Persistent genital arousal disorder (PGAD), previously called persistent sexual arousal syndrome,
is spontaneous, persistent, unwanted and uncontrollable
genital arousal in the absence of
sexual stimulation
Sexual stimulation is any stimulation, stimulus (including bodily contact) that leads to, enhances and maintains sexual arousal, and may lead to orgasm. Although sexual arousal may arise without physical stimulation, achieving orgasm usually requ ...
or
sexual desire
Sexual desire is an emotion and motivational state characterized by an interest in sexual objects or activities, or by a drive to seek out sexual objects or to engage in sexual activities. It is an aspect of sexuality, which varies significantly ...
,
and is typically not relieved by
orgasm
Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region charac ...
.
Instead, multiple orgasms over hours or days may be required for relief.
PGAD occurs in women.
It has been compared to
priapism
Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases ...
in men.
PGAD is rare and is not well understood.
The literature is inconsistent with the nomenclature. It is distinguished from
hypersexuality
Hypersexuality is extremely frequent or suddenly increased libido. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania and satyriasis were terms previously used for the c ...
, which is characterized as heightened sexual desire.
Classification
In 2003, "persistent genital arousal" was considered for inclusion with regard to the International Consultation on Sexual Medicine (ICSM). In 2009, "persistent genital arousal dysfunction" was included in its third edition.
PGAD is not included in the ''
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' (
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
) or the
International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
(
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
), which may be due to the disorder requiring further research.
The condition has been characterized by a researcher as being a term with no scientific basis.
There is concern that the title may be misleading because, since the genital arousal is unwanted, it is dubious to characterize it as arousal.
Other researchers have suggested that the disorder be renamed "persistent genital
vasocongestion
Vasocongestion, vascular congestion or vascular engorgement is the swelling of bodily tissues caused by increased vascular blood flow and a localized increase in blood pressure. Typical causes of vasocongestion in humans includes menstruation, sexu ...
disorder (PGVD)"
or "restless genital syndrome (ReGS)."
Signs and symptoms
Physical arousal caused by PGAD can be very intense and persist for extended periods, days or weeks at a time.
Symptoms include pressure, pain, irritation,
clitoral
The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the open ...
tingling, throbbing, vaginal congestion, vaginal contractions, and sometimes spontaneous orgasms.
Pressure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris,
labia
The labia are part of the female genitalia; they are the major externally visible portions of the vulva. In humans, there are two pairs of labia: the ''labia majora'' (or the outer labia) are larger and thicker, while the ''labia minora'' are fol ...
,
vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
,
perineum
The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...
, or the
anus
The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, d ...
.
The symptoms may result from sexual activity or from no identified stimulus, and are not relieved by orgasm except for cases where multiple orgasms over hours or days allow for relief.
The symptoms can impede on home or work life.
Women may feel embarrassment or shame, and avoid sexual relationships, because of the disorder.
Stress can make the symptoms worse.
Cause
Researchers do not know the cause of PGAD, but assume that it has
neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
,
vascular
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...
,
pharmacological
Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
, and
psychological
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
causes.
Tarlov cyst
Tarlov cysts, are type II innervated meningeal cysts, cerebrospinal-fluid-filled (CSF) sacs most frequently located in the spinal canal of the sacral region of the spinal cord ( S1– S5) and much less often in the cervical, thoracic or lumbar ...
s have been speculated as a cause.
PGAD has been associated with
clitoral priapism,
and has been compared to priapism in men.
It is also similar to
vulvodynia
Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made ...
, in that the causes for both are not well understood, both last for a long time, and women with either condition may be told that it is psychological rather than physical.
It has been additionally associated with
restless legs syndrome
Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is generally a long-term disorder that causes a strong urge to move one's legs. There is often an unpleasant feeling in the legs that improves somewhat by moving them. This ...
(RLS), but a minority of women with PGAD have restless legs syndrome.
In some recorded cases, the syndrome was caused by or can cause a pelvic arterial-venous malformation with arterial branches to the clitoris.
Surgical treatment was effective in this instance.
