Arousal Disorder Is No Laughing Matter

Christina Bates -

When you first hear about persistent genital arousal disorder (PGAD), you may be tempted to make a joke. (That sounds like a good time!") But to women who experience PGAD, it is no laughing matter.

This disorder is characterized by genital engorgement similar to what occurs when you feel sexually aroused-except that, rather than being temporary and enjoyable, it instead is unrelenting, uncontrollable and uncomfortable. In fact, according to Irwin Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital, patients often describe it as a "living hell."

PGAD is gaining recognition in the medical community, thanks in part to its recent renaming. The former term, persistent sexual arousal syndrome, carried insinuations of lust or sexual fanaticism-but a growing number of doctors now realize that this condition has nothing to do with true sexual desire.

Even so, women often feel too embarrassed to discuss their symptoms with their physicians. This makes it hard to estimate how common PGAD is. Worse, it means that many women suffer in silence-which is sad, because treatments are available.

Recognizing PGAD

You know that feeling you get right before an orgasm? The intense pressure, the throbbing, the need for release? Imagine living with that sensation, constantly or sporadically, even when you have no emotional desire or physical stimulation. For a PGAD patient, an orgasm (whether from masturbation or sex with a partner) brings little or no relief because within seconds, she is right back at that precipice, Dr. Goldstein explained. This disorder affects women of all ages. The male counterpart is similar-unwanted sexual arousal leading to unwanted orgasm-though more rare.

PGAD may result from varicose veins surrounding the vagina and uterus...injury to the pudendal nerve in the pelvis (for instance, during childbirth or bicycling)...spasms of the pelvic floor muscles...or a congenital malformation that causes excess blood flow to the genitals.

Another cause of PGAD is an imbalance between neurotransmitters Chemicals that transmit nerve impulses) that are excitatory, such as dopamine, and those that are inhibitory, such as serotonin. As a result, nerve signals travel too freely from the brain to the genitals, Dr. Goldstein said. This imbalance may be the result of abrupt withdrawal from medication that affects neurotransmitter levels, such as antidepressants called selective serotonin reuptake inhibitors (and PGAD symptoms can persist even if the medication is resumed)...or use of Parkinson's disease medication, which increases dopamine...or use of the antidepressant trazodone (Desyrel), a serotonin modulator.

If you have symptoms that suggest PGAD, see a physician who specializes in sexual medicine.

Referrals: Institute for Sexual Medicine (www. sexualmed.org)...or Sexual Medicine Society of North America www.sexbealtbmatters.org). Diagnosis is based on a physical exam, medical history, psychological interview, blood tests to assess hormone levels, and/or imaging tests to check for neurological or structural problems.

What Brings Relief

In most cases, PGAD cannot be cured, but one or more of the following treatments can help control symptoms…

  • Topical anesthetizing agents, such as ice packs or numbing gels, reduce discomfort.

Also helpful: Avoid wearing tight pants.

  • Physical therapy eases pelvic tension. Treatment may include pelvic massage...stretching exercises...and/or transcutaneous electrical nerve stimulation (TENS), in which a device transmits low-voltage impulses via electrodes placed on areas of discomfort.
  • Medication options include varenicline (Chantix), which is FDA-approved for helping smokers quit but can be prescribed off-label for PGAD to rebalance dopamine levels...the prescription painkiller tramadol (Ultram), which raises opiate levels in the brain and inhibits arousal...certain antidepressants or dopamine receptor blockers...or antiseizure medication, such as Neurontin or divalproex.
  • Psychotherapy can improve coping skills and reduce the stress of living with PGAD.