Pelvic Floor Condition
Persistent Genital Arousal Disorder (PGAD)
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
You feel sensations of genital arousal that you do not want and did not invite. They can last for hours or days, and release does not make them go away. PGAD is distressing and often isolating, but it is a real condition, and in many cases the pudendal nerve and pelvic floor are closely involved.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding PGAD
Persistent genital arousal disorder describes unwanted and persistent sensations of genital arousal, such as throbbing, tingling, pressure or engorgement, without sexual desire. It is also called genito-pelvic dysesthesia, which reflects that the sensations are closer to nerve symptoms than true arousal. It mostly affects women but can occur in men.
Several contributors are common. Irritation of the pudendal nerve or sacral nerve roots is one of the most frequent, and PGAD often occurs alongside pudendal neuralgia, sitting pain and pelvic floor tension. Tarlov cysts in the sacrum, certain medication changes, and nervous system sensitization can also play a role. Sitting, vibration and stress commonly make symptoms worse.
Your physician should evaluate medication and neurological factors, and imaging may be appropriate. Dr. Gordon's focus is the pelvic floor and pudendal nerve contributors, which can often be treated directly.
Persistent Genital Arousal Disorder (PGAD) at a Glance
Also called
Genito-pelvic dysesthesia, PGAD/GPD
Who it affects
Mostly women, sometimes men, at any adult age
Common aggravators
Sitting, driving, vibration, tight clothing, stress
Often seen with
Pudendal neuralgia, pelvic floor tension, bladder symptoms, sitting pain
Main drivers
Pudendal and sacral nerve irritation, pelvic floor tension, nervous system sensitization
The Gap in Care
Why PGAD Is So Often Misunderstood
PGAD is often misread as a sexual or psychological problem. For many people, it behaves much more like a nerve condition, and the nerve and muscle side is rarely examined.
What routine testing is looking for
- Hormone levels
- Gynecologic or urologic disease
- Medication side effects
- Neurological disease on standard imaging
What often keeps symptoms going
- Irritation of the pudendal nerve along its route
- Pelvic floor tension that compresses nerves
- Sitting and vibration that aggravate the nerve
- Tension in the deep hip muscles
- A sensitized nervous system that amplifies signals
These are found by tracing the pudendal nerve and assessing the pelvic floor, which is how Dr. Gordon approaches PGAD.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Unwanted arousal sensations
Throbbing, pulsing, tingling or engorgement that is not linked to desire.
Symptoms that persist
Sensations lasting hours or days that do not resolve with release.
Worse with sitting or vibration
Driving, sitting on hard surfaces, or vibration commonly worsen symptoms.
Burning or pain
Nerve-type burning, pain or restlessness in the genital area.
Bladder symptoms
Urgency or frequency alongside genital sensations.
Significant distress
Anxiety, sleep disruption and difficulty concentrating.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Pudendal nerve irritation
The pudendal nerve carries genital sensation. When it is compressed or irritated, it can produce sensations that feel like arousal.
Pelvic floor tension
Tight pelvic floor muscles surround and compress the nerve and add pressure to the area.
Sacral nerve involvement
Irritation at the sacral nerve roots, including from Tarlov cysts, can contribute and should be evaluated by your physician.
Nervous system sensitization
Ongoing symptoms increase nervous system reactivity, which amplifies sensation and distress.
Your First Visit
How Dr. Gordon Evaluates PGAD
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
Records and history review
Dr. Gordon reviews your medical history, medications, imaging and any neurological evaluation in a confidential, clinical setting.
Pudendal nerve tracing
Dr. Gordon follows the nerve's route through the buttock, sit bone area and pelvis to find points that reproduce symptoms.
External pelvic floor assessment
The pelvic floor muscles are examined from the outside, with no internal exam. With you draped for comfort, gentle pressure around the perineum, sit bones, tailbone and inner thighs checks tone, tenderness and trigger points.
Sitting and trigger review
Dr. Gordon looks at sitting, driving, exercise and stress patterns that affect your symptoms.
Plan and coordination
A clear plan, plus communication with your physician or pelvic floor PT when that helps your care.
When to see a physician first
- Fever or chills with pelvic or urinary symptoms
- Inability to urinate
- Visible blood in the urine or stool
- Sudden, severe pelvic or abdominal pain
- Unexplained weight loss
- New numbness in the saddle area or loss of bladder or bowel control
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for PGAD, chosen from your exam findings.
