Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach

• Published in: Archives of sexual behavior Vol. 52; no. 5; pp. 2249 - 2260
• Main Authors: Merwin, Kathleen E., Brotto, Lori A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2023; Springer Nature B.V
• Subjects: Arousal - physiology; Behavior modification; Behavioral Science and Psychology; Case reports; Clinical Case Report Series; Cognition & reasoning; Cognitive therapy; COVID-19; Emotional regulation; Female; Genitalia; Humans; Middle Aged; Mindfulness; Pandemics; Paresthesia - complications; Psychology; Public Health; Quality of Life; Self compassion; Sexual Behavior; Sexual disorders; Sexual Dysfunctions, Psychological - diagnosis; Sexual Dysfunctions, Psychological - therapy; Social Sciences; Urogenital system; Dialectical behavior therapy; DSM-5; Mindfulness; Persistent genital arousal disorder; Genitopelvic dysesthesia; Cognitive behavioral therapy
• ISSN: 0004-0002; 1573-2800
• DOI: 10.1007/s10508-023-02617-3

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.