Understanding & Managing Persistent Genital Arousal Disorder

Persistent genital arousal disorder or restless genital syndrome is a rare condition that causes unwanted, spontaneous genital arousal without stimulation or desire. This condition creates physical responses of arousal at times that can be inconvenient and distressing.

Before we get deeper into discussing this condition, let’s first state that this is a safe place. Talking about sex, sexual health, or sexual pleasure is always accepted and welcome here. It is a topic nobody should ever have to feel ashamed of! Sexual pleasure, sexual activities, and masturbation are all totally normal human activities and feelings. They should be celebrated in our society, rather than discouraged—it’s personal health, after all!

However, something important to understand about PGAD is that this arousal is often disruptive and unwanted. It can cause arousal that happens unexpectedly, and the symptoms may be very frequent or long-lasting. Because of this, the condition can create feelings of embarrassment, shame, anxiety, and low body image in an individual.

Those with persistent genital arousal disorder are often afraid of speaking about their condition and may avoid treatment as a result. You should never hesitate to seek treatment, as sexual health is just as important as any other type of health. 

Your sexual health matters, so don’t feel ashamed to speak about PGAD to your provider. By receiving treatment, you can better manage your symptoms and improve your quality of living! Not only that, but you’ll also contribute to furthering the research and awareness of PGAD.

So, let’s take a closer look at the symptoms of persistent genital arousal disorder below.

Persistent genital arousal disorder is rare, but is seen more often in those with a vagina. In those with a penis, it is often referred to as priapism, which is a more specific term for when an erection lasts a very long time.

PGAD is not a sex addiction or form of hypersexuality. It involves the physical aspects of arousal that occur without desire or stimulation. It can occur without even a thought about sexual activity, which is why it is so disruptive. Additionally, the symptoms of this condition can last for hours, days, or even weeks at a time.

The uncomfortable sensations felt as a result of PGAD include:

• Wetness
• Pressure
• Itching
• Pounding
• Burning
• Pins and needles
• Erection
• Vaginal swelling
• Genital pain

Persistent genital arousal disorder can make an individual feel as though they are close to orgasm. For some, orgasm can provide momentary relief—but unfortunately, orgasm doesn’t always relieve the sensations or arousal. 

While this is a safe space for sexual activities such as masturbation, it is important to note that masturbation is not a replacement for diagnosis or professional treatment. The brief feeling of relief that individuals with PGAD may feel after orgasm can give a false sense of hope. Even after an orgasm, symptoms may likely return, and frequent masturbation may cause PGAD to last longer or become worse. 

Eventually, the sensation of an orgasm may begin to be unenjoyable, due to the climax being a relief from pain, rather than enjoyment. Therefore, in order to not ruin sexual pleasure or activities such as masturbation, it is recommended to seek a diagnosis as soon as you notice symptoms of PGAD.

As mentioned before, this disorder can cause psychological symptoms too. It may cause frustration, an inability to focus, strain in relationships, depression, and anxiety. It may create a negative association with sex and sexuality. For these reasons, those who seek treatment for persistent genital arousal disorder should also consider seeking other forms of therapy, too.

There is not a definite cause for PGAD known currently, but there are many things that are thought to influence the condition. First, it may help to understand how physical arousal works.

Many parts of the body work together to allow for arousal—including your nerves, hormones, blood vessels, and muscles. Hormones stimulate libido and dopamine, which play a role in regulating arousal. Nerves send signals between the brain and other parts of the body that signal arousal responses. 

Blood vessels contribute to swelling and sensitivity, which can allow for things like the erection of a penis or engorging of vaginal walls. Lastly, muscles help manage blood flow (such as keeping an erection) and also play a massive role in your ability to orgasm.

Many of the above-mentioned areas are thought to play a role in persistent genital arousal disorder. While they may not have been proven to definitively cause the condition, these areas still play a role in arousal and may influence PGAD symptoms. Let’s briefly explore how:

• Nerves: Hypersensitivity, nerve compression, and central sensitization are thought to have possible connection to PGAD.
• Blood: Blood vessels play a major role in physical arousal. Disruptions to blood flow are thought to be a possible contributor to PGAD.
• Hormones: Medications that affect hormones may cause fluctuations in estrogen or testosterone, which influence arousal.
• Muscles: The pelvic floor muscles directly control things like swelling, erection, and orgasm. They can affect important nerves necessary for arousal, too. Dysfunction of these muscles may cause a variety of sexual dysfunctions, and may influence a person’s experience with PGAD.

As you can see from the last bullet point, it is very possible for the pelvic floor to have an influence on PGAD. The pelvic floor is very involved in the physical arousal process, and so strategies for managing symptoms of PGAD often involve pelvic floor physical therapy.

There is no cure for persistent genital arousal disorder, but many individuals can experience a significant decrease in their symptoms through long-term management strategies.

So, depending on your individual diagnosis and needs, pelvic floor physical therapy may be a very effective method to manage your symptoms of PGAD. We’ll explore treatment later; but first, it’s important to understand just how interconnected the pelvic floor is with the arousal response…

The pelvic floor affects the arousal response regardless of your type of genitals. To perform many of its different functions, the pelvic floor muscles must contract and relax. 

