What is Persistent Genital Arousal Disorder?
If you have never heard of this condition, you are not alone.
Persistent Genital Arousal Disorder (PGAD) – a condition in which a person feels a constant arousal feeling for hours to days at a time without provocation. It was only first described in 2001 using a review of 5 patients. PGAD is also referred to as Persistent Sexual Arousal Syndrome (PSAS).
Since then, research on more than 500 patients has been published, and since 2013 the condition has been accepted and recognised in the Diagnosis and Statistics Manual of Mental Disorders (DSM – 5)
PGAD is a condition about which knowledge and treatment are still very much evolving – but this is what we know so far. What are the causes of Persistent Genital Arousal Disorder?
Although the cause of PGAD is still being researched, the dominant theory is that the main genital nerve (pudendal nerve) gets trapped somewhere along its course in the pelvis.
Anxiety is considered to also be part of the cause – 30% of people with PGAD have had panic attacks and 60% have had depression in the year before symptoms begin.
What are the symptoms of Persistent Genital Arousal Disorder?
The symptoms of PGAD are spontaneous, resulting in feeling uncontrollable and persistently aroused with genital engorgement and even orgasm. Unlike usual arousal, induced orgasm brings only temporary relief.
PGAD is defined and diagnosed by the presence of six main symptoms that differentiate it from normal or hypersexuality:
- Continues for hours or days (or even weeks);
- Not relieved by orgasms;
- Unrelated to the desire for sex and sexual excitement;
- Unrelated to sexual stimulation of the genitalia;
Although this condition occurs in both sexes, PGAD in males is much less common than in females, where it can affect any or a combination of the:
with symptoms that include a feeling of fullness, pain, and tingling.
Testing for Persistent Genital Arousal Disorder
Assessment is mainly through symptom history. However, a physical examination is important to exclude other causes. Additionally, in certain cases, an MRI scan of the pelvis looks for evidence of nerve entrapment and physiotherapists test pelvic floor muscle control.
What is the treatment for Persistent Genital Arousal Disorder?
Currently, treatment involves a combination of medication and psychological support to minimise discomfort from symptoms. Many types of medication have been used. For symptom relief, different types of painkillers ranging from nerve painkillers like gabapentin to standard painkillers like opiates to nerve stimulation machines called TENS have been used. For the psychological element, antidepressants and antipsychotic medications have been prescribed. The choice of medication very much depends upon the individual’s symptoms.
What are the psychological therapies for Persistent Genital Arousal Disorder?
Recommended psychological therapies include cognitive behavioural therapy (CBT) with or without mindfulness (a type of meditation practice). CBT aims at changing response and reaction to pain and other symptoms associated with PGAD, while mindfulness helps a person to become aware of body sensations without associating them with anything.
Further treatments depend upon the individual case – relationship counselling may be of value where a situation of constant arousal significantly impacts a relationship and pelvic floor strengthening exercises may help where weak muscle control is a contributing factor.
Principles and Practice of Sex Therapy, Fifth Edition by M. Yitzchak et al.