Persistent Genital Arousal Disorder Treatment Abstract

PERSISTENT GENITAL AROUSAL DISORDER
TREATMENT WITH ULTRASOUND GUIDED PELVIC
FLOOR TRIGGER POINT INJECTIONS AND
PERIPHERAL NERVE HYDRODISSECTION
- A CASE SERIES
Abstract by Abigail Bayer-Mertens Human, Tayyaba Ahmed, DO and Allyson
Shrikhande, MD; Presented by Allyson Shrikhande, MD

Introduction
The objective of this study was to
determine the effectiveness of manual
physical therapy, pelvic floor trigger
point injections and peripheral nerve
hydrodissection used together in
treating Persistent Genital Arousal
Disorder (PGAD). This disorder is
highly under-researched which is
troubling given what broad negative
affects it has on patient life. Thus,
research into treatment is imperative.

Previous Research
In this article, 76 women with PGAD
and 48 women with similar disorders
were given surveys about their
symptoms in order to determine the
distinct symptomology of PGAD. The
women with PGAD scores suggested
more consistent psychologically
difficult symptoms. This solidifies
PGAD’s legitimacy as its own disorder
as well as underlines the importance
of further research on it.
(Leiblum et al, 2001)

Previous Research
This case report shows the
effectiveness of manual physical
therapy for pelvic pain patients. A 47
year old male pelvic pain patient with
CPPS was treated using myofascial
physical therapy techniques. His pain
levels improved from 6 out of 10 to 1
out of 10 over the course of 6 months.
Although this patient suffered from a
different pelvic pain disorder, this
article does support the thought that
physical therapy improves pain levels
for pelvic pain patients.
(Davia et al, 2014)

Previous Research
This review of different pelvic pain
treatments regarding pelvic floor
trigger points speaks to the validity of
trigger point injections as a means of
treatment.
It notes that there is clinical evidence
of the effectiveness of trigger point
injections, especially in conjunction
with other types of treatment such as
manual physical therapy.
(Gilleran, Beaumont)

Previous Research
In this article, a patient with pelvic
pain as well as bladder frequency and
urgency who failed to respond well
with just physical therapy was treated
with therapeutic nerve blocks of the
pudendal nerve. The patient’s pain
related symptoms were significantly
alleviated by this treatment plan.
(Gilleran, Beaumont)

Methods
The participants in our study consisted of three female patients, ages 57, 42 and 30, with PGAD. All
three patients were on antidepressant medication, and all patients had pelvic floor physical therapy
pre and post taking part in the study as well as a home program. Patient’s vitals and scores on the
Visual Analogue Scale (VAS) and Five Point Likert Scale Regarding Functionality were collected pre-
treatment.
Five Point Likert Scale Regarding Functionality
Statement: My quality of life is good.
1
Strongly
Disagree
5
Strongly
Agree
4
Agree
2
Disagree
3
Neutral
Visual Analogue Scale
1 2 3 4 5 6 7 8No
Pain
Worst
Pain
9

Methods
Each patient then was treated using myofascial manual physical therapy. An individualized plan for
physical therapy was developed and employed for each patient after an initial internal physical exam
considering tightness, pain tenderness, and tautness.
(beyondbasicsphysicaltherapy
.com)

Methods
While continuing physical therapy on a weekly basis, patients also underwent weekly pelvic floor
trigger point injections. This treatment method consisted of external ultrasound guided trigger point
injections. Each injection combined Traumeel and Lidocaine, increasing blood flow to the affected
area, raising oxygen levels in the affected area and improving both nerve based and muscular disarray.
*Image Credit - (healthygoods.com, cdn.shopmedvet.com, symbiosisrcm.com)

Methods
Additionally, patients received peripheral nerve hydrodissection on a weekly basis performed on the
pudendal nerve and the posterior femoral cutaneous nerve. These treatments allow the nerves to
reset, decreasing hypersensitivity.
* Image Credit - (shenshenrehab.pixnet.net)

