Persistent Genital Arousal Disorder

Persistent genital arousal disorder – also called PGAD – might sound like an unusual condition, but it does happen. And it’s distressing to those who are affected. Another name for this condition is Persistent Sexual Arousal Syndrome (PSAS).

Women with this condition have an unwelcome feeling of genital sexual arousal without desire and without genital stimulation. The condition improves only briefly with orgasm and is unwanted and intrusive on lifestyle.

PGAD is generally considered rare, but exactly how rare it is remains unclear. It has been reported in women of all ages, and affects those who are married or unmarried, hetero- or homosexual, before or after menopause, and across all levels of education.

To diagnose PGAD, 5 different features should be present:

– the genital arousal should last for an extended time (hours to months)

– no other cause for genital arousal should be present

– the genital arousal should be unrelated to feelings of sexual desire

– the arousal sensation should feel intrusive and unwanted, and be associated with some distress

– the arousal sensation should persist, at least to some degree after orgasm

Distress is important in the diagnosis of PGAD, as there may be a set of women who experience sensations of genital arousal and find them neutral or even pleasurable and hence do not fit the criteria of PGAD.

Many women find it hard to describe the sensation, but they do agree that it is unpleasant.

Typical words used describe it as a congested, swelling, tingling, wet, throbbing, itching, numb, burning, vibrating or restless feeling in the clitoris, vagina, labia, pelvis, or upper legs. Around 1 in 3 women find this sensation physically painful.

Common triggers include physical stimulation (intercourse or masturbation), psychological stress or anxiety, genital pressure (sitting on hard surfaces or cycling), vibrations from a motor vehicle or erotic visual stimulation. Some women report worsening of the symptoms at night, when blood flow to the vagina increases.

Women try many things to relieve the unwelcome feeling. Masturbation, orgasm, distraction, intercourse, exercise or a cold compress may help but unfortunately relief of the condition is often only brief or partial. The increased sexual arousal in PGAD does not mean that these women have increased desire for sexual activity. Often satisfaction with sexual activity is lower than in other women.

PGAD is not the same as conditions like nymphomania or satyriasis where there is an increased sexual desire or hypersexuality. PGAD is often associated with a lower satisfaction with sexual activity, and significant distress. The sensations are unwelcome.

•  In most women, even after careful assessment, no cause is found. However, there are some conditions that can be associated with PGAD. These include: Restless Legs Syndrome, where there is a feeling of needing to move the legs frequently, especially at night; an Overactive Bladder; a history of Sexual Abuse. In these women, genital sensations may be particularly unwelcome – Depression, Anxiety or Obsessive Compulsive Disorder; Pudendal Neuralgia – the Pudendal Nerve is the nerve to the clitoris, vulva and lower vagina.– Neurological disease, including Epilepsy, Parkinsons Disease, or Tarlov Cysts of the spine

• Simple treatments include avoiding tight clothing, prolonged sitting or cycling. Masturbation and repeated orgasm can reduce symptoms in some women, but not others. Pelvic physiotherapy to reduce the tension in overactive pelvic muscles is helpful if pelvic muscles are tight and painful.Relaxation techniques, such as regular mindfulness meditation, reduce anxiety and improve brain function.

• If your symptoms of PGAD are still distressing, then it is important to discuss these with your doctor. PGAD is rare and very few doctors have experience in the management of this condition. If you believe you have PGAD, then you may wish to print this page and take it with you to your doctor. We recommend that they: do a full clinical assessment, including asking about your medical history, medications, gynaecological history, bladder function and any life stresses or anxiety issues that may be contributing to your pain; do a full gynaecological examination, including assessment of the pelvic floor muscles (which may be tight), and location of any sensitive areas – consider whether a pelvic ultrasound (to assess the pelvic organs) or MRI scan (to assess the Pudendal Nerve and Lumbosacral spine) should be done; discuss whether review with a Sexual Trauma Therapist might assist you; consider the use of a TENS machine for your pain.

• Several different medications have been tried for PGAD. None suit every woman with this condition, so it may be necessary for you to try a few medications to find one that suits you. Medications that have been used for this condition include: Medications to reduce anxiety – these include benzodiazepines (clonazepam or oxazepam), tricyclic anti-depressants (amitriptyline or nortriptyline), serotonin medications such as duloxetine. Some women find that their PGAD symptoms begin after these medication are ceased  Medications that affect dopamine in the brain – these include varenicline (used to stop smoking) or risperidone; Medications for Restless Legs Syndrome, such as pramipexole– Medications for nerve pain such as gabapentin or pregabalin

• Although mainly described in women, a variety of PGAD called Priapism does occur in men. These men have persistent and painful erection of the penis.PGAD remains a poorly understood condition. Women with this condition may suffer substantial distress. It is important to raise awareness of this disabling but treatable condition, to avoid misdiagnosis and inappropriate investigation and treatment.

• The following medical journal articles discuss PGAD in more detail, and may be of interest to women with training in science.
  1. Leiblum S, Chivers M. Normal and persistent genital arousal in women: New perspectives. Journal Sex Marital Therapy 2007; 33: pp.357–73
  2. Facelle TM, Sadeghi-Nejad H, Goldmeier D. Persistent genital arousal disorder: characterization, etiology, and management. Journal Sex Medicine. 2013; 10(2): pp.439-450
  3. Goldstein I, Johnson JA. Persistent sexual arousal syndrome and clitoral priapism. In: Goldstein I, Meston C, Davis S, Traish S, eds. Women’s sexual function and dysfunction: Study, diagnosis and treatment. London: Taylor & Francis; 2005: 674–85.