Primary approach
Intrapelvic & Extrapelvic Dry Needling
Dr. Gordon holds ASE certification in both intrapelvic and extrapelvic dry needling. Treatment focuses on the pelvic floor and deep hip muscles that surround and compress the pudendal nerve. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum.
Learn about pelvic floor treatmentNerve focus
Neuro-Functional Acupuncture
Gentle electro-acupuncture along the pudendal and sacral nerve pathways to calm nerve irritation.
See servicesBetween visits
Sitting Plan & Team Coordination
Guidance on sitting, cushions and triggers, coordinated with your physician, neurologist or therapist.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Visits 4 to 8
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Visits 9 to 12 and beyond
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
"Dr. Gordon is thoughtful, thorough and incredibly knowledgeable. He has significantly helped me with pain management and pelvic floor issues. I am grateful to have his expertise in my corner."
Dina Isola, Google Review
Persistent Genital Arousal Disorder (PGAD) Questions
Answers About PGAD
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
PGAD sensations are unwanted and not linked to desire. For many people it behaves more like a nerve condition, which is why it is also called genito-pelvic dysesthesia.
Causes vary. Pudendal nerve irritation, pelvic floor tension, sacral nerve issues, medication changes and nervous system sensitization are common contributors.
Yes. All care is private and clinical, and you can discuss symptoms in whatever terms feel comfortable.
Your physician may recommend imaging or a neurological evaluation. Dr. Gordon coordinates with them.
Most people need eight to twelve sessions with reassessment.
Often. Reducing pressure on the pudendal nerve with cushion and sitting changes is part of the plan.
Before You Book
General Questions
The clinic is an out-of-network practice. The initial evaluation is $300 and follow-up visits are $250. After each visit you receive a detailed superbill to submit to your PPO plan for possible reimbursement. FSA and HSA cards are accepted, and the clinic can run a complimentary benefits check before your first appointment. The check is a courtesy, so please confirm your coverage with your plan. See Insurance & Fees for details.
The first evaluation is 60 to 75 minutes and usually includes treatment. Follow-up visits run 45 to 60 minutes.
Yes. Call (516) 597-5400 or send a message through the contact page. This is especially helpful if your case is complex and you want to understand the approach before committing to a full evaluation.
1508 Union Turnpike, Suite 133, North New Hyde Park, NY 11040, with free parking on site. The clinic is an easy drive from Manhasset, Great Neck, Garden City, Lake Success, Floral Park and Mineola. Early morning, evening and weekend hours are available.
Most people feel a quick muscle twitch or a deep ache that lasts a few seconds. That twitch is a normal sign the trigger point is releasing. Mild soreness for 24 to 48 hours afterward, similar to a hard workout, is common. Depth, angle and stimulation are adjusted to your comfort.
Both use the same fine, sterile, single-use needles. Dry needling targets specific trigger points and tight bands in muscle based on your exam. Neuro-functional acupuncture targets nerve pathways, often with gentle electrical stimulation, to calm nerve sensitivity. For PGAD, Dr. Gordon commonly uses both.
When performed by a trained, licensed provider with detailed knowledge of anatomy, it has a strong safety record. Tell Dr. Gordon if you take blood thinners, have a bleeding disorder, are pregnant or have a weakened immune system so he can plan accordingly.
It is a technique that reaches the deep pelvic floor muscles, including the levator ani, obturator internus and coccygeus, to release trigger points and restore normal muscle function. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum. Dr. Gordon holds ASE certification in this technique, which few practitioners in New York have.
Yes. Your privacy and comfort come first. When undressing is needed for the area being treated, you are fully draped. Needles are placed through the skin only, and nothing is ever inserted into the vagina or rectum. You can pause or stop at any time.
Yes. Persistent genital arousal disorder (PGAD) can affect people of every gender, and Dr. Gordon treats adults of all genders and identities.
It helps to have had a medical workup so serious causes have been checked. If you have not seen a physician for your pelvic symptoms yet, call the clinic to talk through the best order of steps.
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Persistent Genital Arousal Disorder
Book an evaluation with Dr. Gordon to assess the nerve and pelvic floor contributors to your symptoms.
Early morning, evening and weekend appointments available. Free on-site parking.
Symptoms
Common Symptoms of PGAD
Further Reading
Persistent Genital Arousal Disorder: A Plain Explanation
From the blog: PGAD causes unwanted genital arousal sensations unrelated to desire. What it is, how nerves and the pelvic floor can be involved, and who to see first.
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