(071) Persistent Genital Arousal Disorder: Associations With Hormonal Fluctuations During Reproductive Transitions

Abstract Introduction Persistent Genital Arousal Disorder (PGAD) is defined as persistent or recurrent, unwanted genital arousal without sexual desire or stimulation, causing distress and predominantly affecting women. Incidence estimates, derived from online and clinical samples in North America, range from 0.6-2.7% in women and 1.1-4.3% in men, though underreporting is likely. The International Society for the Study of Women’s Sexual Health (ISSWSH) recommends a five-region diagnostic approach, with region 5 encompassing central nervous system and hormonal factors. PGAD is associated with substantial psychosocial morbidity, including anxiety, depression, obsessive-compulsive disorder, and cognitive dysfunction. Periods of hormonal fluctuation, puberty, postpartum, and perimenopause, are established risk windows for affective and neuropsychiatric symptoms, suggesting a plausible biological link to PGAD susceptibility and severity. Objective To evaluate susceptibility to PGAD, onset and severity of PGAD, and related mood and cognitive conditions during hormonal fluctuation. This review synthesizes evidence on the association between reproductive transitions (puberty, postpartum, perimenopause) and PGAD onset or intensity, integrating neurobiological, hormonal, and psychiatric dimensions within the five-region diagnostic framework. Methods A PubMed search identified studies on hormonal factors in PGAD, using terms combining PGAD with reproductive, adrenal, and thyroid hormones, hormonal therapies, and life stage transitions. Studies focused solely on antidepressants or SSRIs were excluded. Titles and abstracts were screened for human studies addressing PGAD in relation to reproductive stages, hormonal contraception, or hormone levels. Eligible designs included case reports, case series, observational studies, and reviews with original data. Of ten texts, three were excluded after full-text review. Data extraction included hormone assessments, reproductive phase, demographics, and study design. Six studies were analyzed. Results Puberty, postpartum, and perimenopause are periods of increased susceptibility to PGAD onset and symptom exacerbation. During puberty, neuroendocrine reorganization and ovarian hormone variability are associated with increased mood disorders, contributing to PGAD vulnerability in susceptible individuals. Perimenopause is similarly characterized by fluctuating sex steroids and risk for affective disturbances, with diagnosis based on symptoms rather than laboratory testing. The postpartum period involves abrupt hormonal shifts and heightened risk of mood and anxiety disorders, which may precipitate or intensify PGAD symptoms. Testosterone sensitivity is observed in some peripubertal females, but its direct role remains unclear. Pregnancy-related PGAD cases are rare and typically transient, often resolving after delivery. Neurobiological studies suggest altered brain connectivity in PGAD, implicating central mechanisms overlapping with affective and cognitive disorders. Dysfunctional sexual beliefs, negative affect, and maladaptive cognitive styles are frequently observed in PGAD and may be exacerbated by hormonal transitions. Across reproductive transitions, the literature demonstrates a consistent link between hormonal fluctuations, mood disorder prevalence, and PGAD onset or severity. Conclusions Mood disorders and cognitive dysfunction are closely linked to PGAD, and both are associated with hormonal fluctuations during puberty, postpartum, and perimenopause. Although current data are limited and mostly from case series and cross-sectional studies, these findings mark the start of investigating how hormonal changes, mood, and cognition relate to PGAD onset or severity. Further research should clarify mechanisms and identify at-risk populations to guide targeted interventions. Disclosure No.