Persistent Genital Arousal Disorder (PGAD)

January 30, 2020

Persistent genital arousal disorder, or PGAD, is a condition in which a person feels repeatedly sexually aroused without provocation. The person’s arousal is NOT linked to sexual desire. Additionally, most people with PGAD experience spontaneous orgasms that do not resolve arousal. PGAD can lead to ongoing physical pain, stress, and psychological difficulties due to an inability to carry out everyday tasks. The condition can affect people of all ages. Women are more commonly affected than men. PGAD is an extremely rare and embarrassing condition. The medical community has not clinically confirmed the incidence of PGAD because as many people with the condition feel too embarrassed or ashamed to seek medical help.

 

Unfortunately, symptoms of PGAD can vary widely, making it more difficult to diagnose and treat.  The primary symptom is a series of ongoing and uncomfortable sensations in and around the genital tissues, including the clitoris, labia, vagina, perineum, and anus. Some people have the ‘feeling’ of an intense bladder infection — although no infection is present. Many people have other, milder bladder symptoms, like urinating frequently or urgency to urinate. Some people also have trouble defecating. Some report having orgasms every 10 seconds. Because there is no normal pattern of symptoms, it is difficult to put definite parameters around the symptoms other than saying the arousal is unwanted and distressing.  The sensations are known as dysesthesias. They can include:

 

  • Wetness
  • Itching
  • Pressure
  • Burning
  • Pounding
  • Pins and needles

 

These symptoms can lead the person with PGAD to feel consistently like they are about to experience orgasm, or the person may experience waves of spontaneous orgasms. However, as previously mentioned, these symptoms happen in the absence of sexual desire. Climaxing may temporarily alleviate symptoms, but they may return suddenly within a few hours. Episodes of intense arousal may occur several times a day for weeks, months, or even years.  Because of this, the condition can lead to psychological symptoms due to the persistent discomfort and impact on day-to-day living. These may include:

 

  • Anxiety
  • Panic attacks
  • Depression
  • Distress
  • Frustration
  • Guilt
  • Insomnia

 

People with chronic, or incurable, persistent genital arousal disorder may eventually lose their notion of sexual pleasure, because the orgasm becomes associated with relief from pain rather than an enjoyable experience. In fact, people with this disorder often avoided sex, because it can make the condition worse. A growing body of research suggests that PGAD is often missed or misdiagnosed. Though vastly more common in women, the condition is considered a version of priapism, where men have persistent and sometimes painful, sustained erections. The psychological consequences can be significant: depression and anxiety being the most common.  In addition, many people experience shame and misunderstanding of what is happening to them.

 

PGAD affects the nerves and can lead to chronic pain and discomfort.  Sexual stimulation, masturbation, anxiety, and stress can trigger PGAD. Some people find that urinating can result in such severe arousal as to be painful. The person with PGAD cannot usually identify the triggers to avoid them, and the causes of the ongoing condition are largely unknown. In some women, stress causes the onset of the disorder. Once the stress is alleviated, the condition tends to calm. Because of this, some think that PGAD may be a psychologic disorder. However, this is not the case in every presentation of PGAD. Research has implied a link between PGAD and the veins, hormone fluctuations or depletion, nervous system issues, and chemical changes after using some types of medication. Some studies suggest that PGAD can be caused by various conditions affecting the nerves that carry sensation from the genitals. One common cause is due to growths on the nerve roots near the bottom of the spine — Tarlov cysts.  Tarlov cysts are sacs filled with spinal fluid that appear on the sacral nerve root. Sacral nerves at the bottom of the spine receive electrical signals from the brain, and they relay these instructions to the bladder, colon, and genitals.  It is thought that pressure on the nerve roots cause disorder. Surgical removal of these growths, however, does not always relieve symptoms, suggesting that this is not the only etiology. Other conditions that damage lower spinal nerves, herniated disks for example, can also cause PGAD.  Other studies have also investigated whether PGAD is caused by changes in hormones or medications.  A few studies have suggested that certain antidepressants either starting a new prescription or abruptly stopping one, has led to this condition. Other research suggests that PGAD can be caused by skin infections, irritation in the genital area, or thinning of the skin due to reduced estrogen levels after menopause. Epileptic seizures and scar tissue from a trauma that puts pressure on the spinal nerves or stretches them can also be a cause. However, in many cases, the cause is unknown, which adds to the difficulty in diagnosing and treating the disorder.

 

It was not possible until recent years to formally diagnose PGAD.  Medical literature has only recently classed PGAD as a distinct syndrome. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) did not recognize PGAD as a diagnosable medical condition until recently. It was added to DSM-V.   There are currently 5 criteria for an accurate diagnosis of PGAD.

 

The 5 criteria are:

  • Involuntary genital and clitoral arousal that continues for an extended period of hours, days, or months
  • No cause for the persistent genital arousal can be identified
  • The genital arousal is not associated with feelings of sexual desire
  • The persistent sensations of genital arousal feel intrusive and unwanted
  • After one or more orgasms, the physical genital arousal does not go away

 

The above criteria are considered to be the only valid criteria established to date for a PGAD diagnosis.

 

The treatment of PGAD usually centers on managing symptoms, due to the often-unclear causes of the condition. Many people don’t mention it to their medical provider due to embarrassment.  Often many opt to suffer in silence. If more people were aware of this condition, the emotional consequences would certainly be diminished.  Self-harm is a major problem among people with PGAD. Surgery may treat the problem, if the cause is a Tarlov cyst, but because the cysts are seen as having no symptoms, insurance usually declines payment. To ease symptoms, many people just try to avoid triggers.  Other treatments to consider include: nerve blocks, sex therapy, steroids, and anesthetics.