(091) When Arousal Becomes a Burden – Clinical Insights from a Registry Study on Persistent Genital Arousal Disorder (PGAD)/Genito-Pelvic Dysesthesia (GPD)

Introduction Persistent genital arousal disorder (PGAD) / Genito-pelvic dysesthesia (GPD) is a disabling condition newly listed as a diagnosis in the ICD-11 nomenclature. It is characterized by prolonged, unwanted and intrusive genital arousal in the absence of sexual desire. The arousal does not subside after one or more orgasms, lasts for at least three months and may include other types of genito-pelvic dysesthesia. While the condition predominantly affects women, men and children can also be affected. Etiopathological considerations range from peripheral to central nervous system mechanisms. After exclusion of treatable somatic causes of PGAD/GPD, pharmacotherapy may be considered alongside non-pharmacological approaches; however, drugs may both alleviate symptoms and worsen / induce symptoms. Objective This study aimed to comprehensively characterize patients with Persistent Genital Arousal Disorder (PGAD) / Genito-Pelvic Dysesthesia (GPD) regarding symptom profiles, associated somatic and psychiatric comorbidities and treatment effects based on data from a clinical registry. Methods This study provides a comprehensive investigation of 92 patients with PGAD / GPD (86 women, 6 men). Assessments encompassed detailed characterisation of PGAD/GPD symptoms, evaluation of both beneficial and detrimental effects on pharmacotherapy, and systematic review of sexual, gynaecological, urological, somatic and psychiatric history, as well as clinical examinations and treatment outcomes. Results PGAD symptoms were predominantly described as persistent tingling sensations, localized to the clitoris or glans penis in over 80% of cases. 50% of patients reported extragenital symptoms and 34% experienced GPD symptoms. Frequent manifestations included swelling of the genitals (46%), spontaneous orgasms (30%), and extraordinary lubrication (27%). Major triggers comprised mental stress (51%), sitting (35%), wearing tight clothes (28%) and vibration (28%), whereas distraction (38%), physical exercise (33%), and warmth (24%) provided relief. Half of the patients reported increased urinary urgency, 40% indicated symptoms of overactive bladder, and approximately one-third described restless legs symptoms. Sexual impairment was present in 57%, while psychiatric comorbidities – most notably depression – were reported in nearly 70%. Diagnostic procedures included urogynaecological and neurological examinations as well as MRI of brain, spinal cord and pelvis. In the majority, a clear somatic correlate of PGAD/GPD was not found. Non-pharmacological interventions comprised physiotherapy, psychotherapy, TENS, neurosurgical procedures, or pudendal nerve block, with psychotherapy and physiotherapy rated as most effective. Pharmacologically, SSRIs, SNRIs, cannabinoids, and anticonvulsants (pregabalin and gabapentin) demonstrated symptom-relieving effects. However, in 28% of cases within our registry, serotonergic medications were also reported to trigger or worsen PGAD/GPD symptoms during treatment or upon discontinuation. Conclusions This is the first registry study to include a substantial number of patients affected by PGAD / GPD. Understanding of the etiopathogenesis of the condition remains limited and pharmacotherapy is likewise still in its early stages. Clinicians should be aware of PGAD / GPD, perform careful diagnostic evaluations and develop individualized treatment plans in collaboration with patients, including a discussion of potential risks and benefits. Disclosure No