What is persistent genital arousal disorder (PGAD)?

by on September 8, 2014

What is persistent genital arousal disorder (PGAD)?


MNT Knowledge CenterPersistent Genital Arousal Disorder, also known as PGAD or Restless Genital Syndrome or Persistent Genital Arousal Syndrome, is a condition characterized by unrelenting, spontaneous and uncontainable genital arousal in females. The condition may or may not include arousal with orgasm and/or genital engorgement. The patient’s arousal is not linked to sexual desire.

PGAD has only recently been classed in medical literature as a distinct syndrome. The Diagnostic and Statistical Manual of Mental Disorders IV does not recognize PGAD as a diagnosable medical condition. There are a growing number of reports describing a similar condition in males.

Some doctors class priapism in men as a type of Persistent Genital Arousal Disorder. Priapism is a persistent penile erection without sexual desire. Put simply, the male has an erection that does not go away. Treatments for priapism include drugs, drainage of blood from the penis, or anesthesia. Unlike PGAD, priapism is recognized as a diagnosable medical condition in the Diagnostic and Statistical Manual of Mental Disorders IV.

Persistent genital arousal disorder is not associated with hypersexuality, otherwise known as satyriasis in males or nymphomania in females.

It is very difficult to know how common PGAD is, because many sufferers may be too ashamed or embarrassed to seek medical help.

A sufferer of PGAD may experience episodes of intense arousal (without sexual desire) several times a day for weeks and even months. Climaxing (reaching orgasm) may alleviate symptoms for a while. However, in many cases the symptoms come back within a few hours. Symptoms come back suddenly and without warning – the patient cannot usually identify the triggers and avoid them.

If symptoms are ignored and not acted upon, the patient may experience waves of spontaneous orgasms. It is said to be a debilitating condition which can leave people unable to focus on everyday tasks.

There are some known triggers which can bring on symptoms, such as vibrations from a cellphone, or riding in a car, bus or train. Some people find that going to the toilet results in such severe arousal as to be painful.

Chronic (long-term) sufferers of persistent genital arousal disorder may eventually lose their sense of pleasure with all things sexual, because release from symptoms, which is achieved by having an orgasm, becomes associated with relief from pain rather than something to enjoy.

Prof. Sandra R. Leiblum

Prof. Sandra R. Leiblum (1943-2010), an American author, lecturer, and researcher in sexology, changed the name from Persistent Sexual Arousal Syndrome (PSAS) to Persistent Genital Arousal Disorder (PGAD), because it was felt the former term had an incorrect sexual connotation.

Sandra Leiblum was a Professor of Clinical Psychiatry at The University of Medicine and Dentistry’s Robert Wood Johnson Medical School.

Prof. Leiblum listed 5 criteria for a diagnosis of PGAD. Today they are considered as the only valid criteria. PGAD advocates say they need to be extended. The 5 criteria are:

  • Involuntary genital and clitoral arousal that continues for an extended period (hours, days, months).
  • No cause for the persistent genital arousal can be identified.
  • The genital arousal is not associated with feelings of sexual desire.
  • The persistent sensations of genital arousal feel intrusive and unwanted.
  • After one or more orgasms, the physical genital arousal does not go away.

The Royal Society of Medicine publishes an article on Persistent Sexual Arousal Syndrome

The Royal Society of Medicine (RSM), in the United Kingdom, mentioned PSAS (Persistent Sexual Arousal Syndrome) in March 2006. It described the condition as “relatively constant, unrelieved feelings of genital arousal in the absence of genuine sexual interest or desire”. The Society added that until then, when David Goldmeier and Prof. Sandra Leiblum published an article in an RSM publication, the condition had been unrecognized in the UK.

Dr Goldmeier said:

“This genital arousal is highly distressing as it is unprovoked and unrelieved by orgasm.”

Dr Goldmeier and Prof. Leiblum said it was unclear what the causes might be. They had tentatively suggested there may be a link to antidepressant usage.

Dr. Goldmeier said the women he had talked to with PGAD reported a high degree of distress; some of them had suicidal thoughts. According to an internet survey he had carried out, the condition can affect females from a wide range of backgrounds and age groups.

It is important for women with PGAD not to feel marginalized, and to seek medical help, Goldmeier emphasized.

Journal of Sexual Medicine publishes a report on PGAD

In 2005, Prof. Sandra Leiblum published a report on Persistent Genital Arousal Disorder in the Journal of Sexual Medicine. In it she explained the symptoms of the disorder, as well as the likely psychological conditions patients may develop because of the distress PGAD causes. Women with PGAD frequently experience anxiety, panic attacks and depression. Sufferers commonly report feelings of distress, frustration and guilt.

In the study, Leiblum found that most PGAD sufferers also had pre-existing stress-related illnesses. However, she stressed that “PGAD is most certainly not all in the mind.”

In an Accompanying Comment in the same journal, the Editor-in-Chief of the Journal of Sexual Medicine, Irwin Goldstein wrote:

“Women of all ages, ranging from teens to menopause, currently suffer from this obtrusive sexual problem. More research efforts to better understand and treat this unusual under-inhibited sexual condition are strongly needed.”

PGAD linked to the presence of Tarlov cysts

A study carried out by Barry R. Komisaruk, PhD and Huey-Jen Lee, from Rutgers, The State University of New Jersey, suggested that Tarlov cysts may be linked to PGAD.

In their study, they concluded:

“Tarlov cysts have been described in the literature as producing paresthesias and genital sensory disturbances. Hence, at least some cases of PGAD might be considered to be a Tarlov cyst-induced paresthesia. Based on the relatively high occurrence of Tarlov cysts currently observed in women who suffer from PGAD symptoms, it would seem advisable to suspect Tarlov cysts as a possible organic etiological factor underlying PGAD.”

Tarlov cysts (perineural cysts) are abnormal sacs filled with cerebrospinal fluid which form at the lower end of the spine (sacrum), at the S1-to-S4 region of the spinal cord.

In August 2012, The Daily Mail, a UK newspaper, published an article about Kim Ramsey whose PGAD causes her to have 100 orgasms each day. She said the slightest pelvic movement, which can occur on a train or when she is doing housework can trigger an orgasm. She describes herself as exhausted, in a lot of pain, and unable to have a normal relationship. Her doctors think her condition was caused when she fell down the stairs in 2001.

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