Persistent Genital Arousal Syndrome (PGAD)

Previously known as Persistent Sexual Arousal Syndrome (PSAS) or Restless Genital Syndrome (ReGS), PGAD is a sexual health problem where the patient experiences spontaneous, persistent, uncontrollable and intrusive genital arousal. This arousal is not guided by sexual stimulation and desire, so even masturbation and the orgasms resulting from it do not provide long-term relief. 

The disorder may be a lifelong one (primary PGAD) or develop at a certain stage or event in life (secondary PGAD), and patients experience various degrees of distress depending on individual triggers. Patients with PGAD are constantly traumatised by their disorder, which makes it difficult for them to manage a daily routine, including work and sleep patterns.

The terms PSAS and PGAD were coined by sexologists Sandra R. Leiblum and Sharon G. Nathan in 2001, and these researchers were the first to study the complexities and limitations of PGAD. There have been only two diagnosed occurrences of PGAD in men, and the disorder is almost exclusively found to occur in women. The symptoms of PGAD are almost impossible to control since any form of external stimulation of the pelvic area, even sitting, can lead to arousal. Anxiety and stress are also factors that can trigger the onset of PGAD symptoms.

PGAD and its symptoms are often misunderstood and confused with Hypersexuality. Hypersexuality is a dysfunctional preoccupation or obsession with sex and is also referred to as sex addiction. It is a psychological disorder and was previously known as Nymphomania in women and Satyriasis in men. Where PGAD is characterised by a complete lack of sexual desire and arousal despite it, Hypersexuality involves increased and unmanageable sexual desire.

Despite much research on PGAD since 2001, its exact causes are yet unknown. Factors like age, location, demography, socio-economic levels, childhood, marital status or family history have already been eliminated as causes of PGAD. Researchers assume that this disorder might have vascular, psychological or neurological causes. Tarlov cysts, which are innervated meningeal cysts that form in the spinal canal, are also speculated to be the cause of PGAD.

None of these speculations and assumptions are substantiated by research, and therefore cannot be presumed to be reliable under any circumstances.

Clitoral priapism, or the painful erection of the clitoris despite the complete lack of stimulation, is usually associated with PGAD. Clitoral priapism, however, does not cause PGAD and is an equally rare illness which has not been studied much.

Living with PGAD has immense psychological repercussions and most patients find leading ordinary lives or completing everyday functions difficult. Each patient has a unique experience of the illness, but the long-term consequences are quite similar. Here are a few short-term and long-term emotional consequences that patients of PGAD might experience while living with the disorder:

• Lack of understanding mingled with shame and embarrassment when the symptoms present while in public.
• Inability to access healthcare facilities and to explain precise symptoms to doctors.
• Inability to convince people that they don’t suffer from Hypersexuality or sex addiction.
• Agitation and distress at frequent disruptions in occupational, educational and social functioning.
• Inability to enjoy sex and lack of a normal sex life.
• A constant sense of shame, helplessness, vulnerability and sadness due to social isolation.
• Lack of a support system consisting of understanding relatives, peers, healthcare officials or fellow patients.

A report in the Journal of Sex Medicine in 2007 revealed that due to these long-term emotional factors women with PGAD were diagnosed with depression, anxiety, obsessive compulsive disorder (OCD), chronic fatigue syndrome and panic attacks. These patients also had a tendency of monitoring their physical sensations more closely and the psychological factors reinforced or increased their PGAD symptoms in turn.

These are some of the tests patients of PGAD need to get done to be able to discern if effective management of the disorder if possible:

• A complete medical history, including regular medications, treatments and a description of symptoms at the onset of PGAD. This can also help the patient cope with the realities of life after the onset of PGAD.
• A thorough pelvic exam should be done by the doctor or healthcare provider so that any signs or peculiarities in both internal and external reproductive organs can be diagnosed.
• A complete pathological examination should be conducted on the sexual and reproductive organs to understand the particulars of the illness in an individual patient.
• Neurological sensation tests should be done regularly to map the sensations of pain and relief during and after arousal. This can help the patient understand the triggers of PGAD and the doctor to recommend medications to inhibit those if needed.
• A Doppler ultrasound or blood flow test conducted during and after arousal can also help the doctor understand the patient’s symptoms.

While treatment or PGAD management recommendations might vary from one case to another, these are a few treatments that have shown effective results in PGAD patients:

• Psychotropic medications that stabilize nerve transmission, like Depakote, Neurontin, Clonazepam, Tofranil, Prozac, Paxil and Ativan.
• Local topical anaesthetic agents that numb sensations in the genitals so that feelings of arousal can be controlled or at least managed.
• Medical treatment of irritating neurological lesions through physical therapy, acupressure, pain medications and muscle relaxants.
• Hormonal milieu normalisation or normalising the production of hormones that trigger PGAD in individual patients can be attempted by specialists if proper mapping of neurological sensations is done.
• Behavioural psychotherapy can help patients cope with the emotional consequences of PGAD.

There is no cure for PGAD yet, but there are treatments and medications that can be partially effective in managing the symptoms of PGAD in some patients. Since most of these experimental treatments depend on monitoring triggers and responses of individual patients, doctors recommend regular tests and screenings for the patient’s overall health and well being.