The Facts About Persistent Arousal Genital Disorder

The lived experience of constantly being aroused isn't what you may have seen depicted in the 2013 film "Nymphomaniac." If arousal is persistent, spontaneous and occurs without sexual stimulation, medically, it's considered persistent arousal genital disorder (PAGD).

Though fairly uncommon, PAGD—also known as restless genital syndrome—is a real disorder that can be highly distressing for people who have it.

How to turn off being turned on

Being "turned on" all the time might sound like a blessing to some people, but in reality, it's a curse, making it almost impossible to function normally. "PAGD is an unwanted, bothersome and persistent spontaneous genital arousal that occurs without sexual stimulation or interest for at least six months," said Lyndsey Harper, a gynecologist in Dallas.

The feelings can last for hours, days or even weeks at a time. Think of this condition as the constant urge to masturbate, but masturbating or otherwise reaching orgasm provides no sustained relief. PAGD mainly affects women, but there have been isolated cases recorded in men, in whom the condition is often called priapism, characterized by a prolonged erection lasting more than four hours.

In women, basically, the clitoris becomes erect or engorged with blood, and the condition doesn't go away, said Betsy Greenleaf, D.O., a New Jersey urogynecologist with extensive experience treating PAGD.

'PAGD is an unwanted, bothersome and persistent spontaneous genital arousal that occurs without sexual stimulation or interest for at least six months.'

"Most women with PAGD end up masturbating constantly because they have this urge in their pelvis," Greenleaf said. "They masturbate, orgasm and get a five-minute relief—if that. That's more so from the release of dopamine and neurotransmitters during the orgasm, and then it comes right back."

"Other symptoms include burning, itching and pain," Harper said. "As a result of these symptoms, people can experience shame, anxiety, reduced sexual satisfaction, relationship problems and, for some, increased thoughts of suicide."

Women are often embarrassed to go to their doctors about this condition, but it's more prevalent than you may think. In a 2020 study, between 0.6 percent and 3 percent of women reported symptoms consistent with PGAD.

Harper said persistent arousal genital disorder was first recognized and described in medical literature in 2001, so it's still very much misunderstood.

"A regular gynecologist might have one case in their whole career," Greenleaf said.

Causes and treatment

"Like any pelvic pain syndrome, everyone's case is unique. There can be a ton of underlying causes, including back issues, nerve problems coming from herniated discs, nerves in the lower back or issues with pelvic floor muscle spasms," Greenleaf explained.

However, Harper said: "Most cases of PGAD seem to be related to the pudendal nerve, which is responsible for sending signals to the genitals. This nerve can function improperly due to surgery, pelvic floor muscle spasms, gynecologic conditions and problems with the spine, like spinal stenosis and Tarlov cysts."

Notably, Greenleaf has seen one constant in every PAGD case she's come across: trazodone.

"Every single person I've seen that has this, it's been a long-standing side effect of a medication called trazodone," Greenleaf said.

Doctors prescribe trazodone for sleep, pain, depression and even weight loss. Although "unusual excitement" is a very rare side effect, it can develop years later, even after you've stopped taking the medicine.

'Every single person I've seen that has this, it's been a long-standing side effect of a medication called trazodone.'

Another potential cause can be an imbalance in the vaginal microbiome. Once the bacteria is balanced again, PAGD can be more manageable.

Additionally, the sensation can be caused by urethra spasms from nerves or infection, Greenleaf said.

On top of a feeling of persistent arousal, people can experience spasms and muscle tightening. Frustratingly, it seems like most treatments target the symptoms of the disorder and not the disorder itself. But when the underlying cause is unknown, it can be challenging to do anything except treat the symptoms.

"I'll start with valium, an antianxiety medication and a great muscle relaxer, and we'll have them put it in the vagina," Greenleaf said. "For most patients, it might not get rid of it all the way, but it definitely takes the edge off."

Other treatments Greenleaf listed were ketamine compounded into a cream, lidocaine gel (which you can get over the counter) for numbing, and even a THC vaginal lubricant (particularly from the brand Foria) in states where medical marijuana is legal.

"There is no one best treatment for PAGD because there are multiple causes," Harper explained. "Treatments that can be helpful depending on the cause include therapy, medication changes or additions, pelvic floor physical therapy and nerve blocks, and spinal surgery."

Time to regain control

For people who suffer from PAGD, the outlook may seem rather bleak.

"This is a symptom of a larger problem. It's not necessarily its own condition and that's true of any pelvic pain syndrome," Greenleaf said. "You have to go searching and keep trying to find the underlying cause and, unfortunately, sometimes we don't ever figure it out."

Greenleaf suggested trying a holistic approach if you're struggling with this condition. Thus, in addition to taking medication, try meditation, cognitive behavioral therapy (CBT) and any other treatments that can help with the mental aspect. This can help individuals reconnect their body and mind, and regain control over their arousal.