Let’s talk about something not a lot of people feel comfortable bringing up—Persistent Genital Arousal Disorder, or PGAD. If you’ve never heard of it, that’s okay! It’s a condition that isn’t often discussed, but for the people who experience it, it can be frustrating, isolating, and even life-altering.

In typical phases of arousal, certain things happen in a certain order. You see something sexually arousing, or maybe you hear a sound or smell a particular scent that gets you in the mood. The physical sensations of arousal and the emotional or mental components of excitement occur together.

But sometimes, the brain can skip a few steps, go out of order, or neglect specific steps altogether. When we feel the physical sensations of arousal or even orgasm without any stimulus or mental sexual excitement, this can be classified as Persistent Genital Arousal Disorder.

What is PGAD?

Persistent Genital Arousal Disorder (PGAD) or Genito-pelvic Dysesthesia (GPD) is the feeling of persistent arousal in the genitals that is unwanted and unrelieved by orgasm. These symptoms are not triggered by sexual activity—it happens out of the blue. It can last for hours or even days, and it doesn’t necessarily go away after orgasm.

This can be extremely disruptive in your day-to-day life, making it difficult to stay present during important events or tasks. And it’s not just uncomfortable; it’s emotionally exhausting. People with PGAD often feel embarrassed or ashamed, which makes it harder to reach out for help.

How common is it?

Although these symptoms can feel very isolating, you are not alone! PGAD can affect up to 4% of men and up to 3% of women.

What causes PGAD?

There are many different proposed causes for PGAD/GPD, though it is typically related to the nerves that innervate the genitals. These nerves travel from the lumbar spine or low back, down to the genitalia, and there are many different areas along this pathway for potential disruption and dysfunction. When this occurs, these nerves are no longer able to send accurate sensory information to the brain, and this can present as tingling, lubrication, engorgement in the genitalia, and orgasms.

Other potential cases of PGAD/GPD include psychological factors, side effects from certain medications, genital infections, and hormonal changes.

How does it feel?

People describe PGAD in different ways, but common experiences include:

A tingling or throbbing sensation in the genitals.
Feeling like you’re on the brink of orgasm, but it won’t go away.
Discomfort or pain that makes it hard to sit, sleep, or focus.

This isn’t pleasurable—it’s overwhelming. Some even say it feels like their body is betraying them.

What can I do about it?

First and foremost, know that you are not alone! It is important to talk with your healthcare providers to determine the root cause and the best course of action for you. Many different options exist for treating PGAD/GPD, including cognitive behavioral therapy, pelvic floor therapy, medications, acupressure, TENS units, and more.

PGAD and pelvic floor physical therapy

Pelvic floor physical therapy can be a game-changer for managing Persistent Genital Arousal Disorder. This specialized therapy focuses on relaxing and retraining the pelvic muscles, which often play a significant role in triggering or worsening symptoms. For many people with PGAD, the pelvic floor muscles are overactive or tense, sending mixed signals to the nerves in the area. A skilled pelvic floor therapist can help you identify and release these tight muscles through techniques such as soft tissue massage, joint mobilizations, biofeedback, and tailored exercises. This isn’t just about strengthening—it’s about finding balance and teaching your body to work in harmony again. With consistent therapy, many people experience a reduction in symptoms and a renewed sense of control over their bodies.

What do we do in physical therapy for PGAD?

During a visit with a pelvic health physical therapist, you will discuss your specific symptoms, triggers you may have noticed, a detailed medical history, and your goals for physical therapy. Your physical therapist will also provide education on the pathways and mechanisms that can lead you to feel what you do. Your physical therapist will complete a comprehensive physical evaluation and examination (with your consent) of the lumbar spine, hips, pelvis, and pelvic floor muscles.

With this specific objective information, you and your physical therapist will devise treatment plan of best practice tailored specifically to you! Some of these interventions may include, but are not limited to:

Soft tissue release and massage
Joint mobilizations of the hips and spine
Nerve glides
Internal and external release of the pelvic floor muscles
Exercises
Behavioral modifications during day-to-day activities
Breathing and nervous system down regulation exercises

Pelvic Floor Physical Therapy for PGAD

Whether you have just recently been diagnosed with PGAD or have been dealing with it for years, there are options available for you. PGAD can feel isolating, but it’s important to remember that you deserve care, and you don’t have to navigate it alone. To take the first step in finding relief, request an appointment with one of our pelvic floor physical therapists.

About Pelvic Health & Wellness

Pelvic Health & Wellness was built with you in mind. We practice whole-person, individualized pelvic floor physical therapy in a caring and safe environment. Our physical therapists specialize in treating pelvic health concerns such as pelvic organ prolapse, coccydynia, PGAD, constipation, pain, incontinence, and various pregnancy and postpartum-related conditions.

We understand that being ready to talk about and address your pelvic floor wellness concerns comes from a place of strength. We are here to support and encourage you on your journey back to health so you can return to doing what you love! If you are ready to take the first step in reclaiming your pelvic health and wellness, don't hesitate to get in touch with us today.

What is Persistent Genital Arousal Disorder?