Focusing on healthcare experiences of those with a poorly understood and managed condition: Persistent genital arousal disorder

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Visiting the doctor can be an anxiety-provoking experience for many people, especially when someone wants to confide in their doctor about something personal. In addition, medical care can leave quite the hole in one’s bank account, depending on how far they have to travel, or how their country covers healthcare (public versus private). At the Sexual Health Research Lab at Queen’s University, we are interested in understanding how different healthcare experiences, such as interactions with doctors and/or costs associated with treatments, affect individuals with sexual health concerns. Specifically, we are interested in better understanding the healthcare experiences of individuals with a not-very-well understood condition called Persistent Genital Arousal Disorder, or PGAD.

You might be asking yourself ‘what is PGAD’? See here for some info.

Individuals with PGAD experience the physical component of sexual arousal – sensitivity and/or swelling in their genitals - but they don’t feel turned on in their heads, or in other words – they don’t feel ‘in the mood’. Actually, individuals with PGAD are typically distressed by their physical sensations as they often occur constantly or at inopportune times, like at work or while travelling. Unfortunately, these genital sensations don’t subside on their own – sometimes not even with one or more orgasms. This condition can affect individuals of all sexual and gender expressions; however, most scientific literature on the condition (although there isn’t very much literature!) pertains to PGAD in female-bodied individuals. When it comes to treatment of PGAD, we have yet to identify any truly successful methods, although some recommended symptom management strategies include things like surgery to get rid of cysts located at the spine, or topical creams that may only provide temporary relief - if any. For individuals with PGAD there appears to be a persistent miscommunication between the mind and the body, in that the body is stuck in a state of physical arousal all or most of the time—while, at the same time, the mind is left out of the equation. Many healthcare professionals have never heard of PGAD (it was only formally described in the clinical literature in 2001), and of those that have, many try various different regimens. You can see how healthcare experiences can range from one person to another, and how the costs of such experiences might differ.

In 2014, Canadian healthcare costs accounted for 10% ($215.8 billion CAD) of its gross domestic product, and an average of $5,543 (CAD) was spent per person on healthcare. There is evidence to show that other gynecological concerns such as vulvodynia (or experiencing chronic pain at the vulva), results in an inflated cost to the individual ($8,800 USD in just six months!), and to society as a whole when you take into account the prevalence (3-7%) of the condition. The estimated national economic burden of vulvodynia on the United States is 31 to 72 billion US dollars. Depending on where someone lives, one can imagine the expenses associated with insurance payments, transportation, and work-related financial loss – if one’s symptoms causes them to have to take days off of work. In terms of empirical research, there has yet to be any investigation of the costs of PGAD.

One of the goals of our research here at the Sex Lab is to better understand the types of experiences that individuals with PGAD have while seeking information about and treatment for their PGAD symptoms. Information about the costs associated with accessing health care for PGAD, interactions with health care providers, and barriers to seeking health care may help to inform more efficient and effective care for this distressing condition. We are looking for individuals who are currently experiencing symptoms of persistent genital arousal, including those who are and are not distressed by these symptoms to complete a survey about their healthcare experiences. Participation includes the completion of a 30-minute online survey, and you must be 18 years of age or older and fluent in English in order to participate.

If you are interested in participating or would like more information, please contact: sex.lab@queensu.ca

Or visit the survey here: https://queensu.qualtrics.com/jfe/form/SV_eM6nmtjldW6gwMl

Sam Bienias, BScH Student, Queen’s University

Robyn Jackowich, MSc, and Caroline F. Pukall, PhD, C.Psych.

Sex Toys – Something More to Enjoy?

