Persistent genital arousal disorder (PGAD), also sometimes called restless genital syndrome, is a very rare condition that causes spontaneous genital arousal without the presence of stimulation, mental arousal, or desire.

This condition creates physical symptoms of arousal unexpectedly, and cannot be resolved with orgasm—although orgasm may provide momentary relief.

Persistent genital arousal disorder is not a sex addiction, as it is not accompanied by desire. Instead, it is an uncontrollable feeling in the genitals that often leads to distress.

PGAD can occur to anyone regardless of their genitals, but it is much more common for individuals with a vagina.

For those with a vagina, the sensation felt in the genitals may include any of the following characteristics:

• Tingling
• Itching
• Burning
• Swelling
• Pulsations
• Contractions
• Pressure
• Lubrication
• Discomfort

For those with a penis, PGAD may cause a feeling of fullness or that you are very close to orgasm, penile spasms, spontaneous erections, and pain in the genitals.

PGAD can create other symptoms as a result of the continuous genital arousal, such as stress, spontaneous orgasms, difficulty sitting, and pelvic pain. The symptoms of this condition can last for hours or even days at a time.

This unexpected and unwanted genital arousal is distressing and unpleasurable. It can disrupt a person’s daily tasks and quality of life.

Individuals with this condition may develop a negative relationship with sex and orgasms, as having an orgasm may become a short escape from their uncomfortable symptoms, rather than a pleasurable experience.

Having spontaneous and uncontrollable genital arousal can create feelings of embarrassment, anxiety, and frustration. Therefore, while this condition is physical in nature, it is very interconnected with psychological aspects, too.

Because of these intense feelings of shame or embarrassment, it is likely that many individuals go untreated and undiagnosed. However, individuals struggling with these symptoms should seek treatment.

At Hive Therapy and Wellness, we leave no room for shame—because sexual health is incredibly important for each and every person! We work with many different sexual dysfunctions, and are trained to handle many different symptoms and situations.

Additionally, we always work with our patients’ comfort level. We’ll always request consent before examination or treatment, and will work with you in the ways we can!

Hive hopes to be your biggest motivator while you achieve your health goals. You deserve the best care and quality of life, so don’t avoid treatment out of embarrassment!

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Unfortunately, there is no definite cause known to create PGAD. The condition is thought to be related to medications, infections, or issues involving the nerves, blood vessels, or hormones. Here are some suggestions as to how these aspects may cause PGAD:

Medications

Some studies suggest that medications can contribute to PGAD. There has been a possible correlation discovered between the condition and individuals who have stopped using an antidepressant medication.

Hormones are also thought to possibly play a role in persistent genital arousal disorder. Fluctuations in estrogen or testosterone levels due to an individual starting or stopping hormonal medications or therapies may have an influence on PGAD.

Nerves

There are a lot of potential nerve-related causes for persistent genital arousal disorder. Nerves are what help begin arousal as a response in the genitals. However, problems with these nerves such as irritation or compression can create hypersensitivity or poor function.

In terms of PGAD, nerve-related causes typically involve irritation or compression of the pudendal nerve, an important nerve that allows for sexual function and sensation.

This compression or irritation may be caused by herniated discs or spinal cysts called Tarlov cysts, which are typically located at the base of the spine. Hyperactive pelvic floor muscles can also compress this important nerve.

Additionally, there was a suggestion that PGAD could be similar to restless leg syndrome, hence the alternate name “restless genital syndrome.” This link has not been officially proven; however, it does demonstrate how PGAD may have a connection to neurological causes.

There’s also the possibility of central sensitization. Individuals with central sensitization have an oversensitive nervous system, which makes them much more sensitive to pain and other sensations.

Unfortunately, central sensitization may exacerbate PGAD.

Blood Vessels

Blood flow plays a major role in genital arousal. It allows for the enlargement of genital tissue, which is essential for sexual functions such as erection or swelling of the clitoris.

However, certain conditions such as pelvic varices (enlarged or swollen veins in this pelvis) can create a disruption to blood flow that may cause pelvic discomfort, which could contribute to PGAD symptoms.

Psychological Elements

Psychological elements such as stress, depression, and anxiety are strongly linked to PGAD. Not only does the condition cause these psychological symptoms, but these feelings also seem to exacerbate PGAD.

There are many possibilities and factors that may contribute to or cause persistent genital arousal disorder. Because the exact cause is unknown and may be difficult to identify for this rare condition, treatment is typically determined on a case-by-case basis.

Therefore, you shouldn’t give up if the first treatment you try doesn’t prove successful. Try to find what works best for your individual needs, and identify any possible triggers that may cause a flare-up of your PGAD symptoms.

Pelvic Floor Dysfunction

Lastly, there is a strong connection between PGAD and pelvic floor dysfunction. The pelvic floor is a group of muscles found within the pelvis which allow for many different bodily functions—urination, bowel movements, sexual function, and sexual appreciation.

It is directly involved with physical arousal of the genitals. Dysfunction of this incredibly important group of muscles can lead to altered blood flow, compressed nerves, pain, and sexual dysfunction; all of which are related to the possible causes listed above.

