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“Am I losing my mind?” When you experience repeated sexual arousal for no apparent reason
If you suddenly start experiencing sexual arousal one day and find yourself repeatedly having strange sensations around your genitals even without any specific sexual stimulation or desire, it’s only natural to feel confused.
“Is something wrong with my head?”
“Could I have developed a sexual disorder?”
“Why do I keep getting this feeling?”
In fact, there are people who hide their symptoms from others for a long time because of these concerns.
But there’s something you should know first.
Just because these symptoms appear doesn’t mean you should immediately interpret them as a personality or mental health issue.
One of the conditions that explains these symptoms is PGAD, or persistent genital arousal disorder.
Recently, the term PGAD/GPD (Genito-Pelvic Dysesthesia)has also been used to describe a broader range of symptoms. PGAD/GPD is a condition in which unpleasant sensations—such as tingling, vibrating, burning, or a feeling of pressure—may recur along with unwanted genital arousal.
The “excitement” associated with PGAD is different from what we typically think of as excitement.
This is the most important part of PGAD.
General sexual arousal is often linked to desire or stimulation.
However, in PGAD, sensations around the genitals may suddenly occur even in the absence of sexual desire.
Symptoms may include a tingling sensation, vibrations, a throbbing sensation, a burning sensation, or a feeling of pressure in the genital area or perineum; some individuals may also experience unwanted orgasms or repeated feelings of arousal.
What makes it even more difficult is that this sensation may not be completely relieved by an orgasm. Sometimes the symptoms subside briefly only to return later.
Therefore, from the patient’s perspective, these may feel less like mere sexual symptoms and more like physical sensations that are difficult to control.
Is PGAD a mental health issue?
There is one misunderstanding we need to clear up here.
It is not appropriate to describe PGAD simply as a “mental health issue.”
Currently, experts view PGAD/GPD as a condition for which multiple possible causes should be considered rather than attributing it to a single cause.
Nerve problems in the pelvis and perineum, issues with the spine or sacral region, pelvic floor dysfunction, changes in medication, and vascular or pelvic problems may be involved; psychosocial factors can also influence the experience of symptoms and the level of pain.
In other words,
“Is it a physical problem or a mental one?”
Rather than approaching this by choosing just one of the two options, we need to go through a process of identifying where the symptoms originate and what factors are contributing to them.
Why does it sometimes occur along with lower back or pelvic pain?
Although the symptoms of PGAD/GPD are felt around the genital area, the cause is not necessarily located in that area itself.
A consensus reached by international experts in 2026 proposes an approach that examines the causes of symptoms by dividing them into various areas, including the genitalia themselves, the pelvic and perineal regions, the cerebrospinal fluid, the spinal cord, and the brain.
Therefore, during an examination, it may not be enough to simply ask, “How does the area around your genitals look?”
For example, the following questions are important.
Did you have lower back pain before your symptoms began?
Did you have pain in your buttocks or pelvis?
Do your symptoms get worse if you sit for a long time?
Do you have any bladder or bowel problems as well?
Did your symptoms begin after a fall or injury?
Have you changed any of your medications recently?
Questions like these can provide clues that help narrow down the cause of your symptoms.
One aspect that is often overlooked in the clinic is “when the symptoms began.”
When speaking with people who report having PGAD, there are cases where other symptoms appeared first, rather than them saying right from the start, “My PGAD has begun.”
For example, new sensory abnormalities may appear after initially experiencing lower back or hip pain, suffering from a long-standing bladder condition, or enduring persistent pain around the pelvic area.
There are also cases where people report experiencing discomfort in their lower back or pelvis following a fall or injury, and subsequently noticing changes in sensation around their genital area.
Of course, we cannot conclude that a specific cause is responsible based solely on these cases.
However, determining what changes occurred when the symptoms first began is an important part of the diagnostic process in itself.
Treatment begins with identifying the cause rather than simply “eliminating symptoms.”
There is currently no single standard treatment for PGAD/GPD that can be applied to all patients.
Depending on the cause and symptoms, various approaches may be used, including medication, physical therapy, methods to regulate nerve stimulation, and psychotherapy. If the cause is identified, treating that cause becomes the primary focus.
Therefore, rather than unconditionally choosing a specific treatment, it is important to find a treatment approach that is appropriate for your current symptoms.
For example, in some cases, medication is necessary, while in others, the condition of the pelvic floor muscles must be assessed.
If you suspect nerve compression or problems related to the spine or pelvis, you may need to undergo the necessary tests to examine those areas.
If psychological distress or anxiety also increases, it is recommended to incorporate psychological support into the treatment process. This does not mean that “PGAD is a mental illness,” but rather that chronic and difficult-to-control symptoms can significantly increase psychological burden.
If the problem keeps recurring even after Botox or medication,
In some patients, Botox or medications may be used to manage symptoms.
