Transcript A-hundred-orgasms

A HUNDRED
ORGASMS A DAY:
PGAD
PROF IHAB YOUNIS
www.redsulfur.net
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“Other women
wonder how to
have an orgasm …
I wonder how to
stop mine"
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Gretchen Molannen (39), who suffered from
PGAD for 16 years, was found dead of a
suicide in her Spring Hill, Fla., home the day
after a story she had participated in with the
Tampa Bay Times appeared online
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“When I describe
it to men, I tell
them, ‘Imagine
having an erection
that does not go
down, all day, all
night, no matter
how many times,
n o m a t t e r ho w
much you’ve
destroyed the skin
on your penis”
• The disorder was first described by
Leiblum
&Nathan in
2001
• They reported five cases and named
it ”persistent sexual arousal
syndrome (PSAS)”
Leiblum SR, Nathan SG: Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality. J Sex Marital Ther.
2001 Jul-Sep;27(4):365-80
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What is arousal in women??
• Engorgement of sexual tissues such as
nipples, vulva, clitoris, vaginal walls
with vaginal lubrication
• It is the counterpart of erection in men
‫تم إزالة الصورة بواسطة‬
‫الرقابة على المصنفات‬
‫العلمية‬
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COMPONENTS
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Genital
swelling &
sensitivity
± Nipple
swelling
Persist for hours or days and do not
subside completely on their own
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2. AROUSAL IS UNRELATED
TO ANY SENSE OF DESIRE
Difference from mania
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•
•
•
•
Riding a car or a train
Using a washing machine
Vibrations of mobile phones
Or by no apparent stimulus
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Goldmeier D et al:Persistent genital arousal disorder: a review of
the literature and recommendations for management. Internat J
STD & AIDS 2009; 00: 1–5
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Some sufferers avoid sexual
relations, because they find it a
painful experience
Tragedy as woman with debilitating sexual arousal disorder ...
12 suicide, The Daily Mail, 4 Dec 2012. Retrieved Dec 2012
commits
The condition may
last for many
years and can be
so severe leading
to depression &
even suicide
How frequent ?
Ninety six randomly chosen women
completed a questionnaire regarding
spontaneous and persistent GA
FULL
PARTIAL 1%
37.40%
NO SYM
61.60%
Garvey LJ, West C, Latch N, Leiblum S, Goldmeier D. Report of spontaneous and persistent genital arousal in women attending a
sexual13health clinic. Int J STD AIDS. 2009 Aug;20(8):519-21.
•
Awareness of sensations of genital
arousal is quite normal for some
women
• It may be experienced as mildly
pleasurable or mildly annoying
Leiblum SR. Persistent Genital Arousal Disorder: What It Is and What It Isn’t. Contemporary Sexuality- Update. 2006, Vol. 40, No.
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CLOUDY
ETIOLOGY
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MEDICATIONS
Trazodone
(Trittico)
Finger, William W., Lund, Margaret and Slagel,
Mark A. "Medications that may contribute to
sexual disorders: a guide to assessment and
treatment in family practice". J Fam Pract , 1997,
44 (1): 3
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SSRI
Discontinuation
Goldmeier D, Leiblum SR. Persistent genital arousal in women - a
new syndrome entity. Int J STD & AIDS, 2006; 17:215-6.
NEUROLOGICAL
DYSFUNCTIONS
Associated with restless
legs syndrome
AND
Restless bladder
syndrome
Waldinger MD, Schweitzer DH. Persistent genital arousal disorder in 18 Dutch. women. J Sex Med. 2009 Feb;6(2):482-97 •
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PGAD was linked with pudendal
nerve
entrapment
during
pregnancy
Symptoms disappeared
physiotherapy
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after
Rosenbaum T Y.Physical Therapy Treatment of Persistent Genital Arousal Disorder During Pregnancy: A Case Report. J Sex Med
2010;7:1306–1310
VASCULAR CAUSES
Varices in the
pelvis,vagina &
nearby structures
Thorne C, Stuckey B. Pelvic congestion syndrome
presenting as persistent genital arousal: a case
report.J Sex Med. 2008 5(2):50419
Arteriovenous
malformations in
clitorial arteries
Goldstein I, De EJB, Johnson J. Persistent sexual arousal
syndrome and clitoral priapism. In: Goldsein I, Meston C,
Davis S, Traish A, eds. Women’s sexual function and
dysfunction: study, diagnosis and treatment. London: Taylor
and Francis; 2006:674-85
÷
In many cases
The etiology
Is idiopathic
“And where
does this
woman live?”
