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Recently I saw a patient with an interesting and peculiar complaint: she felt constant clitoral arousal that lead to pressure that she could not relieve. It was leading to anxiety and disrupting her life and activities. Even after achieving orgasm from masturbation, she would still sense the clitoris to be stimulated.
It was fortuitous that I read about this condition about 3 months before I saw the patient in the office. It is a little known condition that was first described in 2001. It is a problem of genital arousal, not sexual arousal. Patients will experience tingling, pressure, irritation, congestion, throbbing, pain or vaginal contractions. Only sometimes can sexual intercourse or masturbating alleviate the sensation. In a recent Dutch study, there appears to be a correlation between PGAD, overactive bladder and anxiety.
In my patient’s case, as is described for PGAD, the patient felt genital/clitoral arousal the entire day; it was unwanted and intrusive to her life; it was triggered by non-sexual activity (she had a UTI that preceded it); it lead to distress; it was not associated with a psychological condition. Because of the problem, her anxiety level is raised which leads to a vicious cycle of worsening the condition.
What are considered to be the triggers for PGAD?
Sexual stimulation
Masturbation
Stress
Anxiety
Loss
Menses
What can exacerbate the condition?
Pressure against the genitals
Visual arousal
Vibration (car, motor)
Stimulation by partner
Intercourse
PMS
Genitals becoming too hot
Riding a bicycle/horse
There is no specific treatment since the cause remains vague. Psychosocial support and defining the condition helps to create some knowledge that such a condition exists. Intercourse or orgasm may bring some temporary relief. Ice or topical anesthetics can help reduce swelling and sensation. Pelvic massage or stretching exercises may help. Mood stabilizing medication is empiric and may or may not help, especially if there is underlying anxiety or depression. Anxiety-reducing coping skills and activities can lead to distraction and may be useful.
Thus far, topical anesthetics have brought my patient some relief.
Add a Comment30 Comments
thank you very much for explaining this so well.
July 7, 2010 - 8:19amI have lived with guilt, shame and frustration, remaining in silence.
Also concern because having some level of PGAs does exclude me from having problems achieving orgasm during intercourse. Ironic, isn t it?
I think if it might be reated with SSRIs (zoloft).
Please keep on giving a message of support to all that women suffering in silence. Knowlegde is so "empowHering".
This Comment
i have found a cure ....i was taking a remedy for interstitial cystitis which i have had for over 25 years...as well as pgas...anyway i tried one tsp of good quality cinnamon mixed with manuka honey and plain yogurt...once a day until you feel better then 3 times a week after that....a miracle for me....still get twinges now and then but nothing like before which was absolute torture....gl
May 13, 2010 - 1:02amThis Comment
I have suffered from this for about 10 years now. None of my doctors could ever find anything wrong or figure it out. Back then they called it female priapism for lack of a better name. I know that this condition is totally undesired and not a result of being "turned-on". It is the most uncomfortable and unrelentless form of torture I can think of. Some may think "Oh, how lucky to be able to experience orgasms", which would be great if that is all it is. However, imagine succumbing to the unrelentless desire to orgasm and experiencing an orgasm that never, never satisfies. As a matter of fact, the more you try to satisfy the urge to orgasm, the harder it is to satisfy. It is like having an intense itch that when you scratch it, it only gets worse. You eventually have to ignore the itch and just hope it goes away. I think we all know how hard that would be. I strongly feel that there should be more studies on this, so that perhaps a cure for symptoms or even the etiology can be discovered. I would like to know, if one is willing to be part of a study for this if there are any active studies out there? Or perhaps a researcher out there looking for a worthy study to request a grant for? I'm game to try anything to find relief.
March 15, 2010 - 4:46pmThis Comment
I am on Tramquel SR for arachnoiditis, and have been for quite a few years now. Due to the Tramadol (Tramquel) and it's nerve blocking effect it takes me quite some time to climax, sometimes completely unable to do so. I am now experiencing PGAD and have an insatiable appetite for sex (which is totally so UNLIKE me!), even with heightened orgasm using a vibrator I still feel extremely sexy and hot and not totally satisfied. My husband has always had a good appetite for sex, so this is like all his birthdays have come at once!! I don't know whether the PGAD is due to the Tramadol, or as a consequence of nerve damage with the arachnoiditis.
March 13, 2010 - 8:27amThis Comment
This is new to me and I too have arachnoiditis. I’m on methadone for the pain and for the longest time didn’t have orgasms when my husband and I had sex. I assumed it was from the medication. But then recently it changed to PGAD and I’m the complete opposite and of course he loves it. However afterwards I still feel right on the edge of another orgasm and if he even touches me I climax. But it gets uncomfortable and make him stop touching me. I’m just curious, I noticed your post is several years old. Do you still have PGAD? I’m wondering if the nerve damage is causing this,
August 22, 2018 - 8:15pmThis Comment
I was prescribed Topamax as a mood stabilizer. One of the worst problems for me was inability to climax, it was as if the nerves in my clitoris had been turned off. I wonder if any PGAD patients had heard of this side effect for Topamax.
February 15, 2010 - 4:10pmThis Comment
Thank you for your post anonymous. Do you remember what you watched, so we may provide a link?
January 1, 2010 - 10:20amThis Comment
I thought ,that I was just over sexed.Because I'm this way,when driving a car and putting on the brakes. Or riding my exersize bike. Or just wearing tight jean's. walking really hard and fast.Or just crossing my leg's.Is this why I wake up through the night humping air. Or setting at the computer desk sometimes. Is there really any help for this,how do you get dianoisas for this. My docter say's just some women are like this,it's normal.
October 27, 2009 - 6:01amThis Comment
I saw a show on TV yesterday about this. They did some tests on a woman with this condition and found a very high blood flow in her clitoris which is normal if you are aroused but it was like that all the time and would not go away. Possible solution - they found elevated levels of dopamine and someone reported that a drug that helps you quit smoking lowered the dopamine levels and the symtoms went away.
January 1, 2010 - 10:01amThis Comment
Thanks for shedding light, the drug is Wellbutrin. :)
October 24, 2011 - 3:40pmThis Comment