~Persistent Genital Arousal Disorder (PGAD) and Physical Therapy

 By Marnie Clemens PT, DPT, OCS, WCS, FAAOMPT and Abby Newman SPT

Imagine eating your favorite food (such as ice cream) when you are hungry.  It tastes great and you really enjoy every last bite.  Now imagine eating ice cream over and over again to the point you are beyond stuffed.  What once was enjoyable becomes unpleasant and uncomfortable.  Finally, imagine being force-fed ice cream over and over again, without being able to stop.  It becomes very painful, you feel sick, and you may never want ice cream again.  What was once pleasurable has become a painful torture.  

This is how people who have persistent genital arousal disorder (PGAD or PSAS) describe their suffering.  PGAD is a condition in which a person experiences constant physical genital arousal, unrelated to sexual desire,  that persists for hours or days and does not go away with orgasm.  This is a very debilitating, painful problem- both physically and psychologically.  It is very difficult to have a normal life with this condition.  Daily activities are interrupted, things like walking, exercising, and sitting may even increase symptoms and are avoided.   Physical and sexual relationships become almost impossible. Then add the fact that friends, family, and even some uninformed medical professionals dismiss the symptoms or even make fun of them.  Suffering is very real for these people.  

There has been a lot in the recent news about this condition.  Many media outlets covered  the recent suicide of a woman who suffered from PGAD (examples here and here .  There was also recently a piece about the devastating effects on one woman's life on the Jeff Probst Show after trying to come forth with her personal PGAD story to help educate others.  

It is still a condition that is poorly understood.  Possible causes may include irritation of the nerve that supplies the clitoris (pudendal nerve), spinal issues (such as spinal cysts), compression of the clitoral circulation leading to swelling, or possibly as a rare side effect of antidepressant medication.  Sometimes there is a known trauma or specific injury such as childbirth or falling,  but often the cause remains unknown.  Medical treatment may include medication to calm the nerve irritation, stabilization of hormones in menopause, or discontinuation of SSRI antidepressant medication   

Physical Therapy can be helpful if the cause is related to the tension in the pelvic floor muscles,  compression of the pudendal nerve or spinal nerves, or connective tissue (fascial) tightness.  There are hands on techniques to treat the pelvic floor and fascia that can help relieve irritation of the nerve from these causes.  There are also very important things to avoid, such as Kegel exercises (tightening of the pelvic floor muscles).  The wrong treatment can cause more discomfort and pain.  It is important to see a PT that works with women's health and pelvic floor issues to address the problem correctly.  You can also seek a good support group online- PGAD support to learn more and connect with others with PGAD.

While there are some common threads, there is no one best course of treatment for everyone and success rates to treatment vary. Most people do best with a combination approach. Physical Therapy can help PGAD issues related to the muscles and fascia and your doctor can prescribe appropriate medication.  The take-away point is that this very real condition is no laughing matter and may be helped by treatment.