Persistent Genital Arousal Disorder And Hypersexuality: Understanding The Key Differences Between The Two

Introduction

Persistent genital arousal disorder was first identified as a condition by doctors in 2001.^1,2 It is a disorder where a person feels arousal in their genitals that is not wanted, and that is not linked to desire.¹ 

Hypersexuality, which is sometimes also called sex addiction, is when a person is so preoccupied with sex that it begins to negatively affect their life.³

While these two conditions have some things in common, they are different, and it is important that they can be told apart so that people with these problems can be treated effectively.¹ 

Persistent genital arousal disorder (PGAD)

This condition involves a person feeling sexual arousal in their genitals that is unwanted.¹ This feeling can last for hours or sometimes even days, and it is not linked to desire.¹ Even if the person has one or even multiple orgasms, the feeling may continue.¹ This constant physical feeling without relief can have a very big effect on the person’s day-to-day life, sometimes affecting their work life, personal life, and relationships.¹ It is more common in people assigned female at birth (AFAB), and doctors think that it affects 1% of women, although it’s difficult to know this for sure, as many people with persistent genital arousal disorder do not go to their doctor.¹

Causes of persistent genital arousal disorder

The cause of persistent genital arousal disorder is not fully understood.^{1, 4} However, researchers have found some things that they believe may be linked to persistent genital arousal disorder in some people.¹ These things are:

• Changes to medication.¹ If someone has been taking antidepressants belonging to the class of selective serotonin reuptake inhibitors and then stops taking these medications, it can lead to persistent genital arousal disorder⁵ 
• Varicose veins in a person’s pelvis.¹ This is caused when the blood in the vein cannot flow from the pelvis back up to the heart effectively, causing varicose veins⁶ 
• Tarlov Cysts.^1,7 These are fluid-filled sacs that grow at the bottom of a person’s spine and sometimes press on nerves⁸ 
• A growth near the clitoris.¹ If someone develops an abscess that presses on a nerve close to the clitoris, this can cause persistent genital arousal disorder⁹ 
• Mental health struggles, like anxiety and depression.¹ People who have these conditions are more likely to develop persistent genital arousal disorder²

Symptoms of persistent genital arousal disorder

People with Persistent Genital Arousal Disorder often report:

• A feeling of pins and needles around the genitals¹ 
• Feeling pressure around the genitals¹
• The genitals may feel full¹
• There may be a sensation of feeling throbbing, like a heartbeat, in the genitals¹
• The person may experience itching in the genitals¹
• There may be a burning sensation present at the genitals¹
• Some people experience pain as part of their persistent genital arousal disorder¹⁰ 

Diagnosis of persistent genital arousal disorder

To diagnose persistent genital arousal disorder, your doctor will look into a few parameters.¹ Someone has persistent genital arousal disorder if:

• They feel physical arousal in the genitals (more blood flowing to the area and a sensation of pressure) even though they are not mentally aroused¹
• This feeling can happen because of a sexual experience, a non-sexual experience, or no experience at all¹
• The feeling of arousal stays with the person for hours, or perhaps a days¹ 
• The feeling of physical arousal doesn’t improve after an orgasm, or sometimes even after several orgasms¹
• The above problems cause the person negative feelings, like distress or anxiety¹

Your doctor may also perform an examination of the genitals to see if there is a physical cause of the symptoms.¹¹ They may also look at the medications that you are or have been taking, in case this may have something to do with the symptoms.⁵

Treatment of persistent genital arousal disorder

Everyone with persistent genital arousal disorder is different, and the treatment will depend on the patient.¹ Some things that the person’s medical team will consider are:

• Physical therapy.¹ These are exercises that are designed to help the patient’s body act normally again
• Medications to help with the sensations¹
• Cognitive behavioural therapy.¹ This is a kind of therapy that helps people deal with their symptoms more effectively¹²
• Surgery.¹³ This can be done to help free a nerve that is being pressed on by a mass, which can help if that is the cause of the symptoms¹³

Hypersexuality

This condition, otherwise known as sex addiction, is a problem where the person is preoccupied with sex to a level that affects their everyday life.¹⁴ 

Hypersexuality is more common in people assigned male at birth; for every AFAB person with hypersexuality, there are two AMAB people with hypersexuality.³ Currently, doctors think that up to one in ten people in America may have hypersexuality.³

Cause of hypersexuality

It’s not known exactly what causes hypersexuality, but some things do seem to be linked to the condition. These include:

• Side effects from medication.³ Certain drugs, for example, a drug that is often prescribed to people with Parkinson’s called Levodopa, may cause hypersexuality³
• Brain chemistry.³ The brain uses chemicals to control mood. If these chemicals are not balanced as they should be, a person may have hypersexuality³
• Taking certain mood-changing substances (like alcohol, amphetamines, or cocaine) may bring on hypersexuality³
• Damage to your brain.³ A part of your brain named the frontal lobe controls sexual feelings.¹⁵ If this gets damaged, either by injury or by a condition that causes damage to the brain (eg. dementia, epilepsy) the person may develop hypersexuality³ 

Symptoms of hypersexuality

People with hypersexuality may have a range of symptoms. Some common problems associated with hypersexuality include:

• Someone continues with certain sex-related behaviours even though they are having an impact on the rest of their life³
• Spending lots of time thinking about or imagining sex (obsession)³
• Being sexually excited by things that may harm other people, either physically or mentally³
• Masturbating often³
• Taking part in sexual activities that you are ashamed of because they go against what you would usually consider acceptable³
• Watching pornography often³
• Taking part in sexual practices which could be dangerous³
• Spending a lot of time thinking about when you can have sex again³
• Using sexual services often, for example, sex workers³

Diagnosis of hypersexuality

To diagnose hypersexuality, your doctor will ask you about your sexual thoughts, feelings and desires.³ They may also speak to your loved ones to see how they have been affected by the patient’s behaviour.³ They will also ask about your general health and medications.³

Treatment of hypersexuality

The treatment required will depend on the person.³

• Doctors may prescribe medications, for example, antidepressants, to help with the person’s mood.³ In extreme cases, they might provide anti-androgens, which can help with recurring thoughts³ 
• Therapy,³ Talking to a medical professional, either in a one-on-one or a group setting, may help someone with hypersexuality with their condition³

Differences between persistent genital arousal disorder and hypersexuality

There are some similarities between the two conditions, but there are some key differences.

Persistent genital arousal disorder is more common in people who are AFAB, where hypersexuality is more common in people who are AMAB.

A person with persistent genital arousal disorder will feel the physical sensation of arousal even if they are not mentally aroused. People with hypersexuality do not have this.

Persistent genital arousal disorder often has a physical cause from nerves in the genital region being affected. If there is a physical cause of hypersexuality, it is usually in the frontal lobe of the person with the symptoms.

Someone with persistent genital arousal disorder may not have any relief after having an orgasm, while someone with hypersexuality will usually experience satisfaction for a while after orgasm.

The symptoms of persistent genital arousal are physical, located in the patient’s genitals. Hypersexuality does not have this feature.

Persistent genital arousal disorder can sometimes be relieved via surgery or physical therapy. This is not true for hypersexuality. 

Conclusion

While persistent genital arousal disorder and hypersexuality have some similarities, it is important to distinguish between the two so that patients can access the correct treatment and support. 

Further research is required on both conditions to help us understand and treat the disorders.³