Persistent genital arousal disorder: A systematic review of diagnosis, etiology, and treatment approaches (2015–2025)

Persistent genital arousal disorder (PGAD) is a distressing, often debilitating condition of unwanted genital arousal occurring independent of desire and difficult to relieve, with substantial psychosocial burden. We systematically reviewed peer-reviewed studies (2015-2025) to synthesize the evidence for diagnosis, etiology, and treatment. PubMed, Ovid (MEDLINE/Embase), and CINAHL (English-language, human studies; last searched on August 31, 2025) were searched. Two reviewers independently screened the records and extracted data, with disagreements resolved by the consensus and third-reviewer adjudication. Risk of bias was assessed using ROBINS-I for comparative observational studies and Joanna Briggs Institute tools for case series. The findings were synthesized narratively in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The review protocol was registered prospectively in PROSPERO (CRD420251108714). Of 799 records identified, 56 duplicates were removed; 743 titles/abstracts were screened, 197 full texts were assessed, and 14 studies were included. Eligible designs comprised cross-sectional surveys, case-control/cohort studies, case series ≥3 patients, and one clinical review with embedded cases; no randomized controlled trials (RCTs) were identified. Owing to clinical and methodological heterogeneity, meta-analysis was not performed. Participants were predominantly women. Diagnostic practice was inconsistent: Most used symptom-based criteria aligned to International Society for the Study of Women's Sexual Health or Leiblum-Nathan frameworks, variably combined with targeted imaging, neurophysiology, or small-fiber testing. Etiologic signals most often implicated neuropathic/structural mechanisms - sacral radiculopathy, Tarlov cysts, and pudendal or small-fiber neuropathy - alongside central neurobiological and psychosocial contributors. Interventions included pelvic-floor physiotherapy, cognitive-behavioral approaches, pharmacologic agents (e.g., gabapentinoids and benzodiazepines), neuromodulation, and selected surgical decompressions for defined lesions; outcomes were mixed and follow-up/safety reporting limited. Overall, PGAD appears multifactorial and under-standardized in assessment. It should be prioritized to include a consensus, multimodal diagnostic pathway and prospective, comparative studies using validated patient-reported outcomes to inform individualized, evidence-based care.