Persistent genital arousal disorder (PGAD, also known as restless genital syndrome or genitopelvic dysesthesia) is a distressing condition that causes unwanted sensations in the vulva. Symptoms are not relieved by masturbation and can lead to stress and anxiety.
This condition is most common in women but has been reported in men as well.
Causes
Usually, sexual feelings are triggered by what we see, smell, touch, hear and feel. But sometimes the body experiences arousal for no reason at all. When this happens, it’s called persistent genital arousal disorder, or PGAD. PGAD can cause pain, vaginal swelling and an erection that lasts several hours or more. It almost always affects women, but it’s been reported in a few men too. It’s different from hypersexuality, which is a desire for sex beyond what’s healthy or appropriate.
People with PGAD experience unrelenting sensations in and around the clitoris, labia, vulva, perineum, nipples and anus. The discomfort is so severe that it interferes with their daily lives and causes anxiety and depression. They may try to cope with the symptoms by masturbating, but this only offers temporary relief. This can create a vicious cycle because the arousal triggers anxiety and stress, which in turn makes the symptoms worse.
It is unclear what causes PGAD, but it’s believed to be related to neurological, vascular, physiological and pharmacological factors. Some patients develop PGAD as a side effect of taking certain medications, such as SSRIs or antidepressants. Other cases are attributed to specific neuropathic conditions such as pudendal neuralgia. It’s also possible that PGAD is a psychological disorder. Whether or not it has a physical cause, it’s important to seek medical care because the condition can lead to serious complications and even suicide.
Symptoms
Persistent genital arousal disorder affects people who are assigned female at birth. PGAD is similar to the condition called priapism, which causes an unrelenting penile erection that lasts for hours. PGAD is often accompanied by pain or discomfort in the vulva and anus. It’s also sometimes accompanied by a sense of urgency to ejaculate. Symptoms may come and go. They can occur at any time of the day or night. People with PGAD often have to be careful not to overdo it, as the arousal can be mistaken for an urge to have sex.
Unlike sexual arousal, which feels good, PGAD does not feel good. It can’t be relieved by orgasm or sexual intercourse. PGAD also isn’t the same as hypersexuality, which involves intense feelings of desire that aren’t related to any sexual activity.
PGAD symptoms can be very distressing. Your doctor will usually check for medical problems that can cause it, including neurological and vascular issues. Your doctor will probably order a pelvic exam and a blood test that checks your hormone levels. They’ll also likely take a tampon-sized device that measures blood flow to your vulva. They might also order an MRI, CT scan or electroencephalogram (EEG) to look for any neurological problems. You might also get a psychological evaluation to find out if stress or anxiety are contributing factors.
Diagnosis
PGAD is often misdiagnosed, and it’s important that your doctor understand your symptoms before making a diagnosis. It’s also important to rule out other medical conditions before determining if you have PGAD.
A diagnosis of PGAD is based on the presence of unwanted, involuntary genital arousal lasting for a long period of time without resolution or relief. These arousal symptoms differ from sexual arousal in that they are unrelated to subjective feelings of sexual desire and don’t end when you have orgasms. The arousal symptoms include genital fullness, swelling or sensitivity and/or spontaneous orgasms that occur outside of the context of subjective sexual arousal or desire. The arousal can be triggered by sexual or nonsexual stimuli, and in some cases, there is no identifiable trigger at all.
A 54-year-old male was referred to a psychosexual clinic because of persistent, uncontrolled arousal symptoms. He reported feeling like he was about to ejaculate for hours and days at a time with no sexual stimulation and that these feelings would not go away even after he had orgasms. He was diagnosed with PGAD and treated with antidepressants and a muscle relaxant. His symptoms have improved and he no longer experiences uncontrollable arousal symptoms. PGAD is most common in women and people assigned female at birth but can also affect men and people assigned male at birth.
Treatment
If you have a sexual arousal disorder, you experience the physical changes that come with sexual excitement, including vaginal swelling and an erection. These symptoms can last hours, days or weeks at a time and cause distress. Treatment options vary and are based on the type of arousal you have. Talk to your doctor about how to manage your symptoms. They may recommend strategies to help you feel better or refer you to a sex therapist for more intensive treatment.
Persistent genital arousal disorder, also known as persistent sexual arousal syndrome, is an intensely distressing condition in which you have unrelenting and unwanted sensations of arousal and pain in your genitalia without the accompanying feelings of desire or motivation to have them. It can occur triggered by sexual or nonsexual cues and doesn’t resolve with orgasms. It is also not diminished by masturbation.
PGAD affects women and people assigned female at birth (AFAB). It isn’t known what causes it and it’s not considered a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision or International Classification of Diseases, 10th edition.
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