PGAD Treatment Methods: How Is Persistent Genital Arousal Disorder Treated?

PGAD (Persistent Genital Arousal Disorder) is a condition characterized by persistent or recurrent sensations in the genital area—such as unwanted arousal, pressure, a throbbing sensation, tingling, or burning—that are unrelated to sexual desire or stimulation.

Recently, this condition has also been described under the term PGAD/GPD (Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia), which encompasses a variety of genital and pelvic sensory abnormalities.

One of the reasons PGAD is difficult to treat is that it is hard to attribute the condition to a single, uniform cause in all patients.

It is known that various factors may be involved, including changes in the nervous system, pelvic floor muscles, the spine and sacrum, and certain medications.

Therefore, rather than relying on a single, fixed treatment method for PGAD, it isimportant to assess which factors are present in each patient and then determine the appropriate course of treatment.

What should you check before starting PGAD treatment?

Before beginning treatment for PGAD, it is not sufficient to assess only the severity of genital symptoms.

It is necessary to determine when the symptoms first began, how long they have lasted, whether they change depending on body position, whether there is pain in the lower back or buttocks, whether there are any sensory abnormalities in the perineum, and which medications the patient is taking or has stopped taking.

We also check for accompanying symptoms such as insomnia, palpitations, indigestion, fatigue, and anxiety.

Based on this, we can consider two main approaches to treatment.

First, an approach to the lower back, sacrum, pelvic floor, and nerve pathways

Second, this approach takes into account overall physical conditions, such as sleep and stress.

There are times when both are needed at the same time.

The Relationship Between PGAD and the Pudendal Nerve and Pelvic Floor Muscles

Sensations in the genital and perineal regions involve various peripheral nerves, including the pudendal nerve, as well as spinal nerve pathways.

In some patients with PGAD/GPD, cases have been reported in which neurological and structural factors—such as peripheral nerve problems or sacral nerve roots—are involved.

Therefore, if the following symptoms appear along with PGAD, it is necessary to evaluate the lower back, sacrum, pelvis, and surrounding nerves.

• Lower Back or Hip Pain
• Numbness and burning sensation in the perineum
• Symptoms worsen when sitting for long periods
• Changes in Symptoms Depending on Specific Postures
• Pain or tension around the pelvic floor

The presence of these symptoms does not necessarily mean you have pudendal neuropathy. However, they can serve as clues to consider when evaluating the cause.

Deep Acupuncture Treatment for PGAD

If tension is observed in the pelvic floor muscles and surrounding muscles and fascia, deep needling may be considered depending on the patient’s condition.

Before treatment, we assess the location of the pain, the extent of sensory abnormalities, and the relationship between posture and symptoms.

Afterward, treatment is provided as needed to relax tense muscles and fascia and reduce the mechanical stress on the surrounding nerves.

Since sensitivity and the location of symptoms vary from patient to patient, we do not treat all patients at the same location or with the same intensity.

PGAD Acupuncture Treatment

Acupuncture therapy is also selected after evaluating the patient’s symptoms and tissue condition, rather than being applied uniformly based solely on a diagnosis of PGAD.

We can assess the areas of pain and paresthesia, as well as tension in the surrounding muscles and fascia, and develop a treatment plan that may include deep acupuncture, if necessary.

Craniosacral Manipulation and Structural and Functional Treatment

For patients who experience lower back or pelvic pain, or whose symptoms vary depending on their posture, we can also evaluate the functional movement of the spine, sacrum, and pelvis.

If necessary, we use manual therapies , such as craniosacral therapy (CST), to assess tension in the surrounding tissues and their functional movement.

The significance of this approach lies not merely incorrecting the position of the bones, but in comprehensively evaluating the functional state of the spine, sacrum, pelvis, and surrounding tissues.

Could PGAD be related to insomnia and heart palpitations?

Some patients with PGAD report insomnia, palpitations, anxiety, digestive discomfort, and fatigue in addition to genital symptoms.

At this point, PGAD should not be automatically classified as a psychological disorder simply because it is accompanied by anxiety or insomnia.

Persistent PGAD symptoms themselves can cause anxiety and sleep disturbances; conversely, sleep deprivation and chronic stress can also contribute to increased sensitivity to bodily sensations and pain.

Therefore, it is important to examine both the sequence of these two symptoms and the patterns of their progression.

How is PGAD treated with herbal medicine?

Herbal medicine treatment also takes an approach that involves evaluating each patient’s individual symptoms and overall health before formulating a prescription, rather than using a single, uniform prescription for all PGAD patients.

For example, we check whether lower back and pelvic pain are prominent, whether there is severe burning or numbness in the perineum, and whether these symptoms are accompanied by insomnia, palpitations, indigestion, or fatigue.

If symptoms persist for a long period, they may be accompanied not only by PGAD itself but also by a general decline in well-being—including sleep disturbances, fatigue, and stress—so these factors are also incorporated into the treatment plan.

Treatment methods for PGAD may vary from patient to patient.

In the end, what matters is

“What is the best treatment for PGAD?”

Rather than the question, “…”

“What factors are associated with my PGAD symptoms?”

That is the question.

For some patients, the focus may be more on treating the pelvic floor and surrounding tissues, while others may require a combination of herbal medicine and management of their overall health.

In some cases, both approaches are considered together.

Therefore, before treatment, it is important to conduct a comprehensive evaluation that includes the onset of symptoms, duration of symptoms, lower back and pelvic pain, the relationship to posture, medications being taken, sleep patterns and systemic symptoms, and previous test results.

If necessary, evaluations or tests by other medical departments may take priority.

Check This Before Starting PGAD Treatment

If you find it difficult to describe your PGAD symptoms, it may be helpful to write down a few details before your appointment.

Do you experience pain in your lower back and buttocks at the same time?
Do your symptoms worsen when you sit for long periods?
Do you experience numbness or a burning sensation in your perineum?
Do you also experience insomnia, palpitations, or indigestion?
Have you recently started or stopped taking any medications?

Try summarizing it.

The key to treating PGAD is not to attribute it to a single cause.

PGAD is a condition that cannot yet be explained by a single cause or treatment method for all patients.

Therefore, rather than determining treatment based solely on a single diagnosis, itis important to develop a treatment plan by comprehensively evaluating systemic symptoms that accompany the condition of the nerves, pelvic floor, spine, and sacrum.

At our clinic, we develop treatment plans by selecting the appropriate therapies—such as herbal medicine, deep acupuncture, pharmacopuncture, craniosacral therapy, and structural and functional approaches—based on the patient’s symptoms and evaluation results, within the necessary scope.

Rather than focusing on the diagnosis of PGAD, we should first ask, “
”—why is this patient experiencing these symptoms?

This is a principle we consider important when beginning treatment for PGAD.