Persistent genital arousal disorder (PGAD), previously called persistent sexual arousal syndrome (PSAS), is characterized by uncontrollable, uncomfortable and spontaneous genital arousal which causes distress. PGAD is not precipitated by sexual desire and is unresolved by orgasm. PGAD is frequently caused by an underlying medical condition, which once identified may be treated.
What Is Persistent Genital Arousal Disorder?
The hallmark of persistent genital arousal disorder (sometimes called restless genital syndrome) is discomfort and distress due to a persistent state of genital arousal. While no subjective desire is present in those afflicted by PGAD, the vulva or penis may become engorged and sexual lubrication may occur. Orgasms can take place, but seldom will provide lasting relief. Some women with PGAD report having orgasms as frequently as every 10 seconds.1
PGAD is qualitatively different from sexual arousal which occurs due to sexual cues or sexual desire. Although PGAD may be preceded by sexual activity, arousal symptoms in PGAD last longer than subjective desire and continue past the point of orgasm. Arousal of the genitals may last for hours, days, or longer. PGAD symptoms may occur several times a day for a period of weeks, months, or even years. Symptoms may worsen at night when blood-flow increases to the genitals.2
What Does PGAD Feel Like?
Approximately one in three women with PGAD find the condition to be painful.3 Whether or not the symptoms are described as painful, they are uncomfortable and irritating.
How Common Is It?
Although PGAD is considered rare, this may be due to frequent misdiagnosis or dismissiveness of symptoms by medical professionals. Due to inconsistent data, it is difficult to ascertain the prevalence of PGAD. Online surveys indicate that hundreds of women may be affected by this disorder.4 PGAD occurs across all ages and stages of sexual maturity and across the spectrum of sexual orientation.5
Differences Between PGAD, PSAS, & Priapism
While PGAD is similar to other sexual problems, it is important to be aware of how it differs in order to get the best help possible:
- Persistent Sexual Arousal Syndrome (PSAS) is an outdated term for PGAD, updated to reflect the lack of subjective desire for those affected by the disorder.
- Priapism is a male subtype of PGAD, characterized by a prolonged and sometimes painful erection lasting hours and often caused by medication.
- The genital arousal of PGAD does not indicate sexual desire, whereas hypersexuality (commonly called “nymphomania”) indicates a subjective desire to engage in frequent sexual activity.
Symptoms of PGAD
The key symptom of PGAD is unwanted and involuntary arousal of the genitals. These symptoms must cause significant distress and other medical conditions should be ruled out prior to diagnosis.
For a person to be diagnosed with PGAD they must have all five of the following symptoms:
- Involuntary genital arousal lasting for an extended period of time (hours to months).
- No cause for persistent genital arousal can be identified.
- The genital arousal is not related to subjective feelings of sexual desire.
- The arousal symptoms are intrusive and unwanted.
- The arousal sensation persists after one or more orgasms.
- Unpleasant genital sensations experienced as part of PGAD may include:
- Burning
- Itching
- Paresthesia or “pins and needles”
- Pressure
- Pounding
- Reduced satisfaction with sexual intimacy
- Increased incidence of self-harm
- Other symptoms of PGAD might include:
- High blood pressure
- Elevated heart rate
- Shallow and/or rapid breathing
- Distortion of vision
- Muscle spasms
- Flushing of the face/neck
- Genital pain
What Causes PGAD?
Persistent genital arousal disorder is not well researched or understood scientifically. While there are a number of medical issues which have been linked to PGAD, there is no single, consistent underlying cause. Medical conditions should be ruled out, or treated prior to or concurrent with treatment of psychological factors.
Medical issues that may contribute to PGAD include:6,7,8,9,10
- Sacral nerve root compression caused by sacral spinal cysts (Tarlov cysts) – this type of cyst is present in as many as 67% of PGAD cases in women
- Side effect of the antidepressant Trazodone
- Withdrawal from antidepressants classified as Selective Serotonin Reuptake Inhibitors (SSRIs)
- Pudendal nerve entrapment, or pudendal neuralgia
- A periclitoral mass, often caused by genital hair grooming and depilation
- Restless Leg Syndrome
- Tourette syndrome
- Epilepsy
- Parkinson’s Disease
- Ehlers-Danlos Syndrome
- Post-surgical effect of addressing pelvic vascular malformation
Non-medical factors which may contribute to PGAD include:
- Mental or emotional stress
- History of sexual trauma
- Physical stimulation (masturbation or intercourse)
- Pressure on the genitals (from sitting, cycling or other activity)
- Vibration on the genitals (from a motor vehicle or vibrator)
Common Co-Occurring Disorders
In addition to the distress, shame, and frustration which may result from PGAD, other serious psychological conditions may occur.
The following disorders may be caused by or exacerbate PGAD:12
- Generalized Anxiety Disorder: Excessive anxiety and worry causing restlessness, irritability and/or fatigue.