Nappi R, Salenia A, Traish AM et al. Clinical biologic pathophysiologies of women’s sexual dysfunction. J Sex Med 2005;2:4-25 Inn
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Leiblum published 3 papers about etiology
of PGAD using web questionnaires(# 491)
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Some findings
in
the 3 studies
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Partial
The
average
age was
40.05 ±12.5
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PART
42.7%
FULL
CRIT
57.3%
Arousal
• Unrelated to desire
PGAD Non-PGAD
100%
62.5%
• Does not resolve by orgasm 100%
66.7%
• Intrusive
100%
66.7%
• Cause at least mod.distress 100%
58.3%
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The longest period without
symptoms
PGAD Non-PGAD
• < 24 hours
41.2%
22.2%
• < one week
26.5%
31.1%
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Physical health
•
•
•
•
•
•
Back pain
Thyroid problems
Hypo and Hypertension
Neurological problems
Diabetes
Chronic fatigue syndrom*
*Significant difference between PGAD & Non-PGAD
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Psychiatric health
PGAD Non-PGAD
• Depression 57.9%
39.6%
• Anxiety
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42.1%
27.1%
Sexual abuse
• As a child
• As an adult
PGAD Non-PGAD
52.6%
43.8%
35.5%
22.9%
• Did it contribute
to your persistent
arousal
11.8%
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16.7%
Negative feelings about PGAD
PGAD Non-PGAD
• Frustrated 85.5%
56.3%
• Distracted 76.3%
58.3%
• Worried
56.6%
35.4%
• Depressed 44.7%
27.1%
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Positive feelings about PGAD
PGAD
Non-PGAD
• Sexy
17.1%
41.7%
• Pleased
14.5%
31.3%
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TREATMENT
• Since the etiology is not established,
No satisfactory treatment is available
• The following treatments were used
in case reports
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General measures
• Avoiding factors that induce PGAD
• Masturbation can
lead to temporary
relief of mild forms
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• In severe forms, orgasms only
perpetuate symptoms
• Simple procedures such as
using ice packs on the area
may be helpful
Goldmeier et al. Persistent genital arousal disorder: a review of the literature and recommendations for management. Int J
STD AIDS, 2009;20(6):373-7.
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Anticonvulsants
Pregabalin (Painica®) 75 mg
in the morning and 100 mg in
the evening
Symptoms disappeared for a
14 months follow up period
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Philippsohn S & Kruger T H, PGAD:Successful treatment with Duloxtine&Pregabalin in two cases.
J Sex Med, 2012;9(1):213-7.
Antipsychotics
Olanzapine (Zyprexa®)
Risperidone (Risperdal®)
Wylie K, Levin R, Hallam-Jones R, Goddard A. Sleep exacerbation of persistent sexual arousal syndrome in a post menopausal
36woman.J Sex Med 2006;3:296–302.
Smoking cessation drug
Varenicline (Champix®)
symptoms relieved within 2
weeks but returned after 2weeks
Korda JB, Pfaus JG, Goldstein I.Persistent Genital Arousal Disorder: ACase Report in a Woman with Lifelong PGAD Where
Serendipitous Administration of Varenicline TartrateResulted in Symptomatic Improvement.J Sex Med. 2009;6(5):1479-1486
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.
ECT
Repeated ECT
Produced +ve
outcome
Yero SA, et al. Successful use of electroconvulsivetherapy
in 2 cases of persistent sexual arousal syndrome and bipolar
disorder. J ECT 2006;22:274–5.
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Surgeryy
Surgical release of
pudendal nerve
entrapment
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has resulted in
PGAD
symptom
improvement
Irwin Goldstein. PGAD: Treatment. http://www.sexualmed.org/index.cfm/sexual-health-issues/for-women/pgadwomen/treatment/2010
The proposed treatments
do not completely
eliminate the condition
MARIANA A. PGAD in elderly women:A case study. J
IMAB - Annual Proceeding (Scientific Papers) 2012,
40 book 3
vol. 18,
They may help reduce
the pain, stress and
discomfort
A HUNDRED
ORGASMS A DAY:
PGAD
THANK YOU
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