An Overlooked Pelvic Pain Disorder: Persistent Genital Arousal Disorder

Have you heard of Persistent Genital Arousal Disorder (PGAD)? Featured in a Season 2 episode of Grey’s Anatomy, this condition is, unfortunately, not openly discussed. PGAD describes the phenomenon of frequent and sudden genital arousal. A key symptom of PGAD is that arousal exists in the absence of sexual desire. PGAD is different than hypersexuality – excessive sexual desire and compulsive sexual desire. Unlike hypersexuality, PGAD is not a sexual disorder — it is a PAIN disorder.

There are 5 factors for a diagnosis of PGAD:

1. The physiological response or sexual arousal persists for hours to days and does not subside completely on its own.
2. The genital arousal does not resolve completely despite one or more orgasms.
3. The persistent genital arousal is experienced as intrusive and unwanted.
4. The persistent genital arousal may be triggered by sexual activity or also by nonsexual stimuli.
5. There is a moderate or greater feeling of distress associated with the experience.

What causes PGAD?

The direct cause of PGAD is unknown, but there are many theories. Some studies have found compression of the dorsal branch of the pudendal nerve may cause increased genital sensation. Some conditions associated with PGAD include: Overactive bladder Irritable bowel disorder Gynecological disorders Previous surgeries to the vagina or abdomen Changes in medications or hormones. There are also links between changes in medications and hormones, and the onset of PGAD.

Treatments

There is no single treatment that works well for all people with PGAD. This disorder is understudied, which leads to a variety of treatments. People respond differently to treatments because of varying causes. There are benefits to the treatments listed below when used in conjunction with Pelvic Floor Physical Therapy:

• Medications:
  • Tricyclic antidepressants
  • Nerve pain medications
  • Hormonal related medication to decrease sensation
  • Anesthetizing gels (lidocaine)
• Transcutaneous electrical nerve stimulation
• CBT therapy to identify triggers and discover coping mechanisms
• Botox or trigger point injections, which relax the muscles compressing the nerve

Pelvic floor physical therapy can help you learn the origin of your hypertonic pelvic floor muscles and how to lower the muscle tone in your pelvic floor. A recent, small study in 2019 found the relief of arousal symptoms could occur from neurolysis of the dorsal branch of the pudendal nerve.

You do not need to suffer from PGAD. Contact us and we can direct you to the appropriate medical management. Accurate diagnosis, medical intervention, physical therapy, and/or counseling can greatly improve symptoms and your quality of life!

Sources: Aswath M., Pandit L. V., Kashyap K., & Ramnath R. (2016, July-August). Persistent Genital Arousal Disorder. Indian Journal of Psychological Medicine, 38(4), 341-343: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980903/
Klifto, K., Dellon, A. L., (2019, April). Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve. Microsurgery, 40(2), 160-166: https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.30464