Persistent Genital Arousal Disorder

The physical sensations of sexual arousal, particularly when experienced in the context of lovemaking with one’s partner, are generally considered desired and pleasurable.  While arousal normally accompanies sexual activity, with or without a partner, many women experience spontaneous sensations of genital arousal that are unrelated necessarily to being in a sexual situation.  This is a normative process which most women perceive in a positive way. After all, what nicer way is there to be reminded of being alive than to feel pleasurable genital sensations once in a while?

However, in some cases, these sensations go haywire, to the extent that they simply do not shut off.  Persistent sensations of arousal in the genitals, which do not subside even after one or several orgasms, can be an overwhelming and debilitating problem.  This presentation has been identified by researchers Sandra Leiblum and Sharon Nathan and named Persistent Genital Arousal Disorder, or PGAD Symptoms of PGAD include genital fullness and sensitivity that persist for an extended period of time and do not subside completely on their own. Often only the genitals are involved but in some cases the nipples may feel tender and swollen as well.  Women with PGAD describe that they experience these symptoms without awareness of any particular sense of sexual desire or excitement. They may come on spontaneously, or be triggered by activity, sexual or otherwise.  What makes this presentation a disorder, is the fact that women with PGAD are very distressed by their symptoms, and experience them as intrusive and unwanted.

The causes of PGAD are not well understood. There are various theories, both psychological and physiological, that have attempted to explain this phenomenon. Some cases of PGAD  have been linked with obsessive compulsive disorder (OCD) and in fact, have been associated with use or discontinuation of use of certain drugs called  Selective Serotonin  Re-uptake Inhibitors (SSRIs),  which are common drugs used to treat OCD as well as depression and anxiety. One study found that a diet rich in soy products containing phytoestrogens may trigger symptoms of PGAD, pointing possibly to a hormonal connection.  Other theories have looked at what is known as central processing, which is how the brain perceives and interprets stimuli. When the central processing system is unbalanced, perceptions such as pain or arousal are heightened. Finally, some theories have suggested that hyperactive or contracted muscles of the pelvic floor may be associated with PGAD, and may explain the fact that some women also have symptoms of bladder pain, urinary urgency, and frequency. (Link to Sex and your bladder)

Several treatments have been suggested for PGAD. These include searching for the proper medication to alleviate symptoms, usually an SSRI. Behavioral treatment may be helpful as well. Identifying and minimizing the triggers which seem to bring on and aggravate the symptoms may be helpful. Pelvic floor physical therapy which includes biofeedback, relaxation, and manual therapy to help reduce pelvic floor muscle tightness may help. Finally, simply knowing the condition exists; educating oneself and loved ones, and joining an online support group with others who share the same experience may be very therapeutic as well. Because not all doctors are well informed about this condition, and as a result have been known to make insensitive comments such as “I wish my wife had this” it is important to choose a physician in your area who specializes in Sexual Medicine.

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