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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 Comment30 Comments
Omg, I have arachnoiditis too and PGAD. I’m wondering if this is related to arachnoiditis? This is new to me and not sure how to cope.
August 22, 2018 - 8:17pmThis Comment
I have recently started taking medicine for bipolar disorder, I'm not sure if this is part of the side effects but I have been having the same feeling of all of you mention above for the past 10 or so days, I been on the medication for three months so is hard for me to think this is part of a side effect, if you have any other answers or home remedies for this let me know, again this is not happen to me but just recently and I'm not sure I have it.
November 9, 2011 - 11:02amThis Comment
Hi.
First of all, I'm sorry to hear that you've been suffering from these symptoms too. I really hope that some of the information I've included in this post will be of use to you and some of the other posters (similarly, I appreciate the information disclosed by the other people with this condition).
I suffer from PGAD/ Vulvodynia symptoms, like those described above, and I've since learned that the onset of this condition has been linked to the use (or sudden discontinuation) of SSRI antidepressant medication. I was prescribed Citalopram (a common SSRI) for Obsessive Compulsive Disorder and related depression. A few weeks after coming off these tablets (they made me feel 'foggy' and drowsy) I started to experience these weird and sometimes painful sensations 'down below'. Naturally, the condition provided a perfect 'hook' for my pre-existing OCD to further latch onto and made that even worse than it was before (despite what some non sufferers may think, this condition is only 'fun' if you enjoy having your head seriously f**ked up).
PGAD also been linked to nerve damage (possibly caused by medication) and over active bladder. Strangely, I seem to have a reasonably strong bladder and don't need to urinate as frequently as many other women.
I am, however, fairly prone to urinary tract infections. I've had various tests done, which show that I definitely don't have a STI, and my blood test indicated that my hormone levels are normal. On the other hand, PMS and menstruation definitely seem to exacerbate my symptoms.
This site is particularly informative: http://www.psas.nl/en/
Good luck.
January 27, 2013 - 3:05pm- 'Another Anonymous Poster'.
This Comment
P.S. I forgot to mention that it is never a good idea to suddenly stop taking prescribed medication without consulting your doctor first.
Sudden withdrawal from my medication seems to have played a role in my development of PGAD and I would always advise anyone wishing to to discontinue a medication to do this gradually and in accordance with the doctor's instructions.
- 'Another Anonymous Poster'.
January 27, 2013 - 3:10pmThis Comment
It's definitely frustrating. Really hard to explain squirming to try and take pressure off. I don't wear any type of tight clothing, as I have found that it exacerbates the problem. Orgasm does not seem to stop the throb. In fact, it's reminiscent of the throb I get if I cut or smash my thumb or finger. It does make it nearly impossible for me to pay attention while having sex, and I have a hard time reaching climax. Does anyone else find this an issue?
October 27, 2011 - 1:58pmThis Comment
Just went in for my pap smear yesterday and asked the doctor about this problem...she was stunned and had no idea what it is. You know it is embarrassing when the doctor asked you if you feel engorged during a pap smear..and I was. I wanted to crawl under the table at that point!! She said I was "rare" and went about testing my hormone levels. My TSH is 1.75 and my free t4 is .7 so they fall in the normal range so I was not given any help. Thanks for this tip...maybe this is what I have...but it still doesn't provide relief. It isn't in my head, it is in my pants! A constant female hard on....with no explaination or cure?? Really???
June 10, 2011 - 1:51pmThis Comment
yes its very frustrating and embarrassing when u tell drs, love 1 etc cause they really cant begin to understand. Why i believe it must be brain related is cause i to have had all the hormone check and every other test know to man and they are all within normal range. Its like theres a switch that just gets turned on, im not necessarily horny mentally its more a physical need for relief to the genitals. My symptoms worsen when im tired or stressed. Wish i had the answers for u but sadly i dont and because ppl are embarrassed to speak up i dont think a cure will be found anytime soon.
July 11, 2011 - 7:29pmThis Comment
i have been diagnosed with psas and restless legs. I believe that its brain related and its effects of dopamine levels are a link, also oversensative nerves. ok treatments that i have found to work most effectively are : nedep (its an antidepressant), masturbation. With an average of 80% reduction in symptoms. It has helped me live a more normal life again after over 10 yrs of suffering. I hope this to can help u
April 12, 2011 - 6:40amThis Comment
Shortly After Developing PSAD, I had a Brain Bleed. Thay ALSO Cannot explain why this happened to me, no relatable Conditions, such as: High Blood Pressure, High Sugar, High Colesterol. I truly believe that there is a link between the two conditions, cannot be just coinsidence. Doctors need to explore the brain to find the link, I am sure of this.
April 2, 2011 - 9:43pmThis Comment
sorry...I mean "PGAs does NOT exclude me from having problems achieving orgasm during intercourse. Ironic, isn t it?"
July 7, 2010 - 8:26amThis Comment