Persistant Genital Arousal Disorder
A Pelvic Pain Disorder
Persistent Genital Arousal Disorder (PGAD) should not be overlooked. Here at 5 Point Physical Therapy, we take it really seriously – we’ve learned that it has little to do with pleasure and everything to do with pain. Many patients come to us after researching online solutions – after they’ve exhausted every other option. If you identify with that scenario, we want you to know that you are not alone – and that we are here to help!
What is PGAD?
PGAD is a persistent feeling of genital arousal with or without orgasm. It is unrelated to any feelings of sexual desire. PGAD occurs predominantly in women, but there are men who experience it as well. The symptoms include tingling feeling in clitoris or genitals, genital throbbing or irritation and/or spontaneous orgasms. This can last a few hours or it can last days.
Symptoms of PGAD are very different from what happens during sexual arousal because they occur with no sexual interest – and these symptoms are often unwanted and unpleasant. Understandably, living with PGAD is very distracting and can be debilitating. It makes sense that it has the ability to completely consume an individual; with this dysfunction, masturbation or orgasm may provide little or no relief.
PGAD is not a sexual disorder, it is a pain disorder.
Some associations with PGAD include overactive bladder, irritable bowel syndrome, gynecological disorders, previous surgeries in the vaginal or general abdominal regions which we see in the clinic. However, PGAD can be triggered by a work-out class gone wrong or even wearing stilettos if the pelvis is offset or muscles are in spasm. There is a nerve – called the dorsal nerve of the clitoris – that may be irritated and as a result, cause some of these symptoms for PGAD sufferers. If the pudendal nerve (which is part of the dorsal nerve to clitoris) is getting increased signaling, then the whole region may become extra sensitive. There are also links between changes in medications and hormones that may contribute. PGAD can come as a secondary symptom to another causative factor such as IBS or vaginal surgery, but it can also develop with an unknown cause.
How is PGAD treated?
During the process of dealing with PGAD, we have to respect that different treatments work for different people. The causes of PGAD vary with each individual, and one person may have a better response to certain treatments than someone else. All of these can benefit the patients, in combination with pelvic floor physical therapy:
- Medical treatments in the literature show medications like tricyclic antidepressants (i.e. Zoloft) and nerve pain medications may reduce this type of discomfort.
- Using a transcutaneous electrical nerve stimulation unit may give certain patients short-term relief – they help to decrease nerve signaling.
- Hormone related medications can be recommended as an antiandrogen to decrease sensation when applied topically to the region.
- Stopping use of certain medications with known aggravators of PGAD may help symptoms.
- Anesthetizing gels such as lidocaine and even using ice to give relief of the skin.
- CBT treatment and meditation can assist the patients in identifying triggers and allows for different coping mechanisms.
- There are studies out to show that botox injections near the dorsal nerve of the clitoris can be performed to relax the region. At 5 Point Physical therapy, we have seen success with patients who have received series of trigger point injections on the muscle to help relieve symptoms as well.
We’re here to help
With increased awareness, we are finally beginning to see referrals from physicians for PGAD, and it is a breath of fresh air!
If you’re experiencing any of the symptoms above, there is no need to suffer in silence – this is a physical disorder. Only an estimated 60% of people suffering from PGAD bring their symptoms to the attention of their physician, and this needs to change if we want to effectively treat sufferers. When patients are treated with medical interventions, physical therapy and counseling as needed, they are bound to see improvements towards full recovery. We’re here to advocate for you!