Diagnosis
The following five criteria must be met by patients in order to be diagnosed with PGAD:
# Typical physiological responses from sexual arousal persist for an extended amount of time and do not cease on their own
# Feelings of arousal remain even after orgasm or multiple orgasms are needed to lessen the arousal
# Arousal is experienced without desire or sexual excitement
# Arousal occurs with both sexual and non-sexual stimuli or with no stimuli
# Symptoms are intrusive, unwanted, and cause distress
Treatment
Because PGAD has only been researched since 2001, there is little documenting what may cure or remedy the disorder.
Treatment may include extensive
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
, psycho-education, and pelvic floor physical therapy.
In one case, serendipitous relief of symptoms was concluded from treatment with
varenicline
Varenicline (trade name Chantix and Champix) is a medication used for smoking cessation. Varenicline is also used for the treatment of dry eye disease.
The most common side-effects include nausea (feeling sick), insomnia (difficulty sleeping), a ...
, a treatment for
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
addiction.
It was reported in a study that masturbation (51%), orgasm (50%), distraction (39%), intercourse (36%), exercise (25%), and cold compresses (13%) were the most relieving treatments that could be done without the help of a professional.
Having a team of professionals such as a medical provider, a pelvic floor physical therapist, and sex therapist has shown to aid patients. One study found that after working with professionals patients felt validated, listened to, and that their sexual function had improved.
Many patients felt practicing mindfulness allowed them to adjust to living with PGAD by recognizing thoughts and emotions corresponding to the symptoms and avoiding brooding over them.
This treatment method focuses on reducing the anxiety that is caused by the condition and pushes the patient to develop effective distraction and relaxation techniques.
Epidemiology
PGAD is very rare and is believed to affect about 1% of women.
Although online surveys have indicated that hundreds of women may have PGAD,
documented case studies have been limited to about 22.
History
The earliest references to PGAD may be Greek descriptions of
hypersexuality
Hypersexuality is extremely frequent or suddenly increased libido. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania and satyriasis were terms previously used for the c ...
(previously known as "satyriasis" and "nymphomania"), which confused persistent genital arousal with sexual insatiability.
While PGAD involves the absence of sexual desire, hypersexuality is characterized as heightened sexual desire.
The term ''persistent sexual arousal syndrome'' was coined by researchers Leiblum and Nathan in 2001.
In 2006, Leiblum renamed the condition to "persistent genital arousal disorder" to indicate that genital arousal sensations are different from those that result from true sexual arousal.
The rename was also considered to give the condition a better chance of being classified as a dysfunction.
Impact on mental health
Women with PGAD report having unstable mental health with thoughts of suicide and difficulty completing daily activities.
Before the start of their PGAD, many women were seen to have higher stress scores as well as symptoms of depression and anxiety.
Panic attacks (31.6%) and major depression (57.9%) were reported commonalities between patients occurring at least one year prior to the onset of PGAD symptoms. Up to 45% of women with the disorder have reported having a history with antidepressants.
A small study found that several women began to see symptoms of PGAD after discontinuing the use of their
selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
SSRIs increase the extracell ...
. It is not known whether reintroduction of the SSRIs would improve PGAD symptoms.
See also
*
Vaginismus
Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often, it begins when vaginal intercourse is first attempted.
...
References
External links
PSAS information about PSAS in Dutch and English
Hundred Orgasms A Day'' Channel 5 (UK)
Channel 5 is a British free-to-air public broadcast television channel launched in 1997. It is the fifth national terrestrial channel in the United Kingdom and is owned by Channel 5 Broadcasting Limited, a wholly-owned subsidiary of American ...
2004 documentary film about PSAS
Car crash leaves woman constantly aroused Ninemsn
Nine.com.au (formerly Ninemsn) is an Australian news and current events website, owned by ASX-listed company, Nine Entertainment Co. It was originally established as a 50:50 joint venture between Microsoft and PBL Media (now Nine Entertainment ...
, 16 December 2009
{{Female diseases of the pelvis and genitals
Noninflammatory disorders of female genital tract
Gynaecologic disorders
Sexual arousal
Sexual disorders
Syndromes
Clitoris
Priapism