Bladder overactivity and persistent genital arousal disorder

We talk more and more about sexuality in this blog breaking the wall of taboos and trying to say things that shame often hushes up.

We have often talked about situations of bladder hyperactivity associated with a form of persistent genital arousal, which is why we have asked to Roberta Biasiotto, physiotherapist and teacher of the Pelvic Floor Master at the FUB Manresa, Spain to write this article about this syndrome.

Persistent genital arousal disorder

It is a phenomenon in which affected women experience spontaneous, constant or very frequent genital arousal which can start as a result of a sexual or non-sexual stimulus and which does not resolve with orgasm.

It should not be confused with hypersexuality, where there is an increase in sexual desire that may or may not be accompanied by sexual arousal. In a PGAD, genital arousal is not accompanied by desire, it is recognized as inappropriate and annoying in most cases, generates a situation of stress and discomfort in the affected person; furthermore, masturbation and orgasm cause little or no relief.

If it is not resolved, it can become a real suffering also due to little knowledge and understanding of the problem and can lead women to states of great stress and depression.

It is also known as restless genitalia syndrome and, in fact, comorbidity with restless legs syndrome has been found in 67% of cases. There is also a great association with overactive bladder syndromes and with the presence of pelvic varices.

Among the possible causes described there are vascular, neurological, pharmacological and psychological alterations.

The presence of varicose veins at the vaginal, perineal, ovarian and uterine levels is increased in women with PGAD and this could be a trigger for a local neuropathy in the pudendal nerve since its dorsal branch innervates the clitoral area.

In this sense, it will be very important to assess whether there is any mechanical factor that may be inducing venous congestion such as excess pressure in the pelvic area due to an incorrect posture, excessive activity of the diaphragm, abdominal inflammation, constipation or excessively sedentary or hyperpressive habits. In this situation, physiotherapy will be a great help in re-educating pressure management and improving vascularization.

Injuries, traumatisms, scars or hypertonia in the perineum can also be risk factors for nervous sensitization that could give rise to spontaneous responses of genital arousal; In this case, physiotherapy treatment will also be very helpful, through the management of elasticity and relaxation of the affected tissues and the release of the nerve.

One area of passage of the dorsal nerve of the clitoris is through the suspensory ligament of the clitoris, a thick fibroadipose tissue that comes out of the deep fascia of the pubic symphysis and the mons pubis, is inserted into the body of the clitoris to give it support and then sends expansions towards the labia majora. This fascial tissue has a very direct relationship with the abdominal fascia and the pelvic fascia, which, in cases of interstitial cystitis and overactive bladder (with which comorbidity with PGAD can be found very frequently), could be altered due to inflammation, constantly generating an increase in the tension of the suspensory ligament.

Another factor found in several cases is the presence of Tarlov cysts in the dorsal roots of S2 and S3, which can also induce peripheral sensitization in the sacral nerve endings, giving symptoms at the genital level as well as in the buttocks and lower extremities.

All the factors that can influence the central modulation of pain, both at an emotional, behavioral, hormonal and metabolic level, will also have an important role in the management of nerve signals, being able to amplify or inhibit them.

So they will also have to be taken into account when designing an approach so that it can be really effective.

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