Persistent Genital Arousal Disorder: A Plain Explanation

Persistent genital arousal disorder, or PGAD, causes genital sensations of arousal, such as throbbing, pulsing or tingling, that a person does not want and that are not linked to desire. The sensations can last for hours or days, and release does not make them go away. It is best understood as a problem with nerve signals, not a sexual problem, and a physician should evaluate it first.

What PGAD is, in plain words

An expert panel from the International Society for the Study of Women's Sexual Health (ISSWSH) describes PGAD as unwanted, unremitting sensations of genital arousal. In 2021 the panel broadened the name to PGAD/GPD. GPD stands for genito-pelvic dysesthesia, which means abnormal, uncomfortable sensation in the genital and pelvic area, such as burning or restlessness.

People describe throbbing, pulsing, tingling or a feeling of fullness. Sitting, driving, vibration, tight clothing and stress commonly make it worse.

The panel calls the condition extremely distressing. Anxiety, poor sleep and trouble concentrating are common.

Why it is not about desire

The sensations happen without sexual thoughts or interest, and many people find them unpleasant or even painful. PGAD is a medical condition. It says nothing about your character or your relationships.

Where the signal can start

The ISSWSH panel proposes a common thread: spontaneous, intense nerve activity in the genital and pelvic region that reaches the brain. Where possible, symptoms are traced to one of five regions:

• The genital tissues themselves
• The pelvis and perineum, the area between the genitals and the anus
• The cauda equina, the bundle of nerve roots at the base of the spine
• The spinal cord
• The brain

Working out which region is involved, when possible, shapes treatment. The panel is also candid that most of what is known comes from case reports and expert opinion.

Where the pudendal nerve and pelvic floor fit

The pelvis and perineum are where I focus. The pudendal nerve carries sensation from the clitoris, the vulva and the skin around the anus. It passes briefly through the buttock, then runs along the obturator internus, a muscle on the inner wall of the pelvis, close to the pelvic floor.

When these muscles are tight, they can crowd and irritate the nerve. An irritated pudendal nerve can cause burning, tingling and, for some people, unwanted arousal sensations. That is why PGAD and pudendal neuralgia often overlap, and why a hard chair or a long drive can bring symptoms on.

A pelvic floor that stays clenched, from stress or from the worry the symptoms bring, can keep the cycle going. The pelvic floor clenching page explains that habit.

Physician care comes first

Start with your gynecologist or primary care doctor. They can review your medications, look for skin, hormonal, bladder and other medical causes, and refer you on. Some people need a neurologist and imaging of the lower spine, since the nerve roots there are one possible source.

A therapist who understands PGAD is a valuable part of the team. The ISSWSH panel considers psychological care critical. That does not mean the symptoms are imagined. Living with them is hard, and support helps. My care works alongside your physician, neurologist or therapist, never instead of them.

What a visit looks like

The first visit runs 60 to 75 minutes, and I explain each step before it happens. I follow the pudendal nerve's route through the buttock, sit bone area and pelvis to find the spots that reproduce your symptoms. The pelvic floor muscles are examined from the outside, with no internal exam, and you are draped for comfort.

Dry needling treats the pelvic floor and deep hip muscles that surround the nerve. For the deep pelvic floor, the needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum. Alongside dry needling, I use neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the pudendal and sacral nerves. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits that keep unwanted arousal sensations going. I also give guidance on sitting, cushions and triggers. Most people need eight to twelve sessions with reassessment. Results vary from person to person.

If you are not sure what is causing your pain, try the My Symptoms tool.