What Is Persistent Genital Arousal Disorder

Overview

Persistent Genital Arousal Disorder (PGAD) is a rare issue that mainly affects women's sexual health. It was formerly known as persistent sexual arousal syndrome (PSAS).¹ Women (AFAB-assigned females at birth) with PGAD experience unexpected and frequent genital arousal, which is different from normal sexual arousal linked to desire. This arousal can happen without any sexual thoughts or feelings. Unlike hypersexuality, where there's excessive sexual desire, PGAD involves persistent genital arousal without the desire for it.²

Since PGAD is not particularly common, some people may decide to keep it to themselves out of humiliation or embarrassment.

It's important to know that PGAD is not the same as hypersexuality. While hypersexuality involves a heightened desire for sex, PGAD is about ongoing genital arousal even when there's no interest in being sexually aroused. Masturbations and orgasms don't provide much relief for those with PGAD.

Even though it's a serious condition, it was only officially described in this century and hasn't been recognized by international disease classification systems yet.³

Symptoms of PGAD

Symptoms may be linked to various factors and can include emotional distress and inconsistent genital arousal evidence during symptoms. PGAD means feeling strong arousal in your private parts, with increased blood flow and tension in your clitoris, labia, perineum, and anus. Some of the symptoms that can linger for hours or days are:

•  Pain
• Tingling in the clitoris
• Spasms in the vagina
•  Vaginal lubrication^4,5

Prevalence and demographics

Most reported cases of PGAD/GPD involve women, and we don't know much about how it affects men. Some research suggests that the number of PGAD/GPD symptoms might decrease with age, but similar proportions are reported between ages 20 and 60. There's limited study on PGAD/GPD in teenagers, but some surveys show it can start before age 18.

Including younger people in studies is important, especially since hormonal changes during adolescence and hormonal dysregulations are linked to PGAD/GPD. There might be underreporting of PGAD/GPD in adolescence due to feelings of shame. Global studies suggest PGAD/GPD is widespread, and initial findings hint at a possible connection between reported symptoms and factors like education and ethnicity, but more research is needed on this.⁶

Causes and triggers

PGAD was initially thought to affect only women, but recent studies show it also impacts men.

• Tarlov cysts can cause arousal and orgasms in men without an erection. This can cause pain during arousal and difficulty ejaculating in some cases. The causes of PGAD in men are still unknown⁶
• Neurological abnormalities in females include pudendal neuralgia (pain in the pelvis or genitals because of pain in the pudendal nerve) and female sexual response which has contributed to PGAD. It's thought that neurovascular dysfunction, genital peripheral neuropathy, and abnormal blood flow may be involved⁴
• Hormonal imbalances have been implicated in PGAD/GPD which might be influenced by sex hormones, as seen in cases related to menarche (onset of menstrual period in AFAM). Sex hormones affect desire, arousal, and brain functions. Emotional reactions to sensory stimuli, like hypersensitivity (misophonia), might also play a role⁶
• Individuals who have discontinued the use of selective serotonin reuptake inhibitors (SSRIs) for depression have mentioned experiencing symptoms of PGAD by irritating the nerves⁶

Diagnosis

Most of the diagnoses are based on expert opinions as there are no manuals to diagnose PGAD.

• Physical examination should be done before using an imaging test. Knowing about nerve patterns can help figure out where there might be a problem. Knowing the locations of nerve pathways helps understand the origins of the condition⁴
• A gynecological examination should be carried out before seeing a nerve surgeon to check sensitivity or swelling in the clitoral, vulvar, or labial areas. The vagina is carefully examined to assess pelvic floor tone and look for any pelvic masses. The clitoris is examined using a cotton tip applicator for any enlargement, sensitivity issues, discomfort, or numbness⁴
• Magnetic resonance imaging (MRI) can be used to find out the pressure on the nerves or if there are issues with nearby structures

Some of the criteria for diagnosis are:

• Private parts stay aroused all the time
• The arousal doesn't go away after an orgasm and might need many orgasms to lessen
• Unwanted feelings of genital arousal or on the verge of an orgasm, lasting for at least 6 months
• It can be triggered by both sexual and non-sexual things
• These symptoms can be disturbing and are not wanted by the person⁴

Treatment options

Neuromodulation, pelvic floor physiotherapy,^6,7Medications like antidepressants and anticonvulsants have been considered in cases of nerve issues which can help with nerve-related pains and itching. To deal with the symptoms of PGAD, medications that might be causing it should be slowly reduced and you should think about using drugs that reduce libido.

