD symptom intensity to depression symptoms and role functioning. In both models, the pathway through symptom catastrophizing, fear of symptoms, and symptom avoidance was significant, but the pathway through symptom catastrophizing, fear of symptoms, and symptom hypervigilance was not. The results of this study provide support for the applicability of the fear-avoidance model to PGAD/GPD. Interventions targeting fear-avoidance factors may help to reduce PGAD/GPD symptom intensity, distress, and increase psychological well-being and daily functioning. PerspectiveThis article provides support for the applicability of the fear-avoidance model of chronic pain to Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). These results suggest that interventions targeting fear-avoidance cognitions and behaviors (catastrophizing, fear, avoidance, hypervigilance) may help to reduce PGAD/GPD symptom intensity and improve psychological well-being and daily functioning.