Methods
After 6 weeks of treatment, each patient retook the VAS and Five Point Likert Scale regarding
Functionality.
Five Point Likert Scale Regarding Functionality
Statement: My quality of life is good.
1
Strongly
Disagree
5
Strongly
Agree
4
Agree
2
Disagree
3
Neutral
Visual Analogue Scale
1 2 3 4 5 6 7 8No
Pain
Worst
Pain
9

Results
Pre-treatment, all patients took the VAS and the Five-Point Likert Scale for functionality. Pre−treatment, Patient
A received a 10 on the VAS and a 1 on the Five Point Likert Scale, Patient B received a 10 on the VAS and a 2 on
the Five Point Likert Scale, and Patient C received a 9 on the VAS and a 3 on the Five Point Likert Scale. All of
these scores indicate high pain levels and low functionality.
Post−treatment, Patient A received a 2 on the VAS and a 5 on the Five Point Likert Scale, Patient B received a 1
on the VAS and a 5 on the Five Point Likert, and Patient C received a 2 on the VAS and a 4 on the Five Point Likert
Scale. These scores indicate a decrease in pain and an increase in functionality.
Patient A Patient B Patient CPatient A Patient B
Patient C

Results
Because of the small sample size,
meaningful p and z scores could not
be calculated. However, when an
average-based statistical analysis is
applied, it is the potential promise this
treatment regime holds is evident.
Overall, the mean pre−treatment VAS
score was 9.7 and the mean
post−treatment VAS score was 1.7.
The mean pre−treatment Five Point
Likert score was 2.0 and the mean
post−treatment Five Point Likert score
was 4.7.
Additionally, a percentage-based analysis of improvement shows Patient A saw 80%
improvement on the VAS and 80% improvement on the Likert Scale, Patient B saw 90%
improvement on the VAS and 60% improvement on the Likert Scale, and Patient C saw 70%
improvement on the VAS and 40% improvement on the Likert Scale.

Conclusion
In this case series, three female patients diagnosed with PGAD underwent myofascial manual
physical therapy, pelvic floor trigger point injections and nerve hydrodissection as a means to
lessen their pain and thereby improve their quality of life. All patients showed improvement on
both the VAS and the Five Point Likert Scale Regarding Functionality.
This study provides foundation for the thought that a long term, larger study of the effectiveness of
myofascial manual physical therapy, pelvic floor trigger point injections and nerve hydrodissection
is merited as a treatment for PGAD.

Bibliography
 Leiblum, S., Seehuus, M., Goldmeier, D., & Brown, C. (2007). Psychological, Medical, and Pharmacological Correlates of
Persistent Genital Arousal Disorder. The Journal of Sexual Medicine,4(5), 1358-1366. doi:10.1111/j.1743-
6109.2007.00575.x
 Davia , J., PT, DPT, & Welty, A., DPT. (2014). Manual Therapy and Education for Physical Therapy Management of Male
Chronic Pelvic Pain Syndrome . American Physical Therapy Association, 38(1), January/April 2014, 3-10. Retrieved August
10, 2017, from http://dlx.booksc.org/38500000/libgen.scimag38589000-
38589999.zip/browse/10.1097/JWH.0000000000000007.pdf
 Moldwin, R. M., & Fariello, J. Y. (2013). Myofascial Trigger Points of the Pelvic Floor: Associations with Urological Pain
Syndromes and Treatment Strategies Including Injection Therapy. Current Urology Reports, 14(5), 409-417.
doi:10.1007/s11934-013-0360-7
 Antolak, S. J., & Antolak, C. M. (2009). Therapeutic Pudendal Nerve Blocks Using Corticosteroids Cure Pelvic Pain after
Failure of Sacral Neuromodulation. Pain Medicine, 10(1), 186-189. doi:10.1111/j.1526-4637.2007.00366.x
 GIlleran, J. P., MD. (n.d.). Trigger Point Injections [Scholarly project]. Retrieved August 31, 2017, from
https://www.beaumont.edu/PageFiles/102883/trigger%20point%20injections%20-%20gilleran.pdf

Thank You
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New York, NY 10017
(646) 481-4998
https://www.pelvicrehabilitation.com/
contact@pelvicrehabilitation.com

Persistent Genital Arousal Disorder Treatment Abstract

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