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.
How common is this condition?
PGAD is generally considered rare, but exactly how rare 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.
How is PGAD diagnosed?
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.
What does PGAD feel like?
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.
How do women relieve these unwelcome sensations?
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.
What causes PGAD?
In most women, even after careful assessment, no cause is found. However, there are some conditions that can be associated with PGAD, including:
Restless Legs Syndrome (RLS) – a condition characterised by an urge to move the legs, often worsening at night.
Overactive Bladder – urinary urgency and frequency may occur alongside PGAD symptoms.
History of Sexual Trauma or Abuse – genital sensations may be particularly distressing or unwelcome for some individuals.
Mental Health Conditions – including depression, anxiety, and obsessive-compulsive disorder (OCD).
Pudendal Neuralgia – irritation or dysfunction of the pudendal nerve, which supplies sensation to the clitoris, vulva and lower vagina.
Neurological Conditions – including epilepsy, Parkinson’s disease, and spinal abnormalities such as Tarlov cysts.
While these conditions may be associated with PGAD, they do not necessarily cause it, and many people with PGAD do not have any identifiable underlying condition. A comprehensive assessment can help identify contributing factors and guide appropriate management.
What can I do about my PGAD?
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.
Can my doctor help me?
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
Are there medications I can take for PGAD?
Several different medications have been tried for PGAD, although no single treatment works for everyone. Finding the most effective medication may involve some trial and adjustment under the guidance of your healthcare provider.
Medications that may be considered include:
Anti-anxiety and antidepressant medications – including benzodiazepines (such as clonazepam or oxazepam), tricyclic antidepressants (such as amitriptyline or nortriptyline), and serotonin-based medications (such as duloxetine). Some people report that PGAD symptoms commenced after they stopped taking these types of medications.
Medications that affect dopamine pathways in the brain – such as varenicline (commonly used for smoking cessation) or risperidone.
Medications used for Restless Legs Syndrome – including pramipexole.
Medications for nerve-related pain – such as gabapentin or pregabalin.
Can Men have PGAD too?
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.
Where can I find out more?
The following medical journal articles discuss PGAD in more detail, and may be of interest to women with training in science.
Leiblum S, Chivers M. Normal and persistent genital arousal in women: New perspectives. Journal Sex Marital Therapy 2007; 33: pp.357–73
Facelle TM, Sadeghi-Nejad H, Goldmeier D. Persistent genital arousal disorder: characterization, etiology, and management. Journal Sex Medicine. 2013; 10(2): pp.439-450
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.