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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.004 | 0.004 |
| Research integrity | 0.015 | 0.009 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
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 source (direct Gemma or distilled Codex), 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".