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Persistent Genital Arousal Disorder

By Matthew Karlovsky M.D.
 
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Recently I saw a patient with an interesting and peculiar complaint: she felt constant clitoral arousal that lead to pressure that she could not relieve. It was leading to anxiety and disrupting her life and activities. Even after achieving orgasm from masturbation, she would still sense the clitoris to be stimulated.

It was fortuitous that I read about this condition about 3 months before I saw the patient in the office. It is a little known condition that was first described in 2001. It is a problem of genital arousal, not sexual arousal. Patients will experience tingling, pressure, irritation, congestion, throbbing, pain or vaginal contractions. Only sometimes can sexual intercourse or masturbating alleviate the sensation. In a recent Dutch study, there appears to be a correlation between PGAD, overactive bladder and anxiety.

In my patient’s case, as is described for PGAD, the patient felt genital/clitoral arousal the entire day; it was unwanted and intrusive to her life; it was triggered by non-sexual activity (she had a UTI that preceded it); it lead to distress; it was not associated with a psychological condition. Because of the problem, her anxiety level is raised which leads to a vicious cycle of worsening the condition.

What are considered to be the triggers for PGAD?
Sexual stimulation
Masturbation
Stress
Anxiety
Loss
Menses

What can exacerbate the condition?
Pressure against the genitals
Visual arousal
Vibration (car, motor)
Stimulation by partner
Intercourse
PMS
Genitals becoming too hot
Riding a bicycle/horse

There is no specific treatment since the cause remains vague. Psychosocial support and defining the condition helps to create some knowledge that such a condition exists. Intercourse or orgasm may bring some temporary relief. Ice or topical anesthetics can help reduce swelling and sensation. Pelvic massage or stretching exercises may help. Mood stabilizing medication is empiric and may or may not help, especially if there is underlying anxiety or depression. Anxiety-reducing coping skills and activities can lead to distraction and may be useful.

Thus far, topical anesthetics have brought my patient some relief.

Add a Comment33 Comments

EmpowHER Guest
Anonymous

Hi, i am 21 year old virgin, and i am having irregular periods since 2013, which leads to heavy waist ache whenever there is delay in my periods. I have been to a GYN, and after being examined twice my uterus was normal. Everything was normal, but all i have ia delayed periods, irregularities. Though the doctor says hormonal problems, but i fear infertlity, and seroius disease. I have periods in 4 to 6 months, i do not understand, whether it will affect my health or i can conceive.
please suggest.

September 14, 2014 - 5:00am
Michelle Thompson (reply to Anonymous)

Your not exactly experiencing the same disorder as the rest of us. Think u should seek drs advice

September 14, 2014 - 7:44am
EmpowHER Guest
Anonymous

I have struggled with this on and off. I have recently stopped taking the antidepressant Citalopram and would have thought nothing of it except for an earlier post.

I couldn't think about what could have possible triggered this irritating and painful feeling. I have experienced the constant arousal, but it gets worse at night because I have nothing distracting me from it. I am losing a lot of sleep.

While an orgasm helps me fall asleep, I am awake 15 minutes later, with that ache. I have used ice packs which alleviates it for a half hour or so, but who can walk around with an ice pack on their genitals all day.

I am just happy that I found this because I have been searching for answers. I have printed out several articles to take into my nurse practitioner and hopefully I can find some relief.

May 7, 2014 - 2:06am
EmpowHER Guest
Anonymous

I suffer from this for at least 2 years now. I wish ppl took it more seriously, from family to doctors it's just seen as an almost desire able condition. If a man complains of being constantly aroused even after release, ppl would easily see the negative ways his life would be impacted. Even women would imagine how horrible it must be to not be able to satiate oneself despite constant attempts at release. For some reason, a woman crying out that she is constantly at the mountains peak and never able to descend, is humorous, belittled, and virtually ignored. I have some days thought I'd just want to die if I have to live life ruled by my body w/ no control whatsoever.

April 28, 2014 - 4:40pm
Susan Cody HERWriter Guide (reply to Anonymous)

Hi Anon

Thanks for sharing your story.

You're right - this is a condition that has been considered almost a joke - even by medical professionals. In reality, it's a terrible condition for women.

I highly encourage you to stay away from regular doctors/family doctors and get to a specialist who has a full understanding of your condition and can be there for you without any smart-ass comments or brushing you aside like this condition is something that every woman should want. You need and deserve proper help and treatment. 

Best,

Susan

April 29, 2014 - 10:08am
EmpowHER Guest
Anonymous

Hi everyone. For the past 2 weeks ever since I started taking Adderall I've been consistently aroused. It hasn't went away but does vary in its intensity. I try and ignore it most of the time but if the pressure is too much I try and relieve myself...which only provides a small amount of relief. I am not experiencing orgasims that I don't have to work for; they don't just happen randomly thank you God. It's never been easy for me to orgasim and that hasn't changed. Now I'm smelling within the last day a strange odor. The arousal pressure also feels like I have to urinate, which if I go to the bathroom I do urinate. I also currently began taking Welbutrin within the past 2 months while being weened off Effexor. I work 2 jobs and don't have one to randomly see my doctor. I'm scheduled to see my psychiatrist on the 19th so I'm trying to hold our until then. Please, does this sound familiar to anyone?

March 12, 2014 - 2:51am
Susan Cody HERWriter Guide (reply to Anonymous)

Hi Anon

I have read some other postings on a connection between Adderall and PGA but not much from a scientific standpoint but that doesn't mean there isn't a connection. 

It's possible that you have a UTI - is it in anyway painful when you pee or right at the end when you go? A non-treated UTI can be really serious; it can easily lead to a kidney infection - something far more serious. 

I am sorry you're going through this, PGA is not something that can be ignored and causes a lot of distress and frustrations. I hope you can work this out soon! Will you keep us posted?

Best,

Susan

March 13, 2014 - 9:58am
EmpowHER Guest
Anonymous (reply to Anonymous)

Update: I went and saw my PCP. The odor is from a bacteria infection that can be treated with antibiotics. Also she took me off the adderall so hopefully that helps with the arousal.

March 12, 2014 - 3:45pm
Susan Cody HERWriter Guide (reply to Anonymous)

Hi Anon

I didn't see your update before I answered! I susepcted an infection so that's great that you are on antibiotics. Good luck with the other issue - if it resurfaces, then see your doctor again. 

Best to you!

Susan

March 13, 2014 - 10:04am
EmpowHER Guest
Anonymous

How do you all cope? Im a week in with this and i feel my life is over
And i have no hope whatsoever.

November 14, 2013 - 5:34pm
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