Persistent genital arousal disorder (PGAD) is an unrelenting, spontaneous, and uncontainable genital arousal, mostly in females.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

A person with PGAD can experience spontaneous orgasms that do not resolve arousal, and their arousal does not result from sexual desire.

PGAD can lead to ongoing physical pain, stress, and psychological difficulties due to an inability to carry out everyday tasks. The condition can affect females of all ages.

However, experts have not clinically confirmed the incidence of PGAD, as many people with the condition feel too embarrassed or ashamed to seek medical help.

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The primary symptom of PGAD is a series of ongoing and uncomfortable sensations in and around the genital tissues, including the clitoris, labia, vagina, perineum, and anus.

The sensations that a person experiences are known as dysesthesias.

They can include:

  • wetness
  • itching
  • pressure
  • burning
  • pounding
  • pins and needles

These can lead the person with PGAD to consistently feel as if they are about to experience orgasm. They may also experience waves of spontaneous orgasms.

However, these symptoms occur in the absence of sexual desire.

Climaxing may temporarily alleviate symptoms, but they may return suddenly within a few hours. Episodes of intense arousal may occur several times a day for weeks, months, or even years.

The condition can lead to psychological symptoms due to the persistent discomfort and effect on day-to-day living.

These may include:

People with chronic or incurable PGAD may eventually lose their notion of sexual pleasure because the orgasm has associations with relief from pain rather than enjoyable experiences.

Priapism, PSAS, and PGAD: What is the difference?

Some doctors class priapism in males as a type of PGAD. Priapism is a persistent and unrelenting penile erection without sexual desire.

PGAD has no links to hypersexuality or an elevated need for sexual gratification, otherwise known as satyriasis in males or nymphomania in females.

The condition was formerly known as persistent sexual arousal syndrome (PSAS), but the term underwent a name change to PGAD, as PSAS suggests active sexual desire.

Sexual stimulation, masturbation, anxiety, and stress can trigger PGAD. Some people also find that going to the toilet results in such severe arousal that it causes pain.

However, a person with PGAD cannot usually identify the triggers to avoid them, and the causes of the ongoing condition are largely unknown.

Stress

In some females, stress causes the onset of the disorder. Once the stress eases, the condition tends to calm. With this in mind, some believe that PGAD may be psychological in nature.

However, this is not the case in every occurrence of PGAD. Older research has implied a link between PGAD and the veins, hormones, nervous system, and chemical balance after using some types of medications.

Tarlov cysts

Other research has shown that Tarlov cysts may also cause the condition. These are sacs consisting of spinal fluid that appear on the sacral nerve root. Sacral nerves at the bottom of the spine receive electrical signals from the brain, and they relay these instructions to the bladder, colon, and genitals.

In a 2012 study, MRI results showed that 66.7% of women who demonstrate PGAD symptoms also have a Tarlov cyst. And while this does not account for every case, in some cases, health experts consider PGAD to be a reaction to a Tarlov cyst.

Other potential causes

Paresthesia refers to a burning, itching, tingling, or crawling sensation.

Researchers have also demonstrated PGAD as a secondary symptom of:

Studies have also investigated whether PGAD results from changes in hormones or medications.

Additionally, antidepressants, such as trazodone, have associations with the inflammation of symptoms, as well as sudden withdrawal from selective serotonin reuptake inhibitors for treating depression.

However, in many cases, the cause is unknown, making it difficult to diagnose and treat the disorder.

Until recent years, it was not possible to formally diagnose PGAD.

Medical literature has only recently classed PGAD as a distinct syndrome. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) did not recognize it as a diagnosable medical condition.

However, its later addition into the DSM-5 means that doctors can now formally diagnose a person with PGAD.

One researcher has now listed five criteria for an accurate diagnosis of PGAD:

  • involuntary genital and clitoral arousal that continues for an extended period of hours, days, or months
  • experts cannot identify a cause for the persistent genital arousal
  • the genital arousal has no associations with feelings of sexual desire
  • the persistent sensations of genital arousal feel intrusive and unwanted
  • after one or more orgasms, the physical genital arousal does not go away

Healthcare professionals consider these to be the only valid established criteria to date for a PGAD diagnosis.

Treating PGAD usually centers on managing symptoms, due to the unclear causes of the condition.

Psychological treatment

Psychological treatment, such as cognitive behavioral therapy (CBT), can help women identify their triggers and also provide some coping and distraction techniques to help manage physical symptoms.

CBT can also help in managing the stress, anxiety, and depression that often accompany and worsen this condition. In severe cases, electroconvulsive therapy (ECT) could also provide positive effects.

In ECT, a healthcare professional passes small electrical charges through the brain of a patient under sedation. These trigger rapid changes in brain chemistry to treat psychological symptoms.

Medications

Prescription medication or changes in medication can also help manage the condition.

Changing current medications by removing drugs with herbal estrogen or known aggravators of PGAD has been shown to improve symptoms.

Health experts also state that antidepressants and anti-seizure medications are particularly effective. Medicines that increase the level of prolactin, or milk-stimulating hormone, in the blood may also provide benefits.

Surgery

In nerve-related cases, such as a Tarlov cyst, a doctor may suggest surgery such as releasing the nerve from entrapment.

Pain relief

A person with PGAD could also physically manage the pain and discomfort by applying ice to the pelvic area or taking an ice bath. A range of topical pain-relieving agents is also available, which an individual can apply to the skin to help ease symptoms.

Due to the unknown causes of PGAD, preventing the condition’s onset can often be difficult.

If a person believes they have PGAD symptoms, it is vital to seek medical assistance. An individual may feel marginalized or embarrassed, but a healthcare professional may be able to devise strategies to manage symptoms.

PGAD is not yet curable. However, they can help ease ongoing symptoms to improve the quality of life and reduce the condition’s psychological harm.

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