PGAD, or Persistent Genital Arousal Disorder, also goes by “restless genital syndrome” or “persistent sexual arousal syndrome.” PGAD symptoms, which are often extremely distressing to the patient, are unwanted, unpleasant sensation of arousal and/or orgasms, that the patient is unable to control. Women who come in to Pelvic Rehabilitation Medicine with symptoms of PGAD often feel that they don’t have control over their life, as it’s very challenging to have this unwanted, unpleasant sensation throughout the day, and extremely disturbing to their quality of life, their ability to function, at work and at home, and in relationships, and, often, their ability to get quality sleep.
The underlying cause of Persistent Genital Arousal Disorder is unknown. There are multiple theories, some including lumbar sacral causes, where there could be lumbar spine pathology, or something called a Tarlov cyst, that could be contributing and causing compression of the nerves that are related to arousal. There could be some hormonal contributions to Persistent Genital Arousal Disorder. There can be some causes associated with descending modulation from the brain, and that could potentially upregulate the nerves that lead to arousal and orgasm, and there could be some pressure from an underlying gynecological disorder. And there could be some role in the pelvic floor muscles itself putting tension on the nerves, that can increase arousal and orgasm in a patient. So we will evaluate a patient, try and find the cause, and then essentially try to relieve pressure on the nerve itself, and also try and calm patients down from chronically tensing their muscles and from activating their nervous system via either high levels of anxiety and/or depression.
There is debate in the medical community if PGAD can go away. We have had success in treating it here with our protocol. However, the longevity of the treatment is still yet to be determined.