Tweet “Sex toys” – the term encompasses everything from dildos and vibrators to whips and floggers, with all sorts of things in between.  Whether you’ve gone into a store to buy them, looked at them online for shits and giggles, or just seen them thrown on the field at sports games, I think most adults are at least somewhat familiar with sex toys in some form. However, despite this widespread knowledge, sex toys are a topic that--like most other topics in sexuality it seems--divides people. Some would have you believe they’re no big deal, walking around with them out in the open, freely, just to make a point, others would have you think they’re ruining our relationships at every turn. So, I think it’s about time we asked, what’s the truth? To vibe or not to vibe? That is the question.

The fact is that near half of all *cis-women are already using one of the industry’s most popular products, vibrators, during masturbation. And the numbers are even higher in queer women (Herbenick et al., 2009)! Most vibrator-using women report that they have more intense orgasms and nearly half say they have multiple orgasms (Davis et al., 1996). Some even say sex toys were integral to the best orgasms of their lives (Fahs, 2014). But women aren’t the only ones who get something out of vibrators; *cis-men can reap the benefits too—but current studies show they’re considerably less likely to do so. Less than one fifth of men report that they use vibrators in solitary sex play (Reece et al., 2009). Although all of the data presented thus far concern the use of sex toys in solitary sexual activity (masturbation), sex toys also have an important role in partnered sexual activity.

Around 40% of people report that they’ve used a vibrator with their partner at some point (Herbenick et al., 2009; Reece et al., 2009). Moreover, 75% of queer female couples have used vibrators, and just as many queer male couples have used sex toys of any kind (Schick et al.,  2011; Rosenberger et al., 2012). And that is perhaps with good reason: vibrator users experience less sexual dysfunction than their non-using counterparts perhaps because their bodies are more primed for sexual response and thus, respond better – think along the lines of “use it or lose it” (Herbenick et al., 2009; Reece et al., 2009). In fact, research has shown that men who had not been able to reach orgasm during partnered sexual activity benefitted from using a penile vibrator – it restored their ability to orgasm with a partner. Likewise, for women, vibrator use can combat the natural downward trend in sexual functioning in domains such as lubrication, pain, and arousal, that comes with age (Nelson et al., 2007; Herbenick et al., 2009). So overall, both men and women who use vibrators tend to be more sexually functional than non-vibrator users.

Now, you might hear some ask, “But won’t a vibrator make me numb to other sensations?”. Well, fear not! Nearly three fourths of all women that use vibrators reported absolutely no side effects! They didn’t experience any of the common concerns such as numbness, irritation, pain, or swelling, and even amongst those that did experience one of these, the most common side effect was numbness which only lasted a day or more in 0.5% of cases (Herbenick et al., 2009). Sorry men, we don’t have any research on vibrator use side effects for you (yet!).

That’s not to say there are no risks with using sex toys. In regards to using vibrators, 1% of women reported vaginal tears, and about 8% reported swelling. They’re small numbers, but they aren’t zero (Herbenick et al., 2009). Vagina-owners also face the unique problem with sex toys of the possibility of bacterial vaginosis, a condition causing unusual smell and discharge, from using improperly cleaned sex toys (Fethers et al., 2009). Bacterial vaginosis can be avoided with proper cleaning, but it remains a possibility.

Now, keep in mind that not all sex toys are created equally. Some are made with high quality medical grade materials, while the material in others can actually be toxic (Biesanz, 2007). Not to mention that some toys are a lot more complicated to use than others, and some can only be used in specific ways. Incorrect toy use can cause some serious problems, such as requiring surgical intervention to remove vibrators and dildos from rectums (Holzer, 2012). This is why sexual health education is important in order to help minimize harmful situations. In fact, people who are more likely to use sex toys are also more likely to know more about how to avoid these and other risks of sexual activity (Herbenick et al., 2009).

That’s not the only sexual health area in which vibrator users have a leg up though. A link has also been found between vibrator use and engagement in serious and important sexual health practices for both men and women; gynecological exams and self-genital exams for women, and testicular exams for men. Using a toy seems to be associated with higher comfort with your body, and this higher comfort might be related to higher comfort levels with doing self-examinations and visiting the doctor to check up on genital health (Herbenick et al., 2009; Reece et al., 2009).

