Therapeutic strategies have developed for men who seek management because of distress from PGAD. Psychologic-based treatments engage management of the depression, or focus on efforts to maximize relaxation, through strategies such as distraction, and/or hypnosis. Biologic-based treatments include ice or topical anesthetic agents. Discontinuing trazodone may provide relief. Surgical release of pudendal nerve entrapment may result in PGAD symptom improvement. Pharmacologic strategies have included use of tricyclic or SSRI antidepressants (e.g. clomipramine, paroxetine), prolactin-elevating agents (e.g. olanzapine, risperidone), anti-seizure medications (e.g. carbamazepine), use of the opioid agonist tramadol, use of the varenicline (a partial agonist at the nicotinic receptor subtype that decreases the ability of nicotine to stimulate the release of mesolimbic dopamine).
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