Persistent genital arousal: Differential diagnosis and management in the emergency room of psychiatry

BackgroundWe describe the case of a 50 years old woman who attended the emergency room for complaints that involves continuous orgasms in the last two months that she describes “as waves”. The woman is a widow and claims not to have had sexual relationships since her husband died four years ago.Main objectivePersistent genital arousal disorder (PGAD) is a relatively unknown clinical condition affecting several women. Moral standards, as well as conservative beliefs regarding sexuality, are believed to be involved in the etiology and maintenance of this syndrome. Nevertheless, there are no consistent data on the content of the beliefs system presented by these women.PGAD It has been identified as a condition of often unprovoked genital arousal associated with a significant level of distress.PGAD is not well understood, and no definitive cause has been determined.Our main objective was to review the literature on PGAD, identify possible causes of the disorder, and provide approaches to the assessment and treatment of the disorder based on the authors’ experience and recent literature.CommentsPGAD is a potentially debilitating disorder of unwanted genital sensation and arousal that is generally spontaneous and unrelenting. Since its first description in 2001, many potential etiologies and management strategies have been suggested. PGAD likely represents a range of conditions manifesting in unwanted genital sensations. Successful treatment requires a multidisciplinary approach and consideration of all reversible causes as well as cognitive therapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Short Communication on Enuresis

In this paper, Winnicott discusses the anxiety surrounding enuresis as the outward show of a sense of guilt accompanying (unconscious) masturbation fantasies. He interprets enuresis as a part of a regression, and the fantasies belonging to genital sensation have coloured those belonging to micturating. Associated defaecation disorders, when present in patients with this type of enuresis, take the form of incontinence. The main affect is a pleasurable one, derived from the infantile experience of micturition in relation to the mother or nurse.

Costs of pleasure and the benefits of pain: self-perceived genital sensation, anatomy and sexual dysfunction

Background Research has highlighted the complex association between female sexual dysfunction (FSD) and distress regarding sexual activity, with decreased physical pleasure being an important mediator. The current study aims to elucidate the association between pleasurable and painful genital sensitivity and FSD, and to further investigate whether FSD may be distressing because it prevents the experience of sexual pleasure, induces pain or both. Methods: Sexually active women (n = 256; median, 22 years; range, 18–49 years) completed web-based questionnaires, including the Self-Assessment of Genital Anatomy and Sexual Function, the Female Sexual Function Index and the Female Sexual Distress Scale. Results: Women reported their clitoris to be more sensitive than their vagina in terms of having more pleasurable responses (P < 0.001), but not more painful responses (P = 0.49). In women with FSD (n = 36), impaired self-perceived genital sensation was found: they reported significantly less sexual pleasure and orgasm intensity, and more orgasm effort and discomfort within the clitoral and vaginal area than women without FSD (n = 220) (P-value < 0.05). The odds of having FSD were significantly greater in women with perceived increased discomfort in the vaginal area during stimulation (odds ratio = 5.59, P = 0.009, 95% confidence interval: 1.53–20.39), but not in the clitoral area. Conclusions: The data provide evidence of the relevance of self-perceived genital sensitivity to sexual pleasure and overall sexual experience. Enhancing the pleasurableness of genital sensations, especially during partnered sex, could decrease the likelihood of experiencing pain and concomitant FSD.