All of this to say: Using sex toys is pretty common (but it might not be for everyone) and doing so is associated with many positive effects in terms of sexual outcomes. It is also important to remember that the inclusion of toys in sex is only one facet in a vast array of potential experiences that make up one’s overall sexuality, and some of these aspects play a much bigger role than a sex toy ever could. Using a sex toy could help, that’s true, but good sex means much more than putting a toy between your legs. Positions, exploration, communication, attraction to your partner(s), and so much more all matter as well (Mark & Herbenick, 2014). A sex toy can’t make up for a deficit anywhere else in one’s sexual well-being. But, if you’re already doing well on all other fronts, maybe a good vibe is all you need.

Colleen Chappell, 5^th Year Psychology/Gender Studies BAH. Student at Queen’s University.

*Please note that because of available research on the topic this blog post is unfortunately incredibly trans-exclusionary. All research referenced was done with cisgender individuals and relied heavily on sex = gender assumptions and no research was available on trans-identified individuals’ experiences with sex toys. While I could have chosen to replace the researchers’ gendered language with more gender-neutral language (e.g., referred to people with vulvas and people with penises instead of men and women), I chose to be consistent with the language used in the research papers.

References

Zach Biesanz (2007). Dildos, Artificial Vaginas, and Phthalates: How Toxic Sex Toys Illustrate a Broader Problem for Consumer Protection. Law & Ineq. 203

Davis, Clive M., Blank, Joani, Lin, Hung-Yu and Bonilla, Consuelo (1996). Characteristics of vibrator use amoug women. The Journal of Sex Research, 33(4), 313-320.

Fahs, B. (2014). Coming to power: Women's fake orgasms and best orgasm experiences illuminate the failures of (hetero)sex and the pleasures of connection. Culture, Health & Sexuality, 16(8), 974-988.

Herbenick, D., Reece, M., Sanders, S., Dodge, B., Ghassemi, A. and Fortenberry, J. D. (2009), Prevalence and Characteristics of Vibrator Use by Women in the United States: Results from a Nationally Representative Study. The Journal of Sexual Medicine, 6, 1857–1866.

Holzer, Lukas A. (2012), A Rectal Foreign Body. European Journal of Surgical Sciences 3(1), 26-27.

Mark, K., & Herbenick, D. (2014). The Influence of Attraction to Partner on Heterosexual Women's Sexual and Relationship Satisfaction in Long-Term Relationships. Archives Of Sexual Behavior, 43(3), 563-570.

Nelson, Christian J., Ahmed, Absaar, Valenzuela, Rolando, Parker, Marilyn and Muhall, John P., (2007) Assessment of Penile Vibratory Stimulation as a Management Strategy in Men with Secondary Retarded Orgasm, Urology, 69(3), 552-555.

Fethers, Katherine A., Fairley, Christopher K., Morton, Anna, Hocking, Jane S., Hopkins, Carol, Kennedy, Lisa J., Fehler, Glenda, and Bradshaw, Catriona S. (2009). Early Sexual Experiences and Risk Factors for Bacterial Vaginosis. Journal of Infectious Disease, 200 (11), 1662-1670

Reece, M., Herbenick, D., Sanders, S. A., Dodge, B., Ghassemi, A. and Fortenberry, J. D. (2009), Prevalence and Characteristics of Vibrator Use by Men in the United States. The Journal of Sexual Medicine, 6, 1867–1874.

Rosenberger, J.G., Schick, V., Herbenick, D. et al. (2012). Sex Toy Use by Gay and Bisexual Men in the United States. Archives of Sexual Behaviour, 41(2), 449-458.

Schick, V., Herbenick, D., Rosenberger, J. G., & Reece, M. (2011). Prevalence and Characteristics of Vibrator Use among Women who have Sex with Women. Journal Of Sexual Medicine, 8(12), 3306-3315.