Introduction

Definition of Persistent Genital Arousal Disorder (PGAD)

Persistent genital arousal disorder (PGAD), is an extremely rare disorder that involves experiencing unpredictable and uncontrollable sexual arousal, but with the absence of desire. Sexual arousal is mainly associated with pleasure, but in PGAD you experience arousal as unwanted physical sensations in your genitals. It is uncontrollable, when these changes begin, and an orgasm may not relieve them.¹

Those who suffer from this disorder, constantly feel like they are on the verge of an orgasm, which can last anywhere from a couple of hours to several dyas. It is known to mostly affect women, although it has been reported to affect men too.¹

Distinction from normal sexual arousal

For most individuals, the subjective part of sexual desire is directly linked to the physical points of sexual arousal. In other words, feeling “in the mood” or “ turned on”. However individuals with PGAD, the physical aspects do not happen in the same way, the sexual desire and genital arousal are not in sync. The physical sensation that comes with the vaginal arousal are of unwanted, distressing, embarrassing, intrusive and frustration.^1,2

Importance of understanding symptoms

Due to this disorder only being recognised in 2001, and being rare, there are not many studies being conducted. For this reason researchers are still learning its cause and understanding the treatment that works best.²

Core symptoms

Physical sensations

PGAD involves feeling very intense genital arousal that is associated with increased blood flow and increased tension to your labia, clitoris in females and penis in men, perineum and anus. Most symptoms are unpredictable and may last minutes, a couple of hours or even days. Symptoms include:^1,3

• Continuous genital arousal without sexual desire/ stimulation
• Pain or discomfort in your genitals
• Genital tingling and throbbing
• Genital swelling
• Pelvic congestion
• Pressure
• Vaginal lubrication - in females
• Vaginal contractions
• Spontaneous erections - in males

Triggers and exacerbating factors

Physical triggers

Women who are diagnosed with PGAD often feel out of control. This is because it happens sporadically and anything can trigger it. Anything from a bumpy car ride, inserting a tampon or sitting can trigger an arousal. It occurs without any sexual thoughts or sexual stimuli, simply daily tasks can seem to be a challenge and it can start to affect your daily life.^1,4

Psychological

A study from 2020, suggested that PGAD is not only associated with distress, but also psychological factors, such as stress and anxiety. These factors may potentially increase the risk of developing PGAD, mediate PGAD symptoms or may even negatively be impacted by PGAD. The anxiety and the emotional stress may intensify the symptoms.⁴

Psychological and emotional impact

Studies suggest also psychological and emotional impact from PGAD, such as:⁴

• Distress and frustration - inability to relieve symptoms, even through an orgasm 
• Anxiety and depression - chronic discomfort and social stigma
• Social and relationship difficulties - strain on personal and intimate relationships

Misdiagnosis and delayed recognition

Common misinterpretations

Since PGAD is still a taboo and not very understood, there are other diseases and disorders that are associated with it, including:^1,5

• Hypersexuality - unlike PGAD, it is associated with the desire to have intercourse and the desire and the urge to engage in sexual activity 
• Urinary tract infection (UTI ) - an infection that causes pain when urinating and the feeling of wanting to urinate. Symptoms include burning and itching
• Vulvodynia - persistent vulvar pain that is unexplained and caused by irritation on the nerves around the vulva
• Penoscrodynia - similar to vulvodynia, but it is related to men causing burning like sensation around the penis 
• Psychological disorders - depression, anxiety and many more

Barriers to diagnosis

One of the reasons why it is difficult to diagnose and to research about PGAD is because it is considered rare. However, esports believe that the number of women living with this condition is actually higher than reported. This can be due to the stigma attached to PGAD. Most women may feel embarrassed and afraid to seek treatment because of the taboo nature of the disorder. 

Another reason would be the lack of awareness to the public and also in the medical community. Since it is considered rare, not a lot is known about it, so it is difficult to make it more aware to the public.²

Summary

PGAD is a rare disorder that causes you to experience unwanted sporadic sensations of arousal in your genitals. You may experience pain, tingling and throbbing in your genitals. PGAD is very different from a sexual arousal, because PGAD is unwanted, uncomfortable and can happen without stimulation. If left untreated, PGAD can take a toll on your body and your mental health, reducing your quality of life. Don't be embarrassed to seek help, and reach out to your local sexual health clinic for help.