Online pelvic floor group education program for women with persistent genital arousal disorder/genito-pelvic dysesthesia: Descriptive feasibility study

Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms

Healthcare experiences of individuals with persistent genital arousal disorder/genito-pelvic dysesthesia

ntroduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent, unwanted sensations of genital arousal (eg, feelings of being on the verge of orgasm, and of lubrication, swelling, tingling, throbbing) that occur in the absence of sexual desire. Although PGAD/GPD is associated with significant impairments in psychosocial functioning, the healthcare (HC) experiences of affected individuals are not well understood. Aim The aims of this study were to examine the barriers to HC, the costs of HC, and the associations among HC experiences, symptoms, and psychosocial outcomes in those with PGAD/GPD symptoms. Methods One hundred and thirteen individuals with PGAD/GPD symptoms completed an online, cross-sectional self-report questionnaire about their HC history and experiences. Main Outcome Measures Self-reported HC barriers, and financial costs associated with PGAD/GPD HC. Validated measures of HC experiences (eg, comfort communicating with HC practitioners [HCPs]), and psychosocial (eg, depression, anxiety) and PGAD/GPD symptom outcomes. Results The majority of participants (56.6%) reported waiting at least 6 months to seek HC for PGAD/GPD symptoms. Those who sought HC approached many HCPs (46.0% approached 6+ HCPs). Several barriers to HC were identified (eg, lack of HCP knowledge of PGAD/GPD), and high costs were reported. A series of multiple linear regression analyses found an association between HC experiences, psychosocial, and symptom outcomes. Specifically, decreased comfort communicating with one's HCP was associated with greater depressive and anxiety symptoms. Conclusion High costs and numerous barriers to seeking HC for PGAD/GPD symptoms were identified, and discomfort communicating with an HCP about PGAD/GPD was associated with increased symptoms of depression and anxiety. These results highlight the need for more awareness of this condition in order to improve care for this population

International Society for the Study of Women's Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)

Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed

Sexual arousal disorders

Sexual arousal disorders are characterized by concerns with subjective feelings of sexual pleasure and associated physiological changes (American Psychiatric Association 2013). These sexual arousal concerns may be persistent or recurring, situational or generalized, and lifelong or acquired. Sexual arousal disorders are associated with distress or inability to engage in sexual activity that the individual wishes, and they are not better accounted for by substance use, a general medical condition, or another nonsexual mental disorder such as major depressive disorde

Persistent genital arousal disorder: a biopsychosocial framework

Purpose of Review Persistent genital arousal disorder (also referred to as genitopelvic dysesthesia or PGAD/GD) is a distressing and largely underrecognized condition characterized by persistent, unwanted genital arousal (sensations, sensitivity, vasocongestion) in the absence of subjective/cognitive arousal and sexual desire. The purpose of this review is to summarize recent findings on biological and psychosocial factors in PGAD/GD as they pertain to the assessment and treatment of this condition. These findings will be considered within a biopsychosocial framework, for the purposes of considering next steps for clinical and research efforts. Recent Findings A small number of studies have recently examined potential biological aetiologies for PGAD/GD: pharmacological agents, spinal pathology and peripheral nerve involvement. Recent studies have also found that PGAD/GD is associated with a significant negative impact on psychosocial wellbeing and daily functioning as compared to symptom-free individuals. In addition, these results highlight cognitive/affective responses to symptoms (e.g. catastrophizing of symptoms) that may influence outcomes. However, biological and psychological research are rarely integrated in these studies, despite the interrelationship between these factors. Summary Although PGAD/GD was first described in the scientific literature almost two decades ago, most research on PGAD/GD is presented in the form of case studies. Prospective treatment trials that integrate biopsychosocial factors are needed in order to provide effective and efficient care to this population. This research would be facilitated by the development of a patient-reported outcome measure, as well as greater education/awareness among healthcare providers and the public about this distressing condition

A comparison of medical comorbidities, psychosocial, and sexual well-being in an online cross-sectional sample of women experiencing persistent genital arousal symptoms and a control group

Background Persistent genital arousal disorder (PGAD) is characterized by symptoms of distressing physiological sexual arousal (Persistent genital arousal [PGA] symptoms such as genital vasocongestion, sensitivity, or both) that occur in the absence of sexual desire. There continues to be a lack of systematic research on this condition. Little is known about the common medical comorbidities and psychological, sexual, or relationship well-being of individuals who experience PGA symptoms. Aims To compare these biopsychosocial factors in an age-matched sample of women with and without symptoms of PGA. A secondary aim was to examine what symptom factors (associated distress, symptom severity) and cognitive factors (eg, catastrophizing of vulvar sensations) were associated with psychosocial outcomes in women with symptoms of PGA. Methods Age-matched samples of women with (n = 72) and without (n = 72) symptoms of PGA completed a comprehensive online survey. Main Outcome Measures Participants self-reported their medical histories and completed validated measures of psychosocial functioning (depressive and anxiety symptoms, catastrophizing of vulvar sensations, sexual functioning and distress, and relationship functioning). Results Women with symptoms of PGAD reported significantly greater depressive and anxiety symptoms, sexual distress, and suicidal ideation, as well as significantly poorer relationship functioning than women without PGA symptoms. Catastrophizing of vulvar sensations was related to PGA symptom ratings (greater severity, distress) and psychosocial outcomes (greater depression, anxiety, and sexual distress). Clinical Implications The results of this study highlight medical and psychosocial difficulties associated with PGA symptoms, which should be assessed and addressed as essential components of treatment. Strengths & Limitations This study seeks to address the paucity of research on the well-being of women with PGA symptoms by undertaking a comparison of age-matched samples using validated questionnaires. This study is limited by its self-report, cross-sectional design. Conclusion PGA symptoms are associated with significant health and psychological difficulties. These results highlight the need for continued research in this area to improve identification and treatment for this population

