Intimate Wellness Institute

What is persistent genital arousal disorder?

Persistent genital arousal disorder (PGAD) involves experiencing unpredictable, uncontrollable physical sensations associated with sexual arousal — but in the absence of desire. Sexual arousal is usually associated with pleasure, but this isn’t the case with PGAD. With PGAD, you experience arousal as unwanted physical sensations in your genitals. You can’t control when these changes begin, and orgasm doesn’t relieve them.

Instead of making you feel sexual, PGAD may lead to feelings of frustration and embarrassment. It may even be debilitating without expert help.

PGAD wasn’t identified until 2001, and it’s not a common diagnosis. For this reason, researchers are still learning its causes and what treatments work best.

What’s the difference between PGAD and hypersexuality?

The researchers who identified PGAD in 2001, Leiblum and Nathan, originally called it persistent sexual arousal syndrome (PSAS). The word “genital” replaced “sexual” because sexual implies desire, which doesn’t apply to PGAD. This is an important difference between PGAD and hypersexuality, or sex addiction.

Hypersexuality involves desiring sex to the point of excess. With PGAD, desire is removed from the physical experience of arousal.

Who does persistent genital arousal disorder affect?

PGAD is more common in women. PGAD has been compared to priapism, a condition that involves having an unwanted erection for four hours or more.

How common is persistent genital arousal disorder?

It’s rare. Research suggests that it may affect about 1% of women. It’s difficult to know for sure because it’s likely that many people who experience PGAD symptoms are too embarrassed to seek help.


What are the symptoms of persistent genital arousal disorder?

PGAD involves feelings of intense genital arousal associated with increased blood flow and heightened tension in your clitoris, labia, perineum and anus. Symptoms may last for hours or even days and include:

  • Pain or discomfort in your genitals.
  • Tingling in your clitoris.
  • Vaginal contractions.
  • Vaginal lubrication.
  • Unpredictable orgasms.

You may experience orgasms that don’t relieve your symptoms, or you may experience momentary relief through an orgasm only to have your symptoms return.

What does PGAD feel like?

The sensations in your genitals associated with PGAD may be described as:

  • Pressure.
  • Fullness.
  • Pounding.
  • Pulsating.
  • Throbbing.
  • Burning.
  • Tingling.
  • Itching.
  • Pins and needles.

These sensations persist without relief. PGAD’s toll on your body can interfere with your day-to-day routine, causing stress, anxiety and depression. Since orgasms become associated with feelings of relief from pain instead of pleasurable sexual release, PGAD can keep you from enjoying sex or having a healthy sexual relationship.

Does PGAD feel good?

PGAD doesn’t feel good in the way that sexual arousal does. Sexual arousal feels good, in part because you desire the physical sensations. Desire is a key part of a healthy sexual response. Also, you can feel comforted that feelings of release and normalcy will follow the physical experience of heightened sexual tension.

PGAD is different in that you lack control over feelings of arousal, and you don’t know when your body will experience relief or return to its baseline.

What causes persistent genital arousal disorder?

Researchers don’t know for certain what causes PGAD. A combination of factors likely plays a role. The causes may be related to blood vessels and blood flow, nerves or behavioral health issues. Certain medications may trigger or worsen PGAD.

Studies have shown that PGAD may be associated with:

  • Pelvic varices: Varicose veins in your pelvis.
  • Tarlov cysts: Cysts that form at the base of your spine.
  • Periclitoral masses: An abscess on or near your clitoris that causes intense pain.
  • Selective serotonin reuptake inhibitors (SSRIs): People who have stopped taking SSRIs for depression have reported PGAD symptoms.

Stress, anxiety and depression have all been linked to PGAD. Still, it’s unclear how they relate to potential biological factors associated with PGAD.


How is persistent genital arousal disorder diagnosed?

There are five criteria for a PGAD diagnosis. They include:

Feeling the physical sensations of sexual arousal (increased blood flow and pressure in your genitals) but without the complementary psychological component of desire.

  • Feeling the onset of symptoms because of a sexual trigger, a non-sexual trigger or no trigger.
  • Experiencing arousal symptoms in your genitals for several hours or days without relief.
  • Having symptoms that don’t resolve after one or even multiple orgasms.
  • Experiencing distress because of these unwanted symptoms.


What is the treatment for persistent genital arousal disorder?

Dr. Guerette and the IWI team offer the most comprehensive treatments for PGAD in the region.

Medications: Antidepressants, antipsychotics, mood stabilizers and drugs for nerve pain.

Behavioral health interventions: Cognitive behavioral therapy, electroconvulsive therapy, psychotherapy, distraction techniques and validation techniques.

Physical therapy interventions: Pelvic floor physical therapy and massage.

EmsellaTM Advanced Pelvic Floor Therapy: Emsella is a FDA-approved revolutionary treatment for improving pelvic floor muscle function and blood flow to the pelvis. The BTL EMSELLA treatment uses High Intensity Focused Electro Magnetic Energy (HIFEM) to stimulate and improve ALL the pelvic floor muscles, nerves and blood vessels, not just the subset that can be exercised with voluntary contractions (Kegel exercises). . During each 28-minute session you sit comfortably on the Emsella chair while it generates thousands of supramaximal pelvic floor muscle contractions.  Each session is equivalent to doing 11000 pelvic floor exercises but without the hard work! The procedure is non-invasive, and you remain fully clothed throughout. No drugs are required and the most you will feel is a slight tingling during the treatment. With no recovery time needed you can leave immediately after each session and resume normal daily activity. The majority of people need a course of six sessions over a period of three weeks to see optimum results, with most people seeing and feeling results after just two or three treatment sessions. For PGAD Emsella can help restore normal sensation and function. Dr. Guerette and the IWI team have been pioneers in the development of Emsella for the treatment of pelvic dysfunction. IWI had the second Emsella machine in North America and has the most experience with Emsella. Dr. Guerette has been the lead investigator on the studies to evaluate Emsella.

Laser and Radiofrequency (RF) Vaginal Treatment: Dr. Guerette is one on the pioneers in using gentle lasers and radiofrequency devices to restore and rejuvenate vaginal tissue to improve many issues including PGAD. These treatments help restore the collagen, elastin, nerves and blood vessels in the vaginal tissue to regain motion, comfort and normal sexual sensation. IWI has the most comprehensive laser and RF options available. In appropriate candidates simple office treatments with no preparation or recovery can be used to improve the issue.

Platelet Rich Plasma (PRP) – PRP is a simple, safe office procedure to isolate growth factors from your own blood and place them into the damaged area to restore the collagen, elastin, nerves and blood vessels in the vaginal tissue to regain motion, comfort and normal sexual sensation. There is no recovery to this procedure.

Ultimately, the treatments for PGAD vary on a case-by-case basis and a muti-treatment approach usually is most effective.


When should I seek care?

You should seek help from your healthcare provider if you’re experiencing symptoms that keep you from having a healthy sex life or that cause distress. Getting help is especially important with PGAD when the experience of genital arousal can disrupt your life and harm your mental health.