影响女性身心健康的新病症：持续性生殖器官兴奋紊乱/生殖器官-骨盆感觉障碍综合征的研究现状及专家共识解读

doi:10.12114/j.issn.1007-9572.2022.0815

摘要/Abstract

摘要： 持续性生殖器官兴奋紊乱（PGAD）和生殖器官-骨盆感觉障碍（GPD）二者合称为持续性生殖器官兴奋紊乱/生殖器官-骨盆感觉障碍综合征（PGAD/GPD），是近年新发现的一种以自发或继发出现持续性性兴奋状态和/或生殖器官及骨盆其他区域感觉异常为特征的特殊病症。此病主要累及女性，因其症状特殊性，常对患者的身心健康造成严重影响，大多数患者处于焦虑、抑郁状态，甚至有自杀倾向。PGAD/GPD已引起国外医疗界的重视，并将其纳入国际疾病分类-11（ICD-11）。目前国内对这一新发现病症普遍认识不足。本文总结了PGAD/GPD的国外研究现状并结合国际妇女性健康研究学会（ISSWSH）最新专家共识对PGAD/GPD的流行病学特点、病理生理机制、诊断和治疗方案进行了介绍，初步探讨了PGAD/GPD的未来研究方向及国内医学界应采取的应对思路，以期引起国内广大医学工作者对此病的关注。

关键词: 生殖器，女（雌）性, 感觉障碍, 持续性生殖器官兴奋紊乱/生殖器官-骨盆感觉障碍, 女性身心健康, 病理生理机制, 诊断和治疗, 专家共识

Abstract:

Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) are jointly known as PGAD/GPD, which is a newly discovered condition in recent years, featured by spontaneous or secondary persistent genital arousal and/or dysesthesia in the genital and pelvic areas. PGAD/GPD mainly affects women, which can seriously influence the physical and mental health of the sufferers due to the specificity of its symptoms. Most patients have anxiety, depression, and even the suicidal tendency. The medical community abroad has paid attention to PGAD/GPD, and included it in the International Classification of Diseases-11th Revision (ICD-11) . Given the fact that this newly discovered condition is under-recognized among domestic health providers at present, we summarized the current research on PGAD/GPD abroad and introduced the epidemiological characteristics, pathophysiological mechanisms, diagnosis and treatment methods of PGAD/GPD based on the review of the latest expert consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) , and discussed the future research direction of PGAD/GPD and the coping strategies that should be taken by the domestic medical community, with a view to arousing medical workers' attention to the disease in China.

Key words: Genitalia, female, Sensation disorders, Persistent genital arousal disorder/genito-pelvic dysesthesia, Female mental and physical health, Pathophysiological mechanism, Diagnosis and treatment, Expert consensus

张允旭,王婷婷,魏俊伶,等. 影响女性身心健康的新病症：持续性生殖器官兴奋紊乱/生殖器官-骨盆感觉障碍综合征的研究现状及专家共识解读[J]. 中国全科医学, 2023, 26(23): 2830-2835. DOI: 10.12114/j.issn.1007-9572.2022.0815.
ZHANG Yunxu,WANG Tingting,WEI Junling, et al. A Newly Discovered Disease Affecting Women's Physical and Mental Health: Research Status and Expert Consensus Interpretation of Persistent Genital Arousal Disorder[J]. Chinese General Practice, 2023, 26(23): 2830-2835. DOI: 10.12114/j.issn.1007-9572.2022.0815.

