Persistent Genital Arousal Disorder

Persistent genital arousal disorder (PGAD) is a condition that causes unpredictable and uncontrollable physical sensations associated with sexual arousal in the ABSENCE of desire.  The persistent genital arousal can occur with or without orgasm.  PGAD is truly a pain disorder and is DIFFERENT than hypersexuality, which is excessive and compulsive sexual desire.  PGAD is more common in people assigned female at birth but is under-reported from all genders due to shame, stigma, and embarrassment.  It can compromise an individual’s well-being, mental health, and even damage relationships with partners.  

SYMPTOMS 

The primary symptom of PGAD is ongoing and uncomfortable sensations in the genital tissue including the clitoris, labia, vagina, perineum, and anus.  

The sensations can include: 

• Lubrication or wetness

• Itching

• Pressure

• Burning

• Pins and needles 

• Genital swelling 

Someone with PGAD may also experience spontaneous orgasms or feel as if they are about to experience orgasm.  However, masturbation or orgasm provide little to no relief for patients.  It is important to again state that these symptoms occur in the absence of desire.  

The persistent discomfort and effect on everyday living can contribute to psychological symptoms including:

• Anxiety 

• Panic attacks

• Depression

• Feelings of guilt 

• Difficulty sleeping  

• Distress and frustration 

DIAGNOSIS

Currently there are 5 factors used to diagnose PGAD:

1. Involuntary sexual arousal that lasts for an extended prior of time (hours, days, moths

2. No other cause for the genital arousal is identified

3. The genital arousal is unwanted and feels intrusive 

4. The persistent genital arousal is not relieve by one or more orgasms 

5. The genital arousal has no association with feelings of sexual desire 

Prior to 2001 there was no diagnosis criteria for PGAD and it had never been described in medical or psychiatric literature. 

CAUSES 

Researchers are still working to learn all the possible causes of PGAD.  Some possible causes are chronic pelvic pain, pudendal neuralgia, tarlov cysts (fluid filled cysts found at the bottom of the spine), previous surgeries to the vagina or abdomen, and pelvic floor dysfunction.  PGAD may also be linked to increased stress, weaning off antidepressants (specifically selective serotonin reuptake inhibitors), and hormone changes.

TREATMENTS 

Treatment of PGAD usually requires a multimodal approach and due to limited research a variety of treatments may be utilized to decrease symptoms.  Patients with PGAD have found relief with some of the treatments listed below in conjunction with pelvic floor physical therapy.  

• Medications including 

• Tricyclic antidepressants 

• Hormone medication (antiandrogen) to decrease sensation 

• Anticonvulsants 

• Nerve pain medication 

• TENS (transcutaneous electrical nerve stimulation) 

• Cognitive behavioral strategies and mindfulness for stress management and coping mechanisms 

• Trigger point injections or botox to decrease compression of the pelvic nerves 

• Lidocaine or other topical anesthetizing medications  

• Acupuncture 

HOW PELVIC FLOOR PT CAN HELP 

Pelvic floor physical therapy can help patients become more aware of their pelvic floor muscles and decrease tension or compression of pelvic nerves by using a number of treatment methods including: 

• Soft tissue massage and myofascial release to decrease trigger points and connective tissue dysfunction

• Visceral mobilization to address fascial restriction of pelvic organs and improve mobility 

• Biofeedback to lengthen and relax pelvic floor muscles 

• Neuromuscular re-education, including autogenic relaxation, to improve and restore parasympathetic nervous system function

• Therapeutic exercise to release tight muscles, promote nerve gliding, and decrease pain 

• Patient education and lifestyle modifications (healthy bladder and bowel habits, vulvar care, fluid/fiber recommendations, sexual positioning)   

As more providers and patients are talking about PGAD, people are finally starting to receive the treatment they need.  Patients with PGAD no longer need to suffer in silence and with the guidance of a multidisciplinary team are able to move forward towards a full recovery.