What is PGAD?

Persistent genital arousal disorder (PGAD) is a condition where you experience sensations of genital arousal in the absence of sexual stimulation or thoughts.¹ Unlike hypersexuality, PGAD is not driven by libido, and usually involves uncontrollable sensations like tingling, throbbing or pressure in your genital area, which can last hours, days, or be constant.² This physiological arousal is considered intrusive and unwanted, often causing people with PGAD emotional distress, anxiety, and social isolation.¹ 

Based on our current knowledge, PGAD primarily affects cisgender women, and although considered rare, its exact prevalence is unknown, predominantly due to being underdiagnosed^1,2,5.

In this article, we’ll explore some of the symptoms of PGAD, and how it affects your nervous system and genital region.

Symptoms of PGAD

Common symptoms of PGAD involve intense genital arousal without sexual stimuli that may last for hours, or even days, and include:^1,2

• Sensations of tingling, throbbing, and pressure in your genital area
• Pain or discomfort in your genitals
• Engorgement of your clitoris
• Vaginal contractions
• Vaginal lubrication
• Unpredictable orgasms

You may experience relief from your symptoms after having an orgasm, although this is often only temporary, and some people report no relief following an orgasm.¹ 

The common triggers of symptom onset can include simple things such as sitting down, urinating, and feeling stressed.^1,5 In some cases, there is no clear trigger, and the symptoms occur spontaneously.³

How does PGAD affect the nervous system?

Abnormal nerve signalling

The peripheral nervous system (PNS), that is, your entire nervous system excluding your brain and spinal cord, plays a key role in sexual arousal. Your genital region is filled with sensory nerves that supply sensations to the area and send signals to your brain when stimulated. They form a delicate network that, if disrupted, can create a ‘false alarm’ effect.

One of the major sensory nerves that travels through your pelvis and innervates your genitals, anus, and perineum, is the pudendal nerve.^. Another nearby nerve that relays arousal-related signals is the dorsal nerve of the clitoris (or penis) and is a branch of the pudendal nerve.⁴

If any of these nerves become damaged, irritated, or compressed, this can cause abnormal sensory relay, meaning incorrect signals are sent to your brain.^1-4 This leads to a heightened or continuous sense of arousal, even when nothing arousing is happening. You can think of it like a faulty wire that keeps sending electrical signals even when the switch is turned off.

Brain sensitivity

Your brain and spinal cord collectively form your central nervous system (CNS) and also have major roles in how you experience sexual arousal. Certain areas of your brain that process emotion (limbic system), control hormones (hypothalamus), and are involved in sexual behaviour (medial preoptic area), can become overly sensitive or dysregulated in PGAD.^2,7 This causes a condition called central sensitisation, where sensations that you previously considered to be ‘normal’ or minor are amplified and perceived as more intense, which can be uncomfortable.² This heightened sensitivity can be likened to a car alarm sounding at the slightest breeze. 

On top of this, certain areas of your brain (prefrontal cortex and periaqueductal grey) that help to calm things down may not function properly in PGAD, meaning the feelings of arousal continue when they would usually stop.^2,7

How does PGAD affect the genital region?

Vascular issues 

Sometimes, people with PGAD have issues with the blood vessels in their pelvic region.^1,7 For instance, a condition known as pelvic congestion syndrome causes the veins in your pelvis to fill with blood and become enlarged. This can create pressure and the sensation of fullness that mimics arousal. 

On top of this, if your autonomic nervous system (responsible for regulating blood flow) is dysfunctional, these vascular issues can worsen and intensify symptoms.⁷

Muscle tension

The muscles at the bottom of your pelvic area can also contribute to PGAD symptoms, especially if they are tight or overactive.⁸ Since these muscles support your bladder, uterus, and other organs, if they become too tight or tense, they can stimulate nearby nerves and create uncomfortable sensations. Not unlike how tight knots in your shoulders can cause pain to radiate elsewhere.

Genital tissue sensitivity

Repeated arousal can take its toll on your genital tissues and, over time, lead to what is called neurogenic inflammation. This is your body's response to repeated or sustained stimulation. Upon stimulation, the affected nerve cells release chemicals that cause swelling and inflammation, making the area extra sensitive. This heightened sensitive state creates a positive feedback loop; more sensitivity leads to the sensations feeling increasingly intense, which leads to more discomfort.

The role of hormones and neurochemicals

Your brain releases and responds to chemicals and hormones that are responsible for regulating your mood and sexual function. Sometimes, in people with PGAD, an imbalance of these can occur, which makes your nervous system hypersensitive, altering how your brain perceives arousal signals. This is not to say that PGAD is “just in your head”, but rather demonstrates the role your brain plays in shaping your overall experience.

Serotonin

Serotonin, also known as a ‘happy hormone’, helps to reduce overactive nerve signalling and calm your brain. It generally acts as a brake on sexual arousal, slowing things down. Low levels of serotonin may contribute to PGAD, as the ‘brake’ is less effective. For instance, withdrawal from selective serotonin reuptake inhibitors (SSRIs), a common antidepressant medication that increases serotonin levels, can trigger what is called discontinuation syndrome. This causes your body to become overly sensitive to the sudden drop in serotonin levels and leads to the onset of PGAD symptoms.^1,3

Dopamine

Dopamine, also known as the pleasure and reward hormone, can enhance sexual desire and arousal. Dopamine and serotonin work together, with dopamine initiating arousal, and serotonin helping to stop it from getting out of control. But if dopamine levels become too high, or serotonin drops too low to maintain balance, your brain can become over-reactive to signals from your genitals.⁶

Noradrenaline

Noradrenaline, also known as norepinephrine, is part of your stress response system. It acts to switch your body into a more alert state by increasing your heart rate and blood pressure. If this system becomes overactive, it can make you more aware of sensations in your body, including those in your genital region. Elevated noradrenaline activity is common in people who have anxiety or trauma-related disorders, like post-traumatic stress disorder (PTSD), and has been linked to PGAD.^9,10

Summary

PGAD is a complex and often misunderstood condition that is both neurological and physical. Whilst the exact causes of PGAD can vary and are still poorly understood, we do know that nerve and blood flow issues, brain sensitivity, and changes in neurochemical levels can contribute to the onset of symptoms. Understanding the biological mechanisms behind PGAD can help reduce the stigma surrounding it, which claims it is hypersexuality or “in someone’s head”.

If you, or somebody you know, is experiencing symptoms of PGAD, speaking with your medical provider can help get you on track to receiving support and treatment.