Orgasm is an easy example of the pelvic floor muscles in action, as it occurs through rhythmic contractions and relaxations. However, when your pelvic floor experiences dysfunction, it cannot always contract or relax properly, which causes a variety of problems—and not just with orgasm. Pelvic floor dysfunction means that your pelvic floor is weak, tight, uncoordinated, or a combination of these factors.

In terms of PGAD, pelvic floor dysfunction can disrupt a lot of important functions and affect other structures in the pelvis. Let’s look at some examples of how pelvic floor dysfunction may affect or worsen PGAD.

As mentioned earlier, the pelvic floor helps maintain blood flow needed for arousal, and keeps that blood in place to maintain that arousal response (such as erection). If you have a lot of tension in your pelvic floor, it can put pressure on your blood vessels and exacerbate PGAD symptoms.

Dysfunction of the pelvic floor muscles can also irritate important nerves involved with arousal and cause tissue sensitivity. Tissue sensitivity may make your body mistakenly send an arousal response, which can contribute to PGAD symptoms.

Other effects of pelvic floor dysfunction on PGAD can include pain, muscle spasms, and pelvic discomfort. These symptoms may not only worsen your symptoms of PGAD, but can even impact the function of your bladder and bowels, too. 

These are not the only connections between your pelvic floor and PGAD. Unfortunately, it is possible that the presence of PGAD may have an impact on your pelvic floor, too. PGAD can cause pain, tissue irritation, and stress—all of which can have a negative affect on your pelvic floor. This means you may be caught in a cycle of symptoms as the arousal responses associated with PGAD affect your pelvic floor health, and vice versa.

Due to the interconnectedness between your pelvic floor and the genital arousal response, it may be very beneficial or even necessary to seek pelvic floor physical therapy. This form of treatment may help you manage your symptoms of persistent genital arousal disorder, as well as help you understand and become more comfortable with your body.

So, what can pelvic floor physical therapy look like? 

When working with me, Dr. Laura Meihofer, you can expect to first engage in an evaluation. This process will involve a discussion of your symptoms, medical history, and other concerns, which will help me get a better idea of your individual needs. 

For some, the evaluation process may include an examination. This examination can be both external or internal, but rest assured that you’ll never be expected to engage with anything you are extremely uncomfortable with. 

While examinations can provide valuable information about your pelvic floor’s condition, I can always work with your individual comfort level. I also always request consent before any treatment or examination, so please feel at ease during treatment! It’s my top priority to make my patients feel safe, secure, and confident with treatment.

Once the evaluation process is complete, I’ll be able to create a comprehensive treatment plan just for you! This plan will look to address your individual needs and symptoms, and therefore may not be the same as the next patient’s treatment plan.

However, there are some treatment techniques and overall goals that are likely to be included in your plan of care! So, let’s explore some common treatments that you may experience during your management of PGAD:

Manual Therapy

Manual therapies are a type of treatment that’s very useful for pelvic floor dysfunction. These types of treatment involve the manipulation of pelvic floor muscles, as well as other tissues in your lower back, hips, or abdominals—areas that are very connected with the pelvic floor. 

These manipulation techniques help mobilize your muscles, nerves, ligaments, tendons, and other structures to reduce tension, encourage blood flow, improve your range of motion, and allow for proper function. Manual therapies can be done using hands or with tools such as pelvic wands, tissue scrapers, cups, and more.

Pelvic Floor Training

Pelvic floor training will be an important part of managing PGAD, as it helps you understand your pelvic floor and maintain its ability to contract and relax effectively. Your pelvic floor can contract and relax involuntarily (on its own), but you can also voluntarily perform these movements, such as when you are trying to hold in gas or urine. 

During treatment, I will look to improve your pelvic floor coordination and health through a variety of exercises that will help you actively contract and relax those muscles as needed. These movements will help you better understand relaxation techniques and strengthening activities, too.

Exercise & Stretching

During your evaluation, I’ll assess your muscle balance in your pelvic floor and other areas of the body mentioned before (hips, lower back, abdominals, etc).

Depending on the results of this assessment, I may curate a unique exercise plan for your body’s individual needs. This exercise plan will aim to balance muscle tone in all areas that affect the pelvic floor in order to reduce straining and alleviate tension. This exercise plan may include things like stretching or yoga to help support better tissue mobility and flexibility, which will further reduce tension and tissue irritation!

Behavioral Modifications

One very important part of pelvic floor physical therapy treatment is behavioral modifications. The pelvic floor is a part of many daily activities, even if you don’t realize it. It helps you use the restroom, lift items, move during sports, and much more. Sometimes, your daily habits can harm the pelvic floor, such as improper lifting posture or poor restroom habits (holding urine for too long, straining on the toilet, etc.). 

Therefore, we’ll thoroughly discuss these potential habits, and I may even examine your posture while lifting, standing, sitting, and more. Making changes to harmful behaviors can have a significant impact on pelvic floor health and play a role in long-term management of pelvic floor dysfunction (which, as we know, can affect PGAD symptoms).

As you can see, pelvic floor physical therapy offers a variety of benefits that can help those with PGAD better manage their symptoms and even reconnect with their body. There’s also one very important thing to know: although this case may be rare, you are not alone in this! You do not have to feel alone or ashamed of your body, or what you are dealing with. Everyone has the right to a healthy body and mind, and that includes sexual health and pleasure.

Get started towards better health today by making an appointment. Or, for further questions, check out the discovery call option!