Persistent genital arousal disorder/Genito-pelvic dysesthesia in all genders: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)
Bibliographic record
Abstract
INTRODUCTION: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), a sensory hyperactivity condition, involves a broad range of undesired, unrelenting dysesthesia(s), including genital arousal, hard flaccid syndrome, and sleep-related prolonged erection. PGAD/GPD is associated with significant, negative psychosocial consequences, including suicidal ideation. In 2021, the International Society for the Study of Women's Sexual Health developed a process of care for biopsychosocial management of PGAD/GPD in women. This article reviews the management of PGAD/GPD in all genders. OBJECTIVES: A consensus guideline for management of PGAD/GPD in all genders was developed based on the understanding that this complex condition may be triggered by multiple pathophysiologic factors. METHODS: The International Consultation for Sexual Medicine identified co-chairs to organize a consensus committee on PGAD/GPD and select an expert multidisciplinary panel. They reviewed literature, basic science, and clinical data, using a modified Delphi method to reach a consensus on the background, diagnostic procedures, and therapeutic options. RESULTS: PGAD/GPD occurs in women and men with similar prevalences, from which we can infer that a substantial number of individuals are adversely affected by PGAD/GPD. While sensory hyperactivity is perceived as located in the genito-pelvic region, symptoms can originate from any of 5 regions: region 1, the end organ; region 2, the pelvis/perineum; region 3, the cauda equina; region 4, the spinal cord; and region 5, the brain. The experts reviewed region-based pathophysiologic triggers, diagnostic procedures, and biopsychosocial treatment strategies based on the location of the trigger(s). Psychological and medical treatments should be performed concomitantly. CONCLUSION: Although PGAD/GPD is associated with significant morbidity, it is still underrecognized by healthcare practitioners. It is strongly recommended that individuals of all genders be safely and effectively managed following the process-of-care diagnostic algorithm that systematically examines the 5 regions to localize the dysesthesia trigger(s). The algorithm emphasizes using psychological and medical interventions in parallel throughout the process, with interventions based on the location(s) of the identified trigger(s).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".