• Surgical procedures that include pudendal nerve neurolysis, Tarlov cyst excision, and clitorectomy (removal of the clitoris). A high percentage of success has been reported in the removal of Tarlov cysts for treatment
• Physical therapy includes pelvic floor exercises, biofeedback
• Psychotherapy and counseling include Coping strategies and addressing psychological factors

The effectiveness of these treatments varies, and there's limited research with no specific recommendations. Before attempting psychotherapy, electroconvulsive therapy, or clitoridectomy, it's crucial to evaluate and treat any neurological issues first.

Coping strategies

1.) Support groups and community resources where people exchange stories and discuss coping mechanisms ought to be considered.

2.) It is recommended to discuss medication management to reduce symptoms and change treatment options by communicating with healthcare providers to establish coping mechanisms.

3.) Modifying one's lifestyle might involve recognising and avoiding triggers as well as putting stress-reduction strategies like mindfulness and relaxation exercises into practice. To foster understanding and support between you and your partner, encourage them to attend couples counseling. Additionally, take part in advocacy and education by learning about PGAD, lowering stigma, and raising awareness among medical groups. It's crucial to concentrate on mental health by engaging in self-care and meditation practices, as well as by seeking counseling or support from support groups to deal with emotional difficulties.

Challenges and stigma

• Both the public and healthcare professionals face difficulties with prompt recognition and treatment due to a lack of awareness and comprehension. It is more difficult to correctly diagnose PGAD when there are no widely recognised diagnostic standards
• Social attitudes and misconceptions that lead to underreporting and possible misdiagnosis because many people may be embarrassed to ask for assistance. People with PGAD may feel ashamed and alone because of societal stigma and cultural taboos around sexual health
• Education and advocacy work can help manage PGAD
• Affected persons and their partners may have difficulties due to the influence of PGAD on interpersonal relationships, namely in terms of communication and emotional well-being
• Inadequate research on PGAD hinders progress in treating the illness by leaving gaps in knowledge, diagnosis, and effective therapy

FAQ

Other names for PGAD?

This order is sometimes referred to as Restless genital syndrome (ReGS or RGS).

Who does PGAD affect?

Most of the research on Persistent Genital Arousal Disorder (PGAD) has been conducted on women. The same may affect men and people assigned male at birth (AMAB).

How does PGAD feel?

The feelings in your private parts with PGAD might include pressure, fullness, pounding, pulsating, throbbing, burning, tingling, itching, pins, and needles. These sensations don't go away and can disrupt your daily life, causing stress, anxiety, and depression. Because orgasms may bring relief from pain instead of pleasure, PGAD can affect your ability to enjoy sex or have a healthy sexual relationship.

How do I prevent PGAD?

You can't stop PGAD, but you can talk to your healthcare provider to find ways to manage your symptoms.

How common is PGAD?

This condition is quite uncommon, believed to affect about 1% of women. Some people might not talk about it because they feel ashamed or embarrassed. It's crucial to understand the difference between PGAD and other sexual health issues, and if someone is experiencing these symptoms, seeking help from a healthcare professional is essential.

Is there a cure for PGAD?

There isn't a widely agreed-upon cure for PGAD, but current approaches aim to help manage the symptoms. People use both biological and psychological methods of treatment. Medications are also sometimes used to help with symptom control.

Summary

Persistent Genital Arousal Disorder (PGAD) is a rare condition that primarily affects women but can also occur in men. It involves experiencing spontaneous and continuous genital arousal, often unrelated to sexual desire, stimulation, or an orgasm. The symptoms can include genital discomfort, tingling, contractions, and unpredictable orgasms.

While the exact cause remains unknown, factors such as nerve irritation, hormonal changes, and emotional sensitivities may contribute. PGAD can significantly impact the quality of life, and there is currently no widely accepted, evidence-based treatment.

Various approaches, including medications, surgery, and psychotherapy, have been explored, but the effectiveness of these treatments varies, and more research is needed to understand this complex disorder better.