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Restless Genital Syndrome: The Intersection of Chronic Pain and Chronic Arousal

This is one itch that will not always be scratched.

Recently, I wrote about orgasm as treatment for Restless Leg Syndrome (RLS). Interestingly, a condition has been described that is often seen in the setting of RLS, yet which might only become more uncomfortable with sexual stimulation.

Persistent Sexual Arousal Syndrome (PSAS) was originally described in 2001 as persistent, spontaneous and uncontrollable genital arousal affecting women for the most part; but it is not related to feelings of sexual desire. This is not nymphomania: PSAS causes pain, insomnia, and often can result in an aversion to sexual relations, as orgasm becomes a vehicle by which a woman attempts to alleviate pain, not the pathway to a higher level of pleasure. While it is rare, it is also likely not often reported by those who suffer this, due to feelings of shame or embarrassment. More severe psychological symptoms include depression, anxiety, and panic attacks.

Theories abound as to the etiology of this condition. Clinicians speculate it may be related to a neuropathy of the sensory nerves innervating the genitalia, or perhaps pudendal nerve entrapment. The histories of some of those who suffer this disease include episodes of sexual victimization.

A Dutch study published in 2008 in the Journal of Sexual Medicine found that women with PSAS had a much higher prevalence of restless legs, symptoms of overactive bladder, varices of the pelvis and varices of the legs compared to otherwise healthy women. This study confirmed what had been described back in 2001: The sensations experienced in their genitalia were not described to the researchers in sexual terms, but they were likened to being on the verge of an orgasm. These PSAS women felt an imperative urge to rid themselves of these sensations through self-stimulation or intercourse; although this ultimately proved unsatisfactory most of the time.

These sensations involved numbness and tingling at the clitoris, vagina, labia, and the pubic area in general. Interestingly, the sensations were described in terms very similar to those used when characterizing RLS: tingling, creeping sensations, burning, and spasm. These are intrusive and unwanted sensations, like RLS becoming worse with sitting still. And like the imperative urge to move the legs for temporary relief of unpleasant sensations in RLS, there would appear a similar urge to "move" the clitoris—sometimes until a woman with PSAS experienced painful exhaustion. Unfortunately, this therapeutic modality gives only a modicum of short-lived relief, despite any repeated orgasm.

The Dutch researchers speculated that PSAS and RLS "belong together" in a clinical cluster, and thus PSAS should instead be known as Restless Genital Syndrome (RGS). RGS is a physical disorder felt at the clitoral region, whereas RLS comprises the same dysfunction confined to the lower limbs.

Both clonazepam and tramadol have shown some utility in the treatment of RLS, improving sleep while diminishing symptoms. These drugs have also been shown to have a positive effect on RGS. Psychotherapy with cognitive reframing of arousal as a healthy response may also be of use in RGS. Whether the beneficial effect of orgasm on RLS is canceled out by the disappointment experienced by the RGS sufferer is left to those who use this as treatment. This is one itch that will not always be scratched.