However, given the wide range of causes of PGAD, it is difficult to say that any single treatment will produce the same results for all patients.
In addition, depending on the type of medication, side effects such as drowsiness and dizziness may occur; therefore, if you are currently taking any medications, you should consult with your healthcare provider to adjust your dosage accordingly.
If your symptoms recur even after receiving treatment, rather than automatically concluding that “the treatment has failed,” itmay be necessary to reassess whether the current treatment is adequately addressing the underlying cause of your symptoms.
Three Things to Check First in Your Daily Habits
In addition to treatment, lifestyle habits are also important.
Activities that put pressure on the perineum, such as cycling
Activities that put direct pressure on the perineum, such as cycling, can exacerbate symptoms in some patients. If there is a link between your symptoms and cycling, it is advisable to adjust your lifestyle to reduce this pressure for the time being.
Constipation and Excessive Straining
If you have constipation, you tend to strain excessively when having a bowel movement.
You should also take a closer look at your habit of spending too much time on the toilet.
If you experience recurring constipation, it’s a good idea to review your diet, fluid intake, and activity level, and take steps to avoid straining too much during bowel movements.
The habit of sitting for long periods of time
If your symptoms get worse the longer you sit, try to cut back on sitting for long periods at a time.
If you have to sit for work or school, try getting up and walking around or changing your posture at regular intervals.
While cushions or seat pads may be helpful for some people, if they actually increase pressure on a specific area and worsen your symptoms, you should stop using them and find an alternative solution.
Here’s how we approach treatment
Just because someone has symptoms of PGAD doesn’t mean we decide on a single treatment right from the start.
First, we carefully examine the pattern of symptoms.
1. When did it start?
Determine whether the symptoms began suddenly or following a specific event or episode of pain.
2. Which areas are causing discomfort?
Check for pain or abnormal sensations in the lower back, buttocks, pelvis, and perineum.
3. Do you have bladder or bowel symptoms?
Check to see if symptoms such as frequent urination, bladder pain, constipation, or discomfort during bowel movements are present.
4. Do you have any neurological symptoms?
Check to see if there are any accompanying symptoms such as numbness, tingling, or changes in sensation.
5. Do you have any autonomic nervous system symptoms?
You can also check to see if other symptoms, such as insomnia, heart palpitations, anxiety, or digestive discomfort, are present.
Through this process, we determine the treatment approach— whether to first identify structural issues, examine neurological factors more closely, or manage both the autonomic nervous system and psychological stress.
As such, when treating PGAD/GPD, it is important to take an approach that identifies the underlying causes across multiple areas rather than focusing on just one symptom.
If you’ve ever thought, “Am I the only one who feels this way?”
Since PGAD isn’t a widely discussed condition, people experiencing its symptoms may feel even more isolated.
In particular, because of the nature of the abnormal sensations around the genitals, some people find it difficult to discuss the issue even at the hospital and end up searching for information on their own, which only makes them more anxious.
However, if you experience repeated unwanted sexual arousal or persistent sensations such as tingling, numbness, burning, or tightness around your genitals, don’t assume these are simply symptoms you just have to put up with.
In particular, if your symptoms began suddenly or are accompanied by lower back, pelvic, or perineal pain, bladder symptoms, or sensory abnormalities, it is helpful to summarize the progression of your symptoms to date and explain them to your healthcare provider.
A “PGAD Tracking Routine” You Can Start Today
If you haven’t seen a doctor yet, try writing down just these three things.
First, when do the symptoms worsen?
Write down whether it happens while you’re sitting, before you go to sleep, after a bowel movement, or after a specific activity.
Second, what kind of sensation is it?
Record in detail whether it is a sensation of excitement, vibration, a tingling sensation, a burning sensation, or a feeling of pressure.
Third, are there any other symptoms?
Record any lower back pain, buttock pain, pelvic pain, bladder symptoms, constipation, or sleep problems.
Writing it down this way allows you to convey the pattern of your symptoms much more specifically than simply saying, “I feel strange .”
Based on its name alone, PGAD might seem like a purely sexual issue.
However, in reality, it is a condition that can cause significant discomfort in daily life due to unwanted genital arousal and abnormal sensations, and it is difficult to pinpoint a single cause.
So what’s important is
Not “Am I weird?” but
“Where did these symptoms start?”
That is, rephrasing the question.
It is necessary to carefully investigate whether the issue stems from the lower back or pelvis, is related to the nervous system, is linked to a chronic bladder or pelvic condition, or is caused by medication or other factors.
Furthermore, if your symptoms cause you to feel anxious or depressed, that is also an important aspect that should be addressed as part of your treatment. The latest expert guidelines on PGAD/GPD also emphasize the importance of considering both medical and psychosocial approaches.
If you’ve been putting up with your symptoms without knowing the cause, try keeping a record of “when they started and what triggered them.”
That record could be the first clue to understanding my symptoms.
