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Red Tomato sliced open representing Persistent Genital Arousal Disorder
Photo by Dainis Graveris on SexualAlpha | https://sexualalpha.com/free-erotic-photos/

Persistent Genital Arousal Disorder (PGAD) is a condition that is poorly understood.

Persistent Genital Arousal Disorder is a rare disorder most commonly seen in those with female anatomy and is characterized persistent sensations of genital arousal in the absence of sexual desire or stimulation. These sensations typically stay after orgasm and are intrusive, unwanted, and can negatively affect quality of life.

The diagnosis itself is not well known among healthcare practitioners yet alone the general public. Those who experience its symptoms can be hesitant to talk about it with their healthcare practitioners even though it may be affecting their quality of life.

PGAD is generally a disorder that affects those with female anatomy, but recent data published suggest that it may affect those with male anatomy as well (Stevenson & Kohler, 2015). The most overarching symptom is persistent arousal of the genitals to the point of it getting in the way of function, habits and routines.

September is Sexual Health Awareness Month - check out our blog feed for more articles to improve your sexual health saviness!

Prevalence, Misunderstanding, and Under-reporting

The prevalence of Persistent Genital Arousal Disorder in the population is still unknown, but it is believed to affect approximately 1% of women. Some researchers believe that many who have Persistent Genital Arousal Disorder do not report it, out of fear that they will have the social stigma of being hypersexual (Klifto & Dellon, 2019).

Diagnosis

Persistent Genital Arousal Disorder is generally diagnosed based on the following 5 criteria, but not all practitioners agree fully and there is no professional consensus (Klifto & Dellon, 2019):

  • genitals are persistently aroused
  • arousal remains following orgasm or requires multiple orgasms to diminish
  • arousal is unrelated to desire
  • arousal is triggered by both sexual and non-sexual stimuli
  • symptoms are intrusive and unwelcomed
  • male anatomy may experience sensations of arousal and ejaculation or orgasm without an erection

What Causes Persistent Genital Arousal Disorder?

The causes of PGAD can vary, which is why accurate diagnosis by a trained doctor is essential.

A thorough evaluation will include a detailed medical history, mental health history, medications, diet, risks of vascular/neurologic disorders, examination of the external genitalia, a pelvic exam and possible labs to look at hormone levels.

Imaging via pelvic ultrasound/doppler may also be used to rule out pelvic masses. Your doctor may also do neurological testing if they suspect any implications of the nervous system, including the pudendal nerve.

Depending on what is causing the Persistent Genital Arousal Disorder, treatment will look different and will often require a team of healthcare practitioners taking care of the mind and body.

Psychological/cognitive

If Persistent Genital Arousal Disorder symptoms are caused or exacerbated by stress and anxiety, therapy, particularly focused on cognitive-behavioral strategies and mindfulness are appropriate for treating Persistent Genital Arousal Disorder.

Neuropathic

When nerves are entrapped they might exacerbate Persistent Genital Arousal Disorder symptoms. If the nervous system is contributing to Persistent Genital Arousal Disorder, treatment may include medicines which would be prescribed by a doctor and modalities such therapeutic exercise, manual therapy, and modalities like transcutaneous nerve stimulation.

How Pelvic Floor Physical therapy Can Help

The treatment modalities you will receive in pelvic floor therapy for Persistent Genital Arousal Disorder will depend on what your care team has identified as the causes of the symptoms. For example, if your pelvic floor muscles are tight and causing nerve entrapment, the techniques used will focus on releasing the tension in the pelvic floor.

Some of the modalities used at Femina Physical Therapy can include (but are not limited to):

  • Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
  • Internal pelvic manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like pain with sex, frequency and urgency of urination, and pain with bowel movements
  • Therapeutic exercises to release entrapped nerves or strengthen the pelvic floor
  • Biofeedback technology to help you focus on relaxing the pelvic floor
  • Photobiomodulation Therapy for pain relief and encouraging cellular healing and desensitization of scar tissue adhesions, tender trigger points, and muscle spasm pain.
  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function
  • Training in self treatment techniques so you can start to manage your systems at home. These techniques can include self pelvicfloor massage using medical dilators
  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion
  • Patient Education and Empowerment
  • Lifestyle modifications like sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake to control other factors that may be contributing to pelvic floor dysfunction.

Help is on the way

If you are being affected by Persistent Genital Arousal Disorder, let us know how we can help by using our simple contact form here, or if you are ready to book an appointment, you can do so here.

Resources

Klifto, K. M., & Dellon, A. L. (2019). Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves. Sexual Medicine Reviews. doi:10.1016/j.sxmr.2019.10.001

Facelle, T. M., Sadeghi‐Nejad, H., & Goldmeier, D. (2013). Persistent Genital Arousal Disorder: Characterization, Etiology, and Management. The Journal of Sexual Medicine, 10(2), 439–450. doi:10.1111/j.1743-6109.2012.02990.x

Garvey LJ, West C, Latch N, et al. Report of spontaneous and persistent genital arousal in women attending a sexual health clinic. Int J STD AIDS 2009;20:519-521.

Jackowich RA, Pink L, Gordon A, et al. Persistent Genital Arousal Disorder: a review of its conceptualizations, potential origins, impact, and treatment. Sex Med Rev 2016;4:329- 342.

Stevenson BJ, Kohler TS. First reported case of isolated persistent genital arousal disorder in a male. Case Rep Urol 2015;2015:465748.

Yildirim EA, Hacioglu M, Essizoglu A, et al. Persistent Genital Arousal Disorder misdiagnosed because of Islamic religious bathing rituals: a report of three cases. J Sex Marital Ther 2012;38:436-444.

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I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

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Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

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Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

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Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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