Persistent genital arousal disorder, or PGAD, is the unwanted sensation of genital arousal that is not resolved with orgasm. It is classified as a pain disorder, not a sexual disorder, and is characterized by throbbing, tingling, pain, tension, or irritation in the genitals with or without spontaneous orgasm. It occurs without sexual interest and is distracting and, at times, debilitating. The underlying cause of PGAD is uncertain, but it can be related to or associated with certain medications, cysts, anxiety, stress, scar tissue, constipation, bladder dysfunction, pudendal nerve dysfunction, surgery, IBS, or a prolonged period of genital irritation. Treatment for PGAD varies, but may include tri-cyclic antidepressants, transcutaneous electrical nerve stimulation, botox injections, hormone or anesthetic creams, and physical therapy.
How can physical/occupational therapy help with something that doesn’t seem… well, related to physical therapy? Pelvic health therapy is extremely beneficial in the treatment of PGAD, because its aim is to calm a sensitized nervous system and the tight muscles that can result. When patients experience PGAD, the nervous system becomes alerted that something is amiss, so the pelvic floor muscles tighten in order to “protect” the area involved. This compounds nerve compression and restricts blood flow to the pelvic structures, leading to trigger points, and an even MORE sensitized nervous system. Pelvic health specialists work with gentle manual techniques to release tight muscles and connective tissue restrictions, as well as instruct patients in how to manage symptoms. This may include leg and pelvic stretches, breathing and postural exercise that maximize neuromuscular function, the use of a device at home to help release tight muscles, or the use of a TENS unit (transcutaneous electrical stimulation) to calm the nerves in the area. Pelvic specialists are also skilled in techniques that address pudendal nerve hypersensitivity and abnormal signaling. Your therapist will address any scar tissue restrictions you may have from endometriosis or abdominal surgeries, as these can contribute to PGAD. Constipation and/or bladder dysfunction will also be discussed and treated.
Many patients with PGAD suffer in silence. Please know that there is help available to you! Yes, there is therapy for that! Let us help relieve the symptoms that are keeping you from enjoying life to its fullest.