The ISSWSH Process of Care for PGAD/GPD Also Applies to Men: Insights from the 27th SMSNA Annual Meeting
On Saturday, October 10, at the 27th Annual SMSNA Fall Scientific Meeting, Dr. Sarah Cigna detailed a practical, region-based algorithm for evaluating and managing persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) in men and women. PGAD involves persistent or recurrent, unwanted sensations of genital arousal that are not necessarily associated with sexual desire, while GPD encompasses other uncomfortable or unwanted genito-pelvic sensations. These conditions can cause significant distress and negatively affect sexual function and daily activities. Dr. Cigna emphasized that identifying where symptoms originate can help clinicians determine which areas to evaluate and target for treatment.
The region-based approach recognizes that PGAD/GPD symptoms may originate from five different regions, even when the sensations are experienced in the genitals:
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Region 1: End organ. Symptoms may arise from local conditions, including skin changes, irritation, or genital adhesions. The key is to identify where the sensations originate and whether a local condition is contributing.
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Region 2: Pelvis/perineum. Pelvic floor dysfunction, pudendal neuropathy, and vascular conditions may contribute to symptoms. Dr. Cigna emphasized the importance of considering pelvic structures and organs when evaluating PGAD/GPD.
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Region 3: Cauda equina. Conditions affecting the sacral spinal nerve roots, including nerve compression, may contribute to genitopelvic symptoms.
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Region 4: Spinal cord. Spinal cord abnormalities may contribute to symptoms and warrant evaluation by a spine specialist when indicated.
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Region 5: Brain. Brain pathways involved in processing genital sensations may contribute to PGAD/GPD symptoms, making this region particularly complex to evaluate.
Dr. Cigna explained that the numbered regions provide a systematic way to identify potential causes of symptoms. Clinicians should begin with the end organ and pelvis before considering more central neurological causes. Depending on the patient's symptoms, topical anesthetics or diagnostic nerve blocks may help identify the source of the sensations. She recommended the International Society for the Study of Women's Sexual Health (ISSWSH) Process of Care document for PGAD/GPD as a starting point for clinicians evaluating and managing these conditions.
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