Persistent genital arousal disorder/Genito-pelvic dysesthesia in all genders: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)

Abstract Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), a sensory hyperactivity condition, involves a broad range of undesired, unrelenting dysesthesia(s), including genital arousal, hard flaccid syndrome, and sleep-related prolonged erection. PGAD/GPD is associated with significant, negative psychosocial consequences, including suicidal ideation. In 2021, the International Society for the Study of Women’s Sexual Health developed a process of care for biopsychosocial management of PGAD/GPD in women. This article reviews the management of PGAD/GPD in all genders. Objectives A consensus guideline for management of PGAD/GPD in all genders was developed based on the understanding that this complex condition may be triggered by multiple pathophysiologic factors. Methods The International Consultation for Sexual Medicine identified co-chairs to organize a consensus committee on PGAD/GPD and select an expert multidisciplinary panel. They reviewed literature, basic science, and clinical data, using a modified Delphi method to reach a consensus on the background, diagnostic procedures, and therapeutic options. Results PGAD/GPD occurs in women and men with similar prevalences, from which we can infer that a substantial number of individuals are adversely affected by PGAD/GPD. While sensory hyperactivity is perceived as located in the genito-pelvic region, symptoms can originate from any of 5 regions: region 1, the end organ; region 2, the pelvis/perineum; region 3, the cauda equina; region 4, the spinal cord; and region 5, the brain. The experts reviewed region-based pathophysiologic triggers, diagnostic procedures, and biopsychosocial treatment strategies based on the location of the trigger(s). Psychological and medical treatments should be performed concomitantly. Conclusion Although PGAD/GPD is associated with significant morbidity, it is still underrecognized by healthcare practitioners. It is strongly recommended that individuals of all genders be safely and effectively managed following the process-of-care diagnostic algorithm that systematically examines the 5 regions to localize the dysesthesia trigger(s). The algorithm emphasizes using psychological and medical interventions in parallel throughout the process, with interventions based on the location(s) of the identified trigger(s).