- Panic Disorder: Recurrent and unexpected panic attacks.
- Persistent Depressive Disorder/Dysthymia: Depressed mood for most of the day accompanied by poor appetite, insomnia, low energy, poor concentration and/or feelings of hopelessness.
- Cyclothymic Disorder: Chronic, fluctuating mood disturbance involving distinct periods of hypomania and depression.
- Insomnia Disorder: Dissatisfaction with sleep quantity or quality associated with difficulty initiating sleep, maintaining sleep and/or early-morning awakening.
- Obsessive Compulsive Disorder (OCD): Recurrent and persistent anxious thoughts, urges and/or repetitive behaviors.
How to Cope With PGAD
Living with persistent genital arousal disorder is challenging. There is a general lack of understanding of the disorder, which typically causes feelings of shame and helplessness in those affected. There may be hesitation to seek professional assistance or disappointment at the lack of help available.
Self-treatment interventions for the symptoms of PGAD include:
- Distraction
- Mindfulness techniques
- Masturbation or sexual intercourse to achieve orgasm
- Vigorous exercise
- Application of a cold compress
- Avoiding tight clothing or pressure on the genitals from cycling or sitting on a hard surface
Unfortunately, these interventions are likely to provide only temporary or insufficient relief. Continuing to pursue medical diagnosis and being assertive about advocating with medical professionals may yield better results. If underlying causes of PGAD are not identified, symptoms must be continually mitigated.
PGAD Treatment
Optimal treatment of persistent genital arousal disorder is based on identifying the cause. When medical factors are at the root of PGAD, a doctor who specializes in that particular medical issue will be the most appropriate practitioner to address symptoms.
Medical interventions for PGAD may include:8
- Anti-seizure medications
- Prolactin elevating agents, such as risperidone
- Antidepressants classified as Selective Serotonin Reuptake Inhibitors (SSRIs)
- Medications used to reduce nerve pain, such as gabapentin or pregabalin
- Pudendal nerve blocks, or surgical intervention of pudendal nerve entrapment
- Surgical removal of Tarlov cysts
- Pelvic floor physical therapy/massage
- Use of a TENS machine to alleviate pain
Psychological interventions for PGAD may include:
- Cognitive Behavioral Therapy (CBT) for providing coping mechanisms and distraction techniques
- General psychological counseling for co-occurring conditions, such as mood disorders or sexual trauma
- Sex Therapy for re-patterning subjective sexual arousal and adjusting individual or partnered sexual activities to accommodate PGAD symptoms
- Electroconvulsive Therapy (ECT) in extreme cases13
Is There a Cure?
While there is currently no cure for PGAD, more research is being conducted and awareness of PGAD within the medical community is growing. Seeking support and validation from partners, family, friends and professionals is an important way to avoid becoming overwhelmed and developing other mental health concerns as a result.
Getting Help for PGAD
If you or your partner is experiencing persistent arousal, you should first seek treatment through your primary care provider or OBGYN. They will be able to assess whether further medical treatment is indicated or referrals to other medical providers should be made. It’s important to make sure that there are no underlying medical conditions or side effects to current medications before treating the psychological components PGAD.
Since few doctors have experience treating PGAD, it is important to advocate for a full medical assessment, including gynecological history, bladder function and pelvic floor musculature testing. MRIs or Pelvic Ultrasounds may be appropriate in assessing pelvic organs and the pudendal nerve for malfunction or the presence of cysts. Neurological testing may be appropriate to test for nerve damage.
Once medical factors have been addressed, seeking further treatment with a mental health practitioner is the next step. Even if the initial cause of PGAD is physiological, psychological factors are likely to develop as a result of discomfort and mental distress.
Finding a Sex Therapist
Regardless of the underlying cause for PGAD, avoidance of sexual interactions or anxiety about sexual intimacy often occurs. In order to adequately treat avoidance or anxiety cycles around sex, an AASECT certified sex therapist should be consulted.
To ensure that you receive adequate and knowledgeable care, make sure that your mental health practitioner is AASECT certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.
You can find a certified sex therapist through an online therapist directory, where you can sort by specialty.
How Much Does Sex Therapy Cost?
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
Persistent Genital Arousal Disorder Statistics
Consider the following statistics about persistent genital arousal disorder:
- PGAD occurs predominantly in women, but does occasionally appear in men as priapism, a painful and persistent erection of the penis.
- Approximately 1 in 3 women with PGAD find the condition to be painful.3
- Sacral spinal cysts (Tarlov cysts) are present in as many as 67% of PGAD cases in women.6,7
- Some women with PGAD report having orgasms as frequently as every 10 seconds.1
- PGAD occurs across all ages and stages of sexual maturity and across the spectrum of sexual orientation.5
- Prevalence of PGAD is unknown due to lack of research. Online surveys indicate that hundreds of women may be affected by PGAD.4
- Symptoms may worsen at night when blood-flow increases to the genitals.2
