What is persistent genital arousal disorder (PGAD)?
A woman with PGAD can experience spontaneous orgasms that do not resolve arousal. The person's arousal is not linked to 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 women of all ages.
Experts have not clinically confirmed the incidence of PGAD, as many people with the condition feel too embarrassed or ashamed to seek medical help.
Persistent genital arousal disorder can limit a person's lifestyle and cause ongoing discomfort and embarrassment.
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 experienced are known as dysesthesias.
They can include:
- pins and needles
These can lead the person with PGAD to feel consistently like they are about to experience orgasm, or they may experience waves of spontaneous orgasms.
However, these symptoms happen 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 impact on day-to-day living.
These may include:
People with chronic, or incurable, persistent genital arousal disorder may eventually lose their notion of sexual pleasure, because the orgasm becomes associated with relief from pain rather than an enjoyable experience.
Priapism, PSAS, and PGAD: What is the difference?
Some doctors class priapism in men as a type of persistent genital arousal disorder. Priapism is a persistent and unrelenting penile erection without sexual desire.
The condition was formerly known as Persistent Sexual Arousal Syndrome (PSAS), but the name was changed to PGAD as PSAS suggests active sexual desire.
Sexual stimulation, masturbation, anxiety, and stress can trigger PGAD. Some people find that going to the toilet results in such severe arousal as to be painful.
Some experts believe that the onset of PGAD can be psychological in nature. The condition often involves symptoms depression and anxiety, related to the debilitating and sensitive nature of the condition.
However, the person with PGAD cannot usually identify the triggers to avoid them, and the causes of the ongoing condition are largely unknown.
In some women, stress causes the onset of the disorder. Once the stress is alleviated, the condition tends to calm. Some, therefore, think that PGAD may be psychological in nature.
However, this is not the case in every presentation of PGAD. Research has implied a link between PGAD and the veins, hormones, nervous system, and chemical balance after using some types of medication.
Research has shown that Tarlov cysts may also cause the condition. Tarlov cysts are sacs filled with 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 percent of women who demonstrate PGAD symptoms also have a Tarlov cyst. This does not account for every case but, in some cases, PGAD may be considered a reaction to a Tarlov cyst.
Paresthesia refers to a burning, itching, tingling, or crawling sensation.
Researchers have also demonstrated PGAD as a secondary symptom of:
- Tourette's syndrome
- trauma to the central nervous system (CNS)
- post-surgical effects of intervention for malformed veins or in the lower back
Studies have also investigated whether PGAD is caused by changes in hormones or medications.
However, in many cases, the cause is unknown. This creates difficulty in diagnosing and treating the disorder.
The root cause of PGAD is unknown. However, a gynecologist will be able to advise pain relief and symptom management methods.
It was not possible until recent years to formally diagnose PGAD.
Medical literature has only recently classed PGAD as a distinct syndrome. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) did not recognize PGAD as a diagnosable medical condition.
However, it was added to DSM-V, so that PGAD may now be formally diagnosed.
Prof. Sandra R. Leiblum, a Professor of Clinical Psychiatry at The University of Medicine and Dentistry's Robert Wood Johnson Medical School, first documented the disease in 2001. She listed 5 criteria for an accurate diagnosis of PGAD.
The 5 criteria are:
- involuntary genital and clitoral arousal that continues for an extended period of hours, days, or months
- no cause for the persistent genital arousal can be identified
- the genital arousal is not associated 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
They are considered to be the only valid criteria established to date for a PGAD diagnosis.
The treatment of PGAD usually centers on managing symptoms, due to the often-unclear causes of the condition.
Electroconvulsive therapy can assist the symptoms of PGAD, especially if stress or depression has triggered the onset.
Psychological treatment such as Cognitive Behavioral Therapy (CBT) can help women identify their triggers and can also provide some coping mechanisms and distraction techniques to manage the physical symptoms of the PGAD.
CBT can also help in managing the stress, anxiety, and depression that often accompany and worsen this condition. In severe cases, electroconvulsive therapy (ECT) has also been shown to make a positive impact.
A person with PGAD may physically manage the pain and discomfort by applying ice to the pelvic area or taking an ice bath. A variety of topical painkilling agents is also available. Topical applications can be applied to the skin to help the relief of symptoms.
In ECT, small electrical charges are passed through the brain of a sedated patient. These trigger rapid changes in brain chemistry to treat a psychological symptom.
Prescribed medication or changes in medication can help to manage the condition.
Changing current medications by removing drugs with herbal estrogen or known aggravators of PGAD has been shown to improve symptoms.
Antidepressants and anti-seizure medications have been demonstrated as particularly effective as well as medicines that increase the level of prolactin, or milk-stimulating hormone, in the blood.
In nerve-related cases, such as a Tarlov cyst, the treating doctor may suggest surgery such as releasing the nerve from entrapment.
Due to the unknown causes of PGAD, prevention of the condition's onset can often be difficult.
If suspected, it is crucial that women with PGAD do not feel marginalized or embarrassed, and seek medical assistance.
PGAD is not yet curable. However, its symptoms can be managed on an ongoing basis to improve the quality of life of people with the condition and to reduce the psychological harm of PGAD.