Pelvic floor dysfunction occurs because the muscles become overly tightened, weak, poorly coordinated, or inflexible. Due to the interconnectedness of the pelvic floor and the suggested causes of PGAD, treatment of the condition should not ignore pelvic floor therapy.

Treatment for persistent genital arousal disorder requires both a physical and psychological approach. Pelvic floor physical therapy aims to support individuals with PGAD and allow them to lessen or better manage their symptoms.

Physical therapy treatment for this condition focuses on reducing tension and sensitivity of hyperactive pelvic floor muscles, improving blood flow and nerve function, and encouraging relaxation.

Additionally, the physical therapists at Hive Therapy and Wellness are always open to collaboration with other health professionals (gynecologists, mental health specialists, etc.), as we greatly value holistic health and understand that this rare condition requires a multidisciplinary approach.

That being said, here are some ways pelvic floor physical therapy can directly support patients with persistent genital arousal disorder:

• Addressing pelvic floor dysfunction and other conditions that may exacerbate PGAD
• Improving blood flow and nerve function in the pelvis
• Reducing muscle tension and improving pelvic floor function
• Desensitization of the muscles in the pelvic area
• Alleviating trigger points
• Encouraging relaxation of the mind and pelvic floor
• Pain management

To achieve these goals, your Hive physical therapist may utilize any of the following treatment methods:

Manual Therapy

Manual techniques will be incredibly beneficial for individuals with PGAD, as these techniques help manipulate muscle tissue, nerves, and ligaments to reduce tension, improve blood flow, and address trigger points.

Not only is this important for reducing tension and improving tissue mobility, but it can help provide some pain relief, too.

Manual therapy is also a great way to relieve irritated or compressed nerves that may be contributing to symptoms of PGAD, especially that of the pudendal nerve—which is located in the pelvis.

Tarlov cysts or herniated discs can be addressed to some extent with physical therapy, depending on the severity.

Manual techniques can be done both internally via the vagina or rectum, or externally to the surrounding areas. Internal techniques can help reduce tension as well as provide desensitization for individuals with hypersensitive tissue.

For some individuals with tight pelvic floor muscles and hypersensitive tissue, dilator therapy may be an appropriate therapy that allows them to reduce muscle tension and improve tolerance to touch at their own pace.

Dilators are insertable tools that vary widely in terms of size. They allow individuals to practice penetration and stretch the surrounding tissues gently and progressively as needed.

These tools are also very useful for helping patients with hypersensitivity become more accustomed to touch and sensation.

Pelvic Floor Training

Individuals with PGAD will be in need of treatment that allows them to regain control of their pelvic floor. As mentioned previously, the pelvic floor is directly involved with many of the suggested causes of PGAD.

Therefore, improving the health of the pelvic floor can reduce pain and other frustrating symptoms of persistent genital arousal disorder.

In order to restore your control and understanding of your pelvic floor, your provider will first provide ample education on anatomy. Understanding your anatomy is one way to reduce anxiety around the sensations you may be feeling.

You will then participate in treatments like neuromuscular re-education and biofeedback, which will help you feel and activate your pelvic floor correctly.

Gaining better control over your pelvic floor will help you be better able to relax hyperactive muscles and control other symptoms of pelvic floor dysfunction.

Exercise Prescription

The pelvic floor is actually interconnected with many other parts of the body besides the pelvis, including the hips, abdominals, and lower back. All of these areas can hold tension and create pressure on the pelvic floor—worsening your pain and pelvic floor dysfunction.

Therefore, your physical therapist will curate a unique stretching and exercise routine that will provide the following benefits:

• Improved tissue mobility
• Improved blood flow
• Muscle balance to reduce tension
• Decreased likelihood of nerve irritation

Relaxation

An important aspect of managing persistent genital arousal disorder is relaxation. Experiencing strong sensations for long periods of time is highly likely to contribute to feelings of stress and frustration, which unfortunately can worsen the tension in your pelvic floor.

To prevent the worsening of your symptoms, your physical therapist will teach you effective relaxation techniques that can help you reduce anxiety and relax your pelvic floor.

Pain Management

PGAD can cause significant pain due to the build up of tension in the pelvic floor, which is further worsened by anxiety and stress caused by the condition.

Therefore, individuals experiencing pain can receive a variety of pain-relieving modalities at Hive, while simultaneously receiving treatment that addresses the root problem. Some examples of pain-relieving treatments offered at Hive can include tissue scraping, cupping, and dry needling.

Behavioral Modifications

Lastly, your physical therapist will help to identify and modify any behaviors that could be worsening your symptoms. This can include certain exercises that may trigger a flare-up, or even lifestyle aspects such as prolonged sitting.

Your physical therapist can help correct harmful postures or habits that will lessen pelvic floor tension in the long run, and allow you to better manage PGAD.

All of the treatments described above work to reduce the pain and uncomfortable sensations associated with PGAD.

Pelvic floor therapy is a great way to improve pelvic health and manage your symptoms; especially when coordinating this treatment with other health professionals for a comprehensive treatment experience. 

At Hive Therapy and Wellness, we want you to experience an individualized and holistic care experience. Therefore, you can expect any of the following treatments to be utilized while you are under our care:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback