What is Persistent Genital Arousal Disorder?
Persistent Genital Arousal Disorder (PGAD) is a rare but distressing condition characterized by persistent or recurrent, unwanted or intrusive distressing feelings of genital arousal that occurs without sexual desire. (1) Unlike typical arousal, PGAD is not linked to sexual activity, sexual thoughts, or stimulation and does not resolve with orgasm. Understanding this condition is crucial for those affected and for healthcare providers seeking to offer effective treatment.
Genito-Pelvic Dysetheisia (GPD)
When patients and providers are researching PGAD, they also may come across a term called Genito-Pelvic Dysesthesia (GPD). GPD is defined as an unpleasant and atypical sensation in the genito-pelvic region that may also involve the lower extremities. (1) While it’s clear that unwanted and persistent genital arousal is the hallmark symptom of PGAD, many of these people also have symptoms of pain and discomfort. (2) Because of this it is now recommended that PGAD should be referred to as PGAD/GPD.
Symptoms of Persistent Genital Arousal Disorder
The symptoms of PGAD can vary but generally include:
Persistent genital arousal that is not related to sexual desire.
A tingling, throbbing, buzzing, itch, pain, or pressure sensation in the genital area.
Frequent and/or uncontrollable orgasm or sensation of being on the verge of orgasm without sexual association.
Sexual activity doesn’t relieve sensation and/or makes it worse.
Physical discomfort that can interfere with daily activities and quality of life.
Emotional distress, including anxiety, depression, and social withdrawal.
This anatomical illustration of the female pelvis highlights the complex network of nerves, blood vessels, and muscles relevant to Persistent Genital Arousal Disorder (PGAD). The pudendal nerve and its branches, often implicated in PGAD, can be affected by muscle tension or compression from structures like the obturator internus. The image also shows key blood vessels, such as the internal iliac artery and vein, essential for understanding pelvic blood flow's role in PGAD symptoms. Additionally, the positioning of pelvic organs like the bladder and rectum can influence nerve sensitivity, contributing to PGAD sensations.
What Causes Persistent Genital Arousal Disorder?
The exact cause of PGAD remains unclear, but several factors may contribute to its development. These can include:
Neurological conditions: Conditions affecting the pudendal nerve (pudendal neuralgia), spinal cord injuries, or other in neuropathies involving pelvic nerves may lead to PGAD.
Pelvic floor dysfunction: Tight, weak, or uncoordinated pelvic floor muscles can contribute to the symptoms of PGAD.
Medication side effects: Certain medications, particularly those affecting neurotransmitters, antidepressants, or hormones, may trigger PGAD.
Vascular involvement: Conditions such as pelvic congestion syndrome, pelvic varicosities, can play a role.
Psychological factors: Stress, anxiety, or a history of trauma may exacerbate symptoms.
Risk Factors
While PGAD can affect anyone, certain factors may increase the risk:
Gender: PGAD is more commonly reported in women, though men can also be affected.
Pelvic surgeries or injuries: Previous pelvic surgeries, injuries, or conditions affecting the pelvic area can contribute to PGAD.
Mental health conditions: Individuals with anxiety, depression, or other psychological disorders may be more susceptible to developing PGAD.
Diagnosing Persistent Genital Arousal Disorder
Diagnosing PGAD can be challenging due to its rarity and the overlap of symptoms with other conditions. A thorough evaluation typically includes:
Medical history: A comprehensive review of the patient's medical, sexual, and psychological history.
Physical examination: A pelvic exam to assess for any signs of pelvic floor dysfunction or nerve issues.
Diagnostic tests: Imaging studies, such as MRI or ultrasound, to rule out other underlying conditions.
Psychological assessment: Evaluating the patient for any psychological factors that may be contributing to the symptoms.
Treatment Options for Persistent Genital Arousal Disorder
While there is no one-size-fits-all treatment for PGAD, pelvic floor physical therapy (PT) stands out as one of the most effective options. Here’s why:
1. Pelvic Floor Physical Therapy
Pelvic floor physical therapy addresses the muscle imbalances, nerve irritations, and dysfunctions that often contribute to PGAD. A trained pelvic floor therapist can help:
Muscle relaxation: Techniques such as manual therapy, biofeedback techniques, and targeted exercises to relax overly tight pelvic floor muscles.
Nerve desensitization: Targeted therapies to reduce the sensitivity of affected nerves.
Stress management: Incorporating relaxation techniques and stress-reduction strategies to alleviate psychological factors contributing to PGAD.
Education and empowerment: Teaching patients about their pelvic anatomy and how to manage symptoms effectively.
Pelvic PT is a non-invasive, holistic approach that addresses the root causes of PGAD, providing relief without the need for medication or surgery.
2. Medications
In some cases, medications may be prescribed to manage symptoms, including:
Antidepressants or anti-anxiety medications: To address any underlying psychological factors.
Muscle relaxants: To reduce pelvic floor muscle tension.
Topical anesthetics: To numb the affected area temporarily.
3. Cognitive Behavioral Therapy (CBT)
CBT can be beneficial for individuals whose PGAD is exacerbated by anxiety, depression, or trauma. This form of therapy helps patients develop coping strategies and change negative thought patterns.
4. Surgical Interventions
Surgery is typically considered a last resort and is only recommended if there is a clear anatomical cause that can be corrected, such as a nerve entrapment.
Frequently Asked Questions
Q: Can PGAD go away on its own?
A: In some cases, symptoms may improve over time, especially with treatment. However, it is important to seek professional help to manage symptoms effectively.
Q: Is PGAD a psychological condition?
A: PGAD is a physical condition, though psychological factors can exacerbate symptoms. Treatment often involves addressing both physical and psychological aspects.
Q: Can men experience PGAD?
A: Yes, while PGAD is more common in women, men can also be affected by the condition.
Q: How long does pelvic floor physical therapy take to work?
A: The duration of therapy varies based on each individual’s prior history, how long their symptoms have been going on and how their body response. Patients can experience improvement anywhere from a few weeks to months of consistent treatment.
Speak With A Professional Today
If you or someone you know is experiencing symptoms of Persistent Genital Arousal Disorder, it’s essential to seek help from a qualified professional. Pelvic floor physical therapy offers a safe, effective, and non-invasive treatment option that targets the underlying causes of PGAD. Don’t let this condition control your life—take the first step towards relief by speaking with a pelvic floor specialist today.
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
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References:
1.Goldstein I, Komisaruk BR, Pukall CF, Kim NN, Goldstein AT, Goldstein SW, Hartzell-Cushanick R, Kellogg-Spadt S, Kim CW, Jackowich RA, Parish SJ, Patterson A, Peters KM, Pfaus JG. 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). J Sex Med. 2021 Apr;18(4):665-697. doi: 10.1016/j.jsxm.2021.01.172. Epub 2021 Feb 19. PMID: 33612417.
2. Pukall CF, Jackowich R, Mooney K, Chamberlain SM. Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias? Sex Med Rev. 2019 Jan;7(1):2-12. doi: 10.1016/j.sxmr.2018.08.001. Epub 2018 Oct 6. PMID: 30301706.
