Persistent Genital Arousal Disorder

Overview

What is persistent genital arousal disorder?

Persistent genital arousal disorder (PGAD) involves experiencing unpredictable, uncontrollable physical sensations associated with sexual arousal — but in the absence of desire. Sexual arousal is usually associated with pleasure, but this isn’t the case with PGAD. With PGAD, you experience arousal as unwanted physical sensations in your genitals. You can’t control when these changes begin, and orgasm doesn’t relieve them.

Instead of making you feel sexual, PGAD may lead to feelings of frustration and embarrassment. It may even be debilitating without help from a healthcare provider.

PGAD wasn’t identified until 2001, and it’s not a common diagnosis. For this reason, researchers are still learning its causes and what treatments work best.

What's the difference between PGAD and hypersexuality?

The researchers who identified PGAD in 2001, Leiblum and Nathan, originally called it persistent sexual arousal syndrome (PSAS). The word “genital” replaced “sexual” because sexual implies desire, which doesn’t apply to PGAD. This is an important difference between PGAD and hypersexuality, or sex addiction.

Hypersexuality involves desiring sex to the point of excess. With PGAD, desire is removed from the physical experience of arousal.

Who does persistent genital arousal disorder affect?

PGAD has mostly been studied in women and people assigned female at birth (AFAB). Recent research suggests that it may also affect men and people assigned male at birth (AMAB). PGAD has been compared to priapism, a condition that involves having an unwanted erection for four hours or more.

How common is persistent genital arousal disorder?

It’s extremely rare. Researchers suggest that it may affect about 1% of people AFAB. It’s difficult to know for sure because it’s likely that many people who experience PGAD symptoms are too embarrassed to seek help.

Symptoms and Causes

What are the symptoms of persistent genital arousal disorder?

PGAD involves feelings of intense genital arousal associated with increased blood flow and heightened tension in your clitoris, labia, perineum and anus. Symptoms may last for hours or even days and include:

  • Pain or discomfort in your genitals.
  • Tingling in your clitoris.
  • Vaginal contractions.
  • Vaginal lubrication.
  • Unpredictable orgasms.

You may experience orgasms that don’t relieve your symptoms, or you may experience momentary relief through an orgasm only to have your symptoms return.

What does PGAD feel like?

The sensations in your genitals associated with PGAD may be described as:

  • Pressure.
  • Fullness.
  • Pounding.
  • Pulsating.
  • Throbbing.
  • Burning.
  • Tingling.
  • Itching.
  • Pins and needles.

These sensations persist without relief. PGAD’s toll on your body can interfere with your day-to-day routine, causing stress, anxiety and depression. Since orgasms become associated with feelings of relief from pain instead of pleasurable sexual release, PGAD can keep you from enjoying sex or having a healthy sexual relationship.

Does PGAD feel good?

PGAD doesn’t feel good in the way that sexual arousal does. Sexual arousal feels good, in part because you desire the physical sensations. Desire is a key part of a healthy sexual response. Also, you can feel comforted that feelings of release and normalcy will follow the physical experience of heightened sexual tension.

PGAD is different in that you lack control over feelings of arousal, and you don’t know when your body will experience relief or return to its baseline.

What causes persistent genital arousal disorder?

Researchers don’t know for certain what causes PGAD. A combination of factors likely plays a role. The causes may be related to blood vessels and blood flow, nerves or behavioral health issues. Certain medications may trigger or worsen PGAD.

Studies have shown that PGAD may be associated with:

  • Pelvic varices: Varicose veins in your pelvis.
  • Tarlov cysts: Cysts that form at the base of your spine.
  • Periclitoral masses: An abscess on or near your clitoris that causes intense pain.
  • Selective serotonin reuptake inhibitors (SSRIs): People who have stopped taking SSRIs for depression have reported PGAD symptoms.

Stress, anxiety and depression have all been linked to PGAD. Still, it’s unclear how they relate to potential biological factors associated with PGAD.

Diagnosis and Tests

How is persistent genital arousal disorder diagnosed?

There are five criteria for a PGAD diagnosis. They include:

  • Feeling the physical sensations of sexual arousal (increased blood flow and pressure in your genitals) but without the complementary psychological component of desire.
  • Feeling the onset of symptoms because of a sexual trigger, a non-sexual trigger or no trigger.
  • Experiencing arousal symptoms in your genitals for several hours or days without relief.
  • Having symptoms that don’t resolve after one or even multiple orgasms.
  • Experiencing distress because of these unwanted symptoms.

Management and Treatment

What is the treatment for persistent genital arousal disorder?

There aren’t standard treatments for PGAD. Studies have demonstrated that the following have eased symptoms for some people with persistent genital arousal disorder:

Ultimately, the treatments for PGAD vary on a case-by-case basis. The condition is so new that researchers are still learning about which treatments and coping strategies work best. Your healthcare provider is your best resource for recommending strategies to manage your symptoms or connect you with a specialist, like a sex therapist, who can help.

Prevention

How can I prevent persistent genital arousal disorder?

You can’t prevent PGAD. You can schedule a visit with your healthcare provider to discuss solutions for getting your symptoms under control.

Living With

When should I seek care?

You should seek help from your healthcare provider if you’re experiencing symptoms that keep you from having a healthy sex life or that cause distress. Getting help is especially important with PGAD when the experience of genital arousal can disrupt your life and harm your mental health.

A note from Cleveland Clinic

It may take some time to locate treatments that work best for you once you’re diagnosed with PGAD. Your care may require a collaborative approach that involves your provider and a behavioral health specialist, like a counselor or therapist. The good news is that although this diagnosis is new, more and more people are receiving the care needed to manage symptoms. Don’t let embarrassment prevent you from getting the help you need to cope with PGAD.

Last reviewed by a Cleveland Clinic medical professional on 08/15/2022.

References

  • Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD). (https://pubmed.ncbi.nlm.nih.gov/33612417/) J Sex Med. 2021;18(4):665-697. Accessed 8/15/2022.
  • Jackowich RA, Mooney KM, Hecht E, et al. Online pelvic floor group education program for women with persistent genital arousal disorder/genito-pelvic dysesthesia: descriptive feasibility study. (https://pubmed.ncbi.nlm.nih.gov/33427673/) JMIR Form Res. 2021;5(1):e22450. Published 2021 Jan 11. Accessed 8/15/2022.
  • Klifto KM, Dellon AL. Persistent genital arousal disorder: review of pertinent peripheral nerves. (https://pubmed.ncbi.nlm.nih.gov/31704111/) Sex Med Rev. 2020;8(2):265-273. Accessed 8/15/2022.
  • Kruger THC. Can pharmacotherapy help persistent genital arousal disorder? (https://pubmed.ncbi.nlm.nih.gov/30220233/) Expert Opin Pharmacother. 2018;19(15):1705-1709. Accessed 8/15/2022.

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