Pain characteristics, psychosocial wellbeing, and sexual wellbeing of women diagnosed with provoked vestibulodynia and a history of sexual abuse

Objective Provoked vestibulodynia (PVD) is a common chronic pain condition characterized by pain at the vulvar vestibule elicited by touch. Both PVD and sexual abuse lead to negative psychosocial and sexual consequences. However, little is known about the wellbeing of women with PVD and a history of sexual abuse. The aim of this study was to characterize a sample of women seeking treatment for PVD who have experienced sexual abuse. Methods A total of 404 women diagnosed with PVD completed self-report questionnaires of PVD symptoms and psychosocial and sexual wellbeing before and after participating in a multidisciplinary PVD treatment program. History of sexual abuse was assessed via self-report, and women were dichotomized into groups. Results No significant differences were found on sociodemographic variables, baseline psychosocial or sexual functioning between women with and without a self-reported history of sexual abuse (n = 40 and n = 364, respectively). Significantly more women with a history of sexual abuse than without reported other comorbid chronic pain conditions and radiating PVD pain. History of sexual abuse did not affect improvements in sexual distress scores following multidisciplinary treatment for their PVD. Conclusion Ten percent of women in our sample self-reported a history of sexual abuse, but the two groups did not differ significantly with respect to their baseline psychosocial or sexual functioning concerns, and both groups reported reductions in sexual distress following treatment for PVD. These findings indicate that a history of sexual abuse does not significantly affect the efficacy of multidisciplinary treatment approaches for PVD

A scoping study of insomnia symptoms in school teachers

Objectives Although the demands and stress of teaching are generally recognized, little is known about the prevalence and nature of insomnia symptoms in teachers. This scoping study investigated the following questions: How prevalent are insomnia symptoms in teachers? What biopsychosocial variables are associated with insomnia symptoms in teachers? What, if any, interventions for insomnia symptoms in teachers have been studied? Method We searched Medline, PsycINFO, Embase, CINAHL, Education Source, and ERIC for original peer-reviewed research on school teachers (kindergarten through high school) and insomnia symptoms (self-reported trouble falling or staying asleep). Results We identified 33 relevant articles from 15 countries. The literature was heterogeneous and generally of low quality with respect to the measurement of insomnia. Based on studies that met validity and reliability criteria, 36–61% of teachers reported insomnia symptoms. Associated factors included: being female, classroom violence, low job satisfaction, pain, depression, and rumination. One online intervention, which included stimulus control, sleep restriction, and techniques for reducing rumination, provided evidence of efficacy. Conclusion Despite the importance of teachers and their work, high-quality research on insomnia in teachers is lacking. Research in this area is sorely needed. Studies should investigate insomnia symptoms over the school year, identify antecedents of insomnia, and develop interventions with the ultimate goals of understanding, preventing, and treating insomnia symptoms in teachers

Persistent genital arousal disorder: a review of its conceptualizations, potential origins, impact, and treatment

Introduction Persistent genital arousal disorder (PGAD) is a condition characterized by symptoms of physiologic (typically genital) sexual arousal in the absence of perceived subjective sexual arousal. The physiologic arousal can last hours or days, or it can occur constantly, and it does not typically remit after orgasm(s). The symptoms are usually described as distressing, intrusive, and unwanted. Aim To review the available literature on PGAD. Methods A literature review through April 2016 was undertaken using terms persistent genital arousal disorder, persistent sexual arousal syndrome, and restless genital syndrome. Main Outcome Measures The main outcome is a review of the conceptualization of PGAD, its prevalence, proposed etiologies and treatments, and its impact on psychosocial and sexual functioning. Results Much of the research on the potential etiologies and treatments of PGAD is published in the form of case studies. Several etiologies of PGAD have been proposed; however, a cause or causes have not been confirmed. A range of treatments has been explored primarily in case studies, from electroconvulsive therapy to oral medication, with variable success rates. Psychologically based treatments have been suggested but have yet to be evaluated. Online surveys have found initial evidence supporting the negative impact of PGAD on mental health and sexual functioning; however, more research is needed in this area. Conclusion Although PGAD was first conceptualized 15 years ago, it remains a very under-researched condition. Currently, little is known about its biopsychosocial correlates, etiologies, or successful treatments. Future research directions are identified

#PGADFacts: Results from a 12-month knowledge translation campaign on persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by unwanted, persistent sensations of genital arousal that occur in the absence of corresponding subjective sexual arousal or desire. PGAD/GPD is associated with significant negative impacts on psychosocial well-being and daily functioning; however, PGAD/GPD remains largely unknown by both healthcare providers and the general public. This lack of awareness is a barrier to receiving healthcare and may lead to greater stigma associated with the condition. This project sought to develop and evaluate an empirically informed 12-month social media-based knowledge translation campaign on PGAD/GPD, titled #PGADFacts. One research-supported fact about PGAD/GPD was posted weekly to three social media platforms from November 2019 to December 2020. Social media analytics indicated that the campaign had significant reach (111,587 total views across platforms). An anonymous online feedback survey indicated that respondents who had seen the campaign reported greater knowledge about PGAD/GPD as compared to those who had not seen it. Responses also indicated high acceptance and appropriateness. Adoption rates (e.g., sharing information learned on or off social media), however, were low with negative emotions (e.g., embarrassment) being a common barrier. Results indicated that the #PGADFacts campaign was successful, however, additional strategies (e.g., paid ads, partnerships with influencers) may increase adoption and reach a broader audience. Greater awareness of PGAD/GPD is needed to increase recognition of the condition and access to care as well as to reduce associated stigma