图/表 1

参考文献 44

[1]	LEIBLUM S R, NATHAN S G. Persistent sexual arousal syndrome：a newly discovered pattern of female sexuality[J]. J Sex Marital Ther，2001，27(4):365-380. DOI：10.1080/009262301317081115.
[2]	LEIBLUM S, SEEHUUS M, BROWN C. Persistent genital arousal：disordered or normative aspect of female sexual response?[J]. J Sex Med，2007，4(3):680-689. DOI：10.1111/j.1743-6109.2007.00495.x.
[3]	PFAUS J G. Persistent genital arousal disorder-fact or fiction?[J]. J Sex Med，2017，14(3):318-319. DOI：10.1016/j.jsxm.2017.01.001.
[4]	PARISH S J, GOLDSTEIN A T, GOLDSTEIN S W, et al. Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions-partⅡ[J]. J Sex Med，2016，13(12):1888-1906. DOI：10.1016/j.jsxm.2016.09.020.
[5]	GOLDSTEIN I, KOMISARUK B R, PUKALL C F, et al. International society for the study of women's sexual health（ISSWSH）review of epidemiology and pathophysiology，and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia （PGAD/GPD）[J]. J Sex Med，2021，18(4):665-697. DOI：10.1016/j.jsxm.2021.01.172.
[6]	GARVEY L J, WEST C, LATCH N, et al. Report of spontaneous and persistent genital arousal in women attending a sexual health clinic[J]. Int J STD AIDS，2009，20(8):519-521. DOI：10.1258/ijsa.2008.008492.
[7]	DÈTTORE D, PAGNINI G. Persistent genital arousal disorder：a study on an Italian group of female university students[J]. J Sex Marital Ther，2021，47(1):60-79. DOI：10.1080/0092623X.2020.1804022.
[8]	JACKOWICH R A, PUKALL C F. Prevalence of persistent genital arousal disorder in 2 North American samples[J]. J Sex Med，2020，17(12):2408-2416. DOI：10.1016/j.jsxm.2020.09.004.
[9]	KOMISARUK B R, WISE N, FRANGOS E, et al. Women's clitoris，vagina，and cervix mapped on the sensory cortex：fMRI evidence[J]. J Sex Med，2011，8(10):2822-2830. DOI：10.1111/j.1743-6109.2011.02388.x.
[10]	LEIBLUM S R, CHIVERS M L. Normal and persistent genital arousal in women：new perspectives[J]. J Sex Marital Ther，2007，33(4):357-373. DOI：10.1080/00926230701385605.
[11]	CARVALHO J, VERÍSSIMO A, NOBRE P J. Psychological factors predicting the distress to female persistent genital arousal symptoms[J]. J Sex Marital Ther，2015，41(1):11-24. DOI：10.1080/0092623X.2013.869776.
[12]	LEIBLUM S, SEEHUUS M, GOLDMEIER D, et al. Psychological，medical，and pharmacological correlates of persistent genital arousal disorder[J]. J Sex Med，2007，4(5):1358-1366. DOI：10.1111/j.1743-6109.2007.00575.x.
[13]	LAMPE A, SÖLDER E, ENNEMOSER A, et al. Chronic pelvic pain and previous sexual abuse[J]. Obstet Gynecol，2000，96(6):929-933. DOI：10.1016/s0029-7844(00)01072-3.
[14]	PUKALL C F, GOLDSTEIN A T, BERGERON S, et al. Vulvodynia：definition，prevalence，impact，and pathophysiological factors[J]. J Sex Med，2016，13(3):291-304. DOI：10.1016/j.jsxm.2015.12.021.
[15]	CARVALHO J. Cognitive and emotional determinants characterizing women with persistent genital arousal disorder[J]. J Sex Med，2013，10(6):1549-1558. DOI：10.1111/jsm.12122.
[16]	JACKOWICH R A. A comparison of medical comorbidities，psychosocial，and sexual well-being in an online cross-sectional sample of women experiencing persistent genital arousal symptoms and a control group[J]. J Sex Med，2020，17(1):69-82. DOI：10.1016/j.jsxm.2019.09.016.
[17]	LEIBLUM S, BROWN C, WAN J, et al. Persistent sexual arousal syndrome：a descriptive study[J]. J Sex Med，2005，2(3):331-337. DOI：10.1111/j.1743-6109.2005.20357.x.
[18]	FACELLE T M, SADEGHI-NEJAD H, GOLDMEIER D. Persistent genital arousal disorder：characterization，etiology，and management[J]. J Sex Med，2013，10(2):439-450. DOI：10.1111/j.1743-6109.2012.02990.x.
[19]	LEIBLUM S R, GOLDMEIER D. Persistent genital arousal disorder in women：case reports of association with anti-depressant usage and withdrawal[J]. J Sex Marital Ther，2008，34(2):150-159. DOI：10.1080/00926230701636205.
[20]	HARTMANN U H. Words of wisdom. Re：persistent genital arousal disorder in women：case reports of association with anti-depressant usage and withdrawal[J]. Eur Urol，2009，55(5):1233-1235. DOI：10.1016/j.eururo.2009.01.054.
[21]	JACKOWICH R, PINK L, GORDON A, et al. Symptom characteristics and medical history of an online sample of women who experience symptoms of persistent genital arousal[J]. J Sex Marital Ther，2018，44(2):111-126. DOI：10.1080/0092623X.2017.1321598.
[22]	KRUGER T H C, SCHIPPERT C, MEYER B. The pharmacotherapy of persistent genital arousal disorder[J]. Curr Sex Heal Rep，2020，12(1):34-39. DOI：10.1007/s11930-020-00240-0.
