On the edge: What triggers persistent genital arousal disorder?

Rose was in distress when she walked into my consultation room. She introduced herself then went quiet for about five minutes. To break the ice, I asked how I could help her. She raised her head, looked me straight in the eye, and then looked down again. Then, all of a sudden, she started crying uncontrollably. I gave her time to cool down. Sex problems are difficult. Very many people suffer quietly and lack the strength to go for treatment. I therefore congratulated Rose for taking the first step and reassured her that I would do my best to help, whatever it was. 

“Sorry, I have just had orgasm and was unable to keep talking. It made me feel horrible that it happened right here in front of you,” she explained. Rose was 35 and a single mother of two. She was a lawyer running her private law firm in the middle of town. “Give me medicine to reduce my libido,” she pleaded. “I am unable to concentrate on my work. I feel like my genitals are in total control of my life.”

After evaluating Rose’s situation, I concluded that she did not have high libido. High libido is synonymous with excessive desire for sex. It is characterised by sex fantasies and a general desire for the act. Sexual experiences resulting from high libido are enjoyable. On the other hand, Rose was always on edge, feeling like she would have orgasm any time.

I made a diagnosis of persistent genital arousal disorder (PGAD). PGAD is basically an abnormality of the nerve supply to the genitals. The nerves that cause sexual stimulation fire signals without control. This activity has no connection to the usual sex cycle, which is normally linked to intimacy and starts with foreplay.

Symptoms include abnormal excitement which makes one feel as if they are going to climax any time. The disorder almost exclusively affects women. On the rare occasion that a man is affected, they suffer priapism – a non-resolving erection of the penis.

Affected women may have sex with the hope of relieving the feeling but it may not go away. A number of cases present to the clinic for masturbating too much, feeling guilty and thinking that masturbation is the cause rather than the effect of their medical problem.

There are triggers which exacerbate it PGAD such as tight underpants, tampons, sitting down, driving on a rough road or riding a bicycle. Anything that exerts pressure or causes vibration around the genitals worsens the condition.

Affected individuals feel helpless, frustrated and depressed, and may even attempt suicide. They are unable to cope with their body demands as well as demands of work or in social cycles. They isolate themselves, feel stigmatised and become loners, eventually sliding into depression.

“But surely doctor what brings such an unfair condition?” Rose lamented.

The abnormal nerve signals to the genitals can result from problems with the brain or spinal cord. They can also result from local nerve or blood system problems. In some cases, the condition is a side effect of some medicines. In other cases it is a consequence of surgical treatment in the genital areas, interfering with nerve or blood functions to the genitals. In other words, PGAD is not to be taken lightly. Affected people must undergo thorough medical tests to determine the cause. Sometimes, though, the cause is not easy to find.

The cause of Rose’s case was unclear. She was put on a combination of treatment targeting the highly likely causes. It took months before some relief was realised. Two years later today, at least Rose is able to function among her peers and in her social space. However she is still on medication and this will not change unless signs clearly show that she is fully recovered.