Introduction 

Imagine a smoke alarm that keeps going off even though there’s no fire. 

You check every room, but there’s no smoke, no heat. Still, the alarm won’t stop. 

It’s loud, constant, and stressful and eventually, it starts to affect your sleep, your mood, and your ability to focus.

That is what persistent genital arousal disorder feels like. 

Your body is sending signals of sexual arousal even though there’s no sexual desire or reason for it, and you can’t easily shut it off. 

Persistent genital arousal disorder is a condition with no definite cause hence different treatment methods.

In this article, you will learn about the use of hormonal therapy for the treatment of this condition and its effects on symptom relief. 

What is persistent genital arousal disorder?

It is a condition where you experience unwanted sexual feelings in your genital area (clitoris, vagina and penis) and the feelings do not stop with orgasms.

It is a rare condition that affects both males and females but has a higher occurrence in females.

Usually, you become sexually aroused by certain touch, smell, feelings, sight or hearing which leads to orgasm if sexual activity is performed.

But in this condition, none of this comes into play for you to feel sexually excited. It just happens without any cause(s).

This sexual excitement comes usually unexpectedly and almost all the time and can last for hours and even days.

It can be very embarrassing and frustrating because it just happens when you are not even physically and emotionally ready for sexual intercourse and also at a place or places where you can't do anything to satisfy the feeling.

This makes it hard to carry out activities of daily living, and concentrate properly and also affects social interactions.¹

Summarily, it's a condition marked by five criteria which are:⁵

• Genital arousal that is persistent and uncontrollable 
• No sexual desire before arousal 
• Orgasm that does not stop it
• Not desired and wanted
• No definite cause

Diagnosis of persistent genital arousal disorder

Because PGAD has many causes, the best way to determine the cause is to do holistic assessment which includes physical, medical, social and psychological (mental) assessments.¹

This way, the cause or causes of the condition can easily be dictated.

During diagnosis, vitally is important to take note of symptoms, where they occur most, degree of association with sexual feelings and pressure, distress, orgasm, previous treatment outcomes, family history, triggers aggravating factors and how symptoms affect everyday living.¹

Symptoms of persistent genital arousal disorder

What you have most times are:

• Spontaneous orgasms
• Swelling of the genitals
• Extraordinary lubrication 
• Depression
• Agoraphobia²
• Generalized anxiety disorder²
• Lifetime panic disorder²

The symptoms might be there all the time or come and go.

Also, symptoms can be something you’re born with or develop later in life, usually around 37 years of age with a range from 6 to 66 years and sometimes, before 18.²

In those assigned female at birth, the clitoris usually gets sexually aroused first, followed by the vagina and labia before spreading to other parts of the body.⁵ 

You may have feelings of pressure, fullness, pulsations and throbbing in your genitals.

Causes of persistent genital arousal disorder

PDAD has no particular cause.  However, the cause can be as a result of sexual or non-sexual stimulus.

 Some causes are 

1. Tarlov cysts:

Which increases the pressure on the nerve root and presses on nearby nerves initiating arousal.³

2. Medications:

Drugs like serotonin selective reuptake inhibitors (SSRIs) during commencement and stoppage.¹ They cause this by affecting nerves involved in arousal and sensation during their course of action.

Other medications associated with PGAD include trazodone, dopaminergic agents for Parkinson’s disease, atypical tricyclic antidepressants, and histaminergic agents, anticonvulsants and antipsychotics.¹

3. Compression of the dorsal branch of the pudendal nerve:²

This can be by a mass, or dorsal nerve injury due to pelvic trauma e.g. riding accidents, bicycle riding, and birth injury.²

The pudendal nerve is like the main highway that conveys the stimulus of feelings in your private areas.

It carries signals from the clitoris and other nearby areas, like the perineum and the back part of the labia to the brain which is interpreted as arousal. 

If this nerve gets damaged or pressed on, it can send mixed-up messages to the brain which interprets it to be continuous arousal.²

4. Mental factors:

Stress, anxiety, pain and depression, and sexual abuse² can precipitate the condition.

5. Heat:

Also plays a role because of its effect on the dilation of blood vessels which leads to increased genital blood flow resulting in higher arousal.

Some circumstances and activities can worsen it like sitting, driving, music or sounds and nervousness.¹

Treatment of persistent genital arousal disorder

The best treatment approach for this condition is a holistic treatment method because of its multi-varied causes.¹

However, in this article, you will learn about hormonal therapy as a treatment modality for this condition. 

Hormonal therapy for persistent genital arousal disorder 

What are hormones?

They are substances produced by glands and organs in your body that transfer information through the blood to target organs where their effect is seen.

They are like messengers you can send on errands and they give a response or an answer.

Most of the processes that keep your body working like homeostasis, metabolism, development, and reproduction are all possible because of hormones and the work they do. 

Same way, in sexual function, there are hormones like oestrogen, follicle-stimulating hormone, luteinizing hormones and prolactin for those assigned female at birth and mainly testosterone for those assigned male at birth.

They are responsible for the growth, maturation and maintenance of sexual function.

When there is alteration, they might have negative effects.

For instance, the hypothalamus in the brain sends out gonadotropin-releasing hormone.

The gonadotropin-releasing hormone causes the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone(FSH).

LH and FSH stimulate the ovaries (in women) or testes (in men) to produce estrogen or testosterone.

When there is too much stimulation in this system, the result can be heightened nerve sensitivity, blood flow, and tissue response in the genital area. 

Hormonal therapy for PFAD

Hormonal therapy, also called hormone therapy or endocrine therapy, is a medical treatment that uses hormones for treatment.

Their actions are mainly by altering hormone levels in the body to treat certain conditions

The hormonal therapy shown to be effective for the treatment of persistent genital arousal disorder is Leuprolide (anti-androgen).⁶

Androgens are sex hormones produced in both males and females but, more in males.⁴ They are very important in regulating vital body functions.

How leuprolide works?

Leuprolide is a gonadotropin-releasing hormone agonist. 

It means when first given, it increases gonadotropin-releasing hormone activity leading to a temporary surge in sex hormones.⁴

However, if taken continuously (instead of in pulses like the body naturally does), it over-stimulates the pituitary receptors and as a result, they stop secreting their hormones.

As a result, luteinizing hormone and follicle-stimulating hormone levels decrease and estrogen/testosterone production also drops.

This shutdown acts as though it's menopause or andropause hence lowered sexual hormone levels which means dampled body sexual response and arousal.

How that helps PGAD symptoms?

• By decreasing estrogen and testosterone levels, it reduces genital blood flow and engorgement, which can reduce the constant feeling of arousal
• There is also a decrease in pelvic nerve sensitivity, which may play a role in triggering or sustaining PGAD sensations
• Overall, it decreases sexual responsiveness, making spontaneous or uncontrollable arousal episodes less likely

Summary 

Persistent Genital Arousal Disorder (PGAD) is an unwanted sexual arousal that can be painful, frustrating and embarrassing.

There are spontaneous orgasms and arousal that do not remit, even after multiple orgasms. 

The exact cause of PGAD is not clear. It can be due to nerve issues, hormonal changes, or medications. 

Treatment involves a combination of medication, psychotherapy, and lifestyle changes.

Medications such as antidepressants, antipsychotics, and pain relievers have shown some effectiveness in managing PGAD symptoms. 

Lifestyle changes such as avoiding trigger activities, practicing stress reduction techniques, and engaging in regular exercise may also be beneficial.