Persistent Genital Arousal Disorder or PGAD is a condition that’s been sensationalized in the media for years with headlines like “Nurse has 100 Orgasms a Day.” Back in 2012, a few news organizations did cover the condition in a more thoughtful manner after a woman suffering from PGAD committed suicide.
But since then the media has resorted to its old sensationalist tricks. As a healthcare provider who has treated patients with PGAD, I know how frustrating and disheartening this can be for those dealing with the condition. And that’s why I’ve decided to dedicate this post to a straightforward, scientific explanation of PGAD.
So what exactly is PGAD?
The International Society for the Study of Women’s Health (ISSWH) defines it as “a persistent or recurrent, unwanted or intrusive, bothersome or distressing, genital dysesthesia (abnormal sensation) unassociated with sexual interest.”
In other words, people with PGAD either constantly or periodically feel like they are on the verge of an orgasm in contextually nonsexual places and times. They are unable to turn this feeling on or off. Normal sexual response has been defined as a four-stage cycle: excitement, plateau, orgasm, and resolution. People suffering from PGAD are thought to exist in the stages between excitement and orgasm, with no resolution.
Symptoms can be associated with overactive bladder and restless legs syndrome and for some sufferers achieving orgasm only further aggravates symptoms. While the condition is thought to be more common in women, both men and women can suffer with PGAD.
Patients I’ve treated who have PGAD have described the feeling as “extremely embarrassing, distracting, and painful.”
“It is impossible to interact socially and professionally with feelings of arousal. Medical professionals and well-intended friends and family members think its funny or say they are “jealous.” They have no idea what I am going through,” said one patient. .
An important thing to understand about PGAD is that the symptoms are not pleasurable, but painful. Although there is a range of symptom severity among sufferers, this is a condition that can be devastating for people.
It’s only in the last few years that research has shed light on this perplexing problem. The current thought is that the symptoms of PGAD can be caused by excessive sensory peripheral information from irritated muscles, nerves and/or genital tissues and/or a central sexual reflex that is under decreased inhibition from the central nervous system.
Functional MRI brain scans can be used to gather physiological insights as to how people process sensation, pain, and in this case, feelings of arousal. In persons with PGAD, fMRI brain scans show over-excitation in the regions of the somatosensory cortex that represents the female genitalia. During a PGAD “attack,” or time when symptoms are exacerbated, researchers can see exaggerated brain activity and differences on the brain scans between people with PGAD and people without symptoms.
What causes a person to develop symptoms of PGAD?
Exactly what causes PGAD is currently unknown. In a recent study of 15 women, symptoms of genital pain, depression, and interstitial cystitis were found in over one half of the patients. In addition, previous antidepressant use, restless legs syndrome, and pudendal neuralgia were found in a number of cases. Pelvic varices and Tarlov cysts (fluid-filled sacs that most often affect nerve roots at the lower end of the spine) have been previously identified as possible contributors to PGAD, but these were not a common finding in this particular study.
Getting a Diagnosis
Currently a diagnosis is made based on a patient’s symptoms. While fMRI brain scans are showing abnormalities in persons with PGAD, these scans are being used for research versus diagnostic purposes. A limited number of physicians in the U.S. have experience with PGAD. These physicians can be found through ISSWSH (link to website).
There are numerous interdisciplinary treatment combinations that are considered reasonable options for people with PGAD.
These includes TENS treatment, physical therapy, hypnotherapy, pharmaceutical management, pudendal nerve blocks, sympathetic nerve blocks, Botox, and neuromodulation.
It is important to remember that people with similar symptoms respond differently to various treatments. Interventions that do not help one person may help another and the order in which various interventions can play a role in the overall success of treatment. For instance, a medication or nerve block may make PT tolerable, so that the two modalities working together will have the best outcome.
If you have any further questions about PGAD or anything mentioned in this post, please do not hesitate to leave them in the comment section below!
All my best,