PGAD is an interesting condition I've stumbled across a lot since creating my Instagram and diving deeper into pelvic health conditions I don't suffer from myself. PGAD, or Persistent Genital Arousal Disorder, is defined as a a condition where women are plagued with spontaneous genital arousal from even non-sexual stimuli which doesn't resolve itself from orgasms. Here is my further explanation into this unique phenomenon.
How many women have it?
This condition is very rare, yet we can't know exactly how much so, since there are probably many women who don't report it. It's estimated that 1-6% of the population has it. Let's distinguish this disorder from hypersexuality, which involves excessive desire for sexual acts and not a lack thereof. With PGAD there is no desire for sexual activity, just consistent arousal of the genitals which could appear as throbbing, pounding, pulsating, engorgement and/or pressure/discomfort in the genital tissues, including the clitoris, labia, perineum, and/or anus. In order to be diagnosed with this condition, the arousal (genital vasocongestion) must last for several hours or days, not subside after multiple orgasms, be brought on by something not sexual in nature, and cause a fair amount of distress to your life. The arousal comes out of the blue and is unwanted to the point that it interferes with daily life. Orgasms through masturbation or sex with a partner do not provide relief from the engorgement. Blood tests and other imaging all show normal levels for those suffering from this condition so there is no medical test to provide a solid diagnosis, just the presence of genitals on alert that can't be relieved.
What causes it?
The fear avoidance model shown above displays how catastrophizing the arousal leads to fear and hypervigilance, which in turn leads to greater depression, but what causes PGAD in the first place? A few factors have been known to lead to this disorder, including increased soy intake, exogenous medication, and Tarlov cysts. Potential central neurologic causes may be secondary to epilepsy, Tourette's Syndrome, post-blunt central nervous system (CNS) trauma, post-neurosurgical intervention of central arteriovenous malformation, or to cervical and lumbosacral surgical interventions. Lesser factors are peripheral neurological changes (such as pelvic nerve hypersensitivity or entrapment), vascular changes (like pelvic congestion), mechanical pressure against genital structures, medication-induced changes, psychological changes (stress), initiation or cessation of treatment with antidepressant medication and other mood stabilizers, physical inactivity, the onset of menopause, or an overactive bladder. As far as general life situations leading to PGAD, women who have been raised in a more Conservative environment with a tendency to shame sex are more likely to have greater levels of stress with this condition, which could cause it to flare up more often and make it harder to find relief. It's important to note, however, that some cases of PGAD are completely idiopathic. Genital sexual arousal is partly controlled by the hypothalamic and limbic dopamine systems working in the brain, so this can help find a solution for you if your dopamine is misfiring.
What can you do it if you have it?
Central hyperactive dopamine release plays an important role in the pathophysiology of PGAD, so one treatment is taking Varenicline to control the amount of dopamine being released, as pictured below. On the other hand, Carbamazepine has been used in the past, but didn't provide any significant relief to patients. The current method of treatment is simply symptom management through pharmacologic and psychological strategies. The use of antidepressants, opioid agonist tramadol, olanzapine, valproic acid, risperidone, or varenicline have all been used with some level of success. Also, validation, identification of triggers, psychoeducation, distraction techniques, and pelvic massage to decrease pelvic floor tension have been tried and shown promising results.
Unfortunately there haven't been many studies into PGAD and we are still learning how it arises and what to do about it. Part of the issue with current studies is that many of the research done has been from case studies on a single individual which may not represent reactions to treatments for women on the whole. Some argue that taking a biopsychosocial approach is important as we consider how the mind affects our perception of pain and discomfort and how we react to it. Just know that you are not alone if you are dealing with unwanted arousal and looking for a place to turn. I recommend following the hashtag #pgad for more information and to find others who share the troubles of this unfortunate condition.