Symptom prevalence, healthcare experiences, and psychosocial predictors of symptoms and wellbeing in individuals with persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)

Abstract

Sexual wellbeing is integral to quality of life. Although research and clinical attention has been dedicated to conditions of low genital arousal (e.g., erectile dysfunction, sexual interest and arousal disorder), little is known about disorders of high or unwanted arousal. Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is a condition characterized by unwanted and persistent sensations of genital arousal that occur in the absence of corresponding subjective sexual arousal or desire. This program of research aimed to examine how common PGAD/GPD symptoms are, as well as factors that influence PGAD/GPD symptoms and psychosocial wellbeing. First, prevalence estimates of PGAD/GPD were undertaken in two North American samples: Canadian undergraduate students and adults in the United States (Chapter 2). The results suggest that PGAD/GPD affects up to 4.3% of individuals and is more common than initially believed. Given the similarities between PGAD/GPD and genito-pelvic pain, the second study (Chapter 3) applied the Fear Avoidance Model of chronic pain to individuals with PGAD/GPD to identify cognitive and behavioural predictors of psychosocial and functional outcomes. Symptom catastrophizing, fear of symptoms, avoidance of symptoms, and hypervigilance to symptoms were associated with greater depression symptoms and poorer functional outcomes. Serial parallel mediation models indicated a significant relationship between PGAD/GPD symptom intensity and psychosocial and functional outcomes through the fear-avoidance variables. The final study (Chapter 4) examined the associations among healthcare experiences (HC), PGAD/GPD symptoms, and psychosocial outcomes, as well as barriers to care and associated costs. Results indicated that most participants waited at least 6 months before approaching a HC provider or had never approached a HC provider about their symptoms. The most frequently reported barrier to HC was HC provider lack of knowledge about PGAD/GPD, and costs associated with HC were high. Increased comfort communicating with one’s HC providers also significantly predicted lower depression and anxiety symptoms. Collectively, the results of this research program highlight that PGAD/GPD affects individuals of all genders and may occur at a higher prevalence than initially assumed. The findings also support the incorporation of cognitive-behavioural interventions for PGAD/GPD as well as the importance of reducing HC barriers to promote treatment accessibility.