[23]	CALABRÒ R S. Lamotrigine-induced persistent genital arousal disorder：an unusual side effect[J]. Epilepsy Behav，2017，68:234-235. DOI：10.1016/j.yebeh.2017.01.012.
[24]	MIYAKE K, TAKAKI M, SAKAMOTO S, et al. Restless genital syndrome induced by milnacipran[J]. Clin Neuropharmacol，2018，41(3):109-110. DOI：10.1097/wnf.0000000000000279.
[25]	HEALY D, LE NOURY J, MANGIN D. Enduring sexual dysfunction after treatment with antidepressants，5α-reductase inhibitors and isotretinoin：300 cases[J]. Int J Risk Saf Med，2018，29(3/4):125-134. DOI：10.3233/jrs-180744.
[26]	BATTAGLIA C, VENTUROLI S. Persistent genital arousal disorder and trazodone. Morphometric and vascular modifications of the clitoris. A case report[J]. J Sex Med，2009，6(10):2896-2900. DOI：10.1111/j.1743-6109.2009.01418.x.
[27]	PEREIRA A, PÉREZ-MEDINA T, RODRÍGUEZ-TAPIA A, et al. Correlation between anatomical segments of the pudendal nerve and clinical findings of the patient with pudendal neuralgia[J]. Gynecol Obstet Invest，2018，83(6):593-599. DOI：10.1159/000489497.
[28]	KOMISARUK B R, GOLDSTEIN I. Persistent genital arousal disorder：current conceptualizations and etiologic mechanisms[J]. Curr Sex Heal Rep，2017，9(4):177-182. DOI：10.1007/s11930-017-0122-5.
[29]	KOMISARUK B R, LEE H-J. Prevalence of sacral spinal（Tarlov）cysts in persistent genital arousal disorder[J]. J Sex Med，2012，9(8):2047-2056. DOI：10.1111/j.1743-6109.2012.02765.x.
[30]	FEIGENBAUM F, BOONE K. Persistent genital arousal disorder caused by spinal meningeal cysts in the sacrum：successful neurosurgical treatment[J]. Obstet Gynecol，2015，126(4):839-843. DOI：10.1097/AOG.0000000000001060.
[31]	KIM C, BLEVINS J, HANLEY J, et al. 019 neurogenic persistent genital arousal disorder（PGAD）secondary to radiculopathy of sacral spinal nerve roots（SSNR）：treatment outcome following spine surgery[J]. J Sex Med，2019，16(6):S9. DOI：10.1016/j.jsxm.2019.03.476.
[32]	WALDINGER M D, SCHWEITZER D H. Restless genital syndrome（ReGS）should be distinguished from spontaneous orgasms：a case report of Cannabis-induced spontaneous orgasm[J]. J Sex Marital Ther，2018，44(3):231-235. DOI：10.1080/0092623X.2017.1377130.
[33]	KLIFTO K M, DELLON A L. Persistent genital arousal disorder：treatment by neurolysis of dorsal branch of pudendal nerve[J]. Microsurgery，2020，40(2):160-166. DOI：10.1002/micr.30464.
[34]	KLIFTO K M, DELLON A L. Persistent genital arousal disorder：review of pertinent peripheral nerves[J]. Sex Med Rev，2020，8(2):265-273. DOI：10.1016/j.sxmr.2019.10.001.
[35]	OAKLANDER A L, SHARMA S, KESSLER K, et al. Persistent genital arousal disorder：a special sense neuropathy[J]. Pain Rep，2020，5(1):e801. DOI：10.1097/PR9.0000000000000801.
[36]	PARUS A, KANHAI M, TRAMONT J M. Persistent genital arousal disorder after motor vehicle accident：a case report[J]. Womens Health Rep：New Rochelle，2020，1(1):341-344. DOI：10.1089/whr.2020.0043.
[37]	TANNENBAUM J, GREENBERG J, RABEEM O, et al. Hormonal imbalances association to persistent genital arousal disorder in females[J]. J Sex Med，2022，19(4):S105. DOI：10.1016/j.jsxm.2022.01.223.
[38]	ZHANG Y X, SU L, GE H, et al. Persistent genital arousal disorder/genito-pelvic dysesthesia caused by sacroiliac joint dysfunction[J]. Sex Med，2022，10(5):100544. DOI：10.1016/j.esxm.2022.100544.
[39]	GOLDSTEIN I, KOMISARUK B, YEE A, et al. Sacral foraminal（S2-3）radiculopathy syndrome（SFRS）：identification of a new PGAD/GPD trigger in the cauda equina[J]. J Sex Med，2022，19(8):S16-17. DOI：10.1016/j.jsxm.2022.05.037.
[40]	PEASE E R, ZIEGELMANN M, VENCILL J A, et al. Persistent genital arousal disorder（PGAD）：a clinical review and case series in support of multidisciplinary management[J]. Sex Med Rev，2022，10(1):53-70. DOI：10.1016/j.sxmr.2021.05.001.
[41]	KRUGER T H C. Can pharmacotherapy help persistent genital arousal disorder?[J]. Expert Opin Pharmacother，2018，19(15):1705-1709. DOI：10.1080/14656566.2018.1525359.
[42]	MARTÍN-VIVAR M, VILLENA-MOYA A, MESTRE-BACH G, et al. Treatments for persistent genital arousal disorder in women：a scoping review[J]. J Sex Med，2022，19(6):961-974. DOI：10.1016/j.jsxm.2022.03.220.
[43]	COHEN A B, HELLSTROM W J, HODGES S J. Persistent genital arousal and major depressive disorder in an adolescent male：case report and discussion[J]. Urology，2021，157:239-241. DOI：10.1016/j.urology.2021.08.012.
[44]	JACKOWICH R A, POIRIER É, PUKALL C F. A comparison of medical comorbidities，psychosocial，and sexual well-being in an online. cross-sectional sample of women[J]. J Sex Med，2020，17(1):69-82. DOI：10.1016/j.jsxm.2019.09.016.