Persistent Genital Arousal Disorder

Persistent genital arousal disorder (PGAD) involves constant unwanted sensations in your genitals or breast tissue without having sexual desire. Another name for it is genitopelvic dysesthesia (GPD).

Sexual arousal is usually associated with pleasure. But this isn’t the case with PGAD. The sensations you have are unwanted and distressing. You can’t control when the symptoms begin. And orgasm may not make them go away.

Researchers identified PGAD in 2001, so it’s a newer diagnosis. For this reason, they’re still learning its causes and what treatments work best.

PGAD has mostly been studied in women. But it may also affect men. Researchers have compared PGAD to priapism. This is a condition where you have an unwanted erection for four hours or more.

PGAD can keep you from doing daily activities and greatly impact your mental health. It’s key to see a healthcare provider for care. They’re available to help you, not judge you.

Symptoms of persistent genital arousal disorder

The main symptom of PGAD is unwanted genital arousal. It causes increased blood flow and tension in your clitoris, labia, perineum and/or anus. For most people, the symptoms start suddenly.

Symptoms may last for hours or even days and include:

• Pain or discomfort in your genitals
• Tingling in your clitoris
• Vaginal contractions
• Vaginal lubrication
• Enlarged breasts and nipple sensitivity
• Unpredictable orgasms

You may describe these feelings as:

• Pounding
• Pulsating
• Throbbing
• Burning
• Tingling
• Itching

Orgasms may not relieve your symptoms. Or you may have brief relief through an orgasm, only to have your symptoms return.

Persistent genital arousal disorder causes

Researchers don’t know what causes PGAD. It’s likely a combination of factors. Studies show that PGAD may be associated with:

• Blood flow changes, like varicose veins in your pelvis
• Hormonal changes, like menopause or pregnancy
• Medication changes, like stopping the use of SSRIs (antidepressants)
• Neurological damage, like brain damage or pinched pelvic nerves
• Psychological issues, like stress and anxiety
• Pressure on genital structures, like riding a bicycle or having a full bladder

Risk factors

You may be at increased risk for PGAD if you have:

• Restless legs syndrome
• Tarlov cysts
• Irritable bowel syndrome
• Chronic pelvic pain
• Endometriosis
• Fibromyalgia
• Pelvic floor muscle dysfunction
• Vaginal atrophy
• Herniated disks in your spine

Complications of this condition

PGAD can interfere with your day-to-day routine, like work and social activities. This can lead to stress, anxiety and depression.

You may associate orgasms with pain relief instead of pleasurable sexual release. This may keep you from enjoying sex or having a healthy sexual relationship.

Get help immediately if you’re having suicidal thoughts. You can call the U.S. National Suicide Prevention Lifeline, now known as the 988 Suicide & Crisis Lifeline, any time of day.

How doctors diagnose this condition

PGAD can be difficult to diagnose. It’s a rare condition that isn’t well understood.

To start, your healthcare provider will ask many questions about:

• Your medical history
• Your symptoms
• How your symptoms start and what makes them worse or better
• How the symptoms affect your daily life

It may feel awkward or embarrassing to talk about your symptoms. But try to tell your provider as much information as possible.

Your provider will do a physical exam, which will include a pelvic exam. They may recommend certain tests to rule out other conditions or find the underlying cause. These could include blood and imaging tests.

How is it treated?

There aren’t standard treatments for PGAD. The research is new, so healthcare providers are still learning about which treatments and coping strategies work best. If your provider can find an underlying cause, treating that condition will be the first step.

Otherwise, your provider may offer a variety of options. You may find that some treatments help and others don’t. It may take time to find the right treatment combination. You can also ask your provider if a clinical trial is an option.

In general, the types of treatment fall into three categories: physical treatments, medications and psychological therapies.

Physical treatments

Physical treatments for PGAD may include:

• Botox^® injections, which block nerve signals
• Pelvic floor exercises to help strengthen or relax pelvic muscles
• Nerve stimulation to alter nerve activity
• Surgery, like neurolysis or removing Tarlov cysts
• Transcutaneous electrical stimulation (TENS) to reduce overstimulation
• Anesthetic creams or gels to numb pain

Medications

Medications for PGAD may include:

• Antidepressants, especially paroxetine, duloxetine and fluoxetine
• Antiseizure medications, like carbamazepine and pregabalin
• Varenicline, a smoking cessation medication that may help with PGAD

Your provider may prescribe one medication or a combination of them. They may directly manage PGAD and/or help with related mental health conditions, like depression.

Psychological therapies

Psychological therapies for PGAD include:

• Cognitive behavioral therapy (CBT), a type of talk therapy
• Distraction and relaxation exercises to help with symptoms
• Couples therapy and sex therapy to help with relationship and intimacy issues

Understanding what triggers your symptoms and avoiding them can also help manage your symptoms.

When should I see my healthcare provider?

Finding the right treatment can take time. If possible, try to find a healthcare provider who specializes in sexual health. Let them know if something’s not working or if your symptoms get worse. This includes mental health symptoms, too.

What can I expect if I have this condition?

Persistent genital arousal disorder is often a long-term (chronic) condition. It may take time to find the right combination of treatments for you. But symptom relief and recovery are possible. Try not to give up hope.

Your sexual health is important to your quality of life. Consider having an honest conversation with your sexual partner(s). Talk about what kind of intimacy is best for you. Couples therapy or sex therapy can help, too.