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If you experience recurring sensations of arousal or pulsation in your genitals and pelvic area even in the absence of any sexual stimulation, it may not simply be a matter of sexual desire. PGAD and GPD are conditions in which unwanted genital and pelvic sensations persist regardless of one’s will. Rather than focusing solely on the areas where symptoms appear, it is necessary to examine the lower back, the sacral nerves, the pelvic floor muscles, changes in medication, sleep patterns, and the state of the autonomic nervous system as well.
Do you experience recurring sensations of arousal or pulsing around your genitals even without any sexual stimulation? Does a tension similar to that just before an orgasm persist throughout the day, or do you find it difficult to go about your daily life because the sensation doesn’t go away even after you wake up from sleep? You may have tried various methods to get rid of these symptoms, only to find that the relief is temporary and the symptoms return, or you may be searching the internet alone because you don’t know who to talk to.
Many people worry when they experience these symptoms for the first time.
“Am I losing my mind?”
“Could it be that my sex drive is too strong?”
“Could it be sex addiction?”
However, symptoms in which a sensation of arousal in the genital and pelvic areas persists regardless of one’s will may not simply be a result of a strong sex drive. Medically, this condition is known as Persistent Genital Arousal Disorder (PGAD), and recently, the term Genital-Pelvic Dysesthesia (GPD) has also been used to describe a broader range of symptoms.
Hello. I’m Dr. Hwang Sang-cheol, and I specialize in the research and treatment of the autonomic nervous system. Today, I’d like to talk about PGAD—Persistent Genital Arousal Disorder—a condition that many people suffer from in silence because it’s difficult to discuss with others.
PGAD is not a problem with sexual desire, but rather a problem with unwanted sensations.
PGAD stands for Persistent Genital Arousal Disorder. Recently, it has also been described using the term Genito-Pelvic Dysesthesia (GPD), which encompasses various sensory abnormalities not only in the genital area but also in the pelvis and perineum.
The core characteristic of PGAD and GPD is the repeated occurrence of physical sensations resembling arousal in the genital and pelvic areas, even in the absence of sexual desire. These sensations do not arise because the patient is having sexual thoughts or seeking stimulation. They occur independently of the patient’s will, do not subside easily, and can cause significant discomfort and distress.
“I experience sensations similar to an orgasm dozens of times a day.”
If you hear just this sentence, you might think it’s no big deal if you haven’t experienced these symptoms yourself. However, the stories of actual patients tell a completely different story.
“I keep feeling aroused even though I don’t want to.”
“It lasts all day without ever feeling like it’s going away.”
“I feel like I can’t control my own body.”
“I’m always on edge because I don’t know when the symptoms might return.”
For patients with PGAD, the experience is not one of pleasure or enjoyment, but rather one of distress caused by unrelenting sensations. If symptoms persist for a long time, they can lead to sleep disturbances, anxiety, difficulty concentrating, feelings of depression, and difficulties in interpersonal relationships; they can also affect daily activities such as going out, driving, work, and school.
What are the symptoms of PGAD (Persistent Genital Arousal Disorder)?
Symptoms of PGAD vary from person to person. Even in the same patient, the intensity of the sensations can vary depending on their physical condition, posture, sleep quality, and stress levels on a given day.
Typically, this involves a sensation of arousal around the genitals in the absence of any sexual stimulation, or a prolonged state of tension similar to that experienced just before orgasm. Pulsations, pressure, tingling, burning, vibrations, or a prickling sensation may also occur in the genitals or perineum.
In some cases, the sensation may temporarily subside only to recur repeatedly, or it may not disappear completely even after sleeping and waking up. Symptoms may worsen when sitting for long periods or while driving, and some people also experience discomfort around the bladder or anus. Some patients even avoid going out or socializing for fear that their symptoms will return.
What is important is not merely the fact that the sensation occurs. What is important is that the sensation recurs regardless of the patient’s will, causing significant discomfort and psychological distress in daily life.
“Am I a weirdo?”
One of the biggest concerns for PGAD patients is being misunderstood by others. They often find it difficult to explain their symptoms even to family members or spouses, and even when they do go to the hospital, they may put off seeking treatment because they don’t know how to describe their symptoms to the medical staff.
“If I mention these symptoms, won’t people think I’m strange?”
“I couldn’t tell anyone because I was afraid people would misunderstand and think it was a sexual issue.”
However, PGAD is not a condition caused by a lack of willpower on the part of the patient. It is not a matter of personality or morality, nor should it be dismissed as a condition resulting from an excessively strong sex drive.
PGAD and GPD are currently understood to be neurological and physical conditions that may arise from the excessive activation of nerves that transmit sensations from the genitals and pelvis, or from changes in the process of processing nerve signals. Symptoms can be influenced by various areas, including not only the tissues surrounding the genitals but also the pelvis, perineum, sacral nerves, cauda equina, spinal cord, and brain.
Rather than assuming that I’ve become strange, I should first consider the possibility that my body is repeatedly sending unwanted sensory signals.
There is no single cause of PGAD.
It is difficult to pinpoint a single cause for PGAD (Persistent Genital Arousal Disorder). This is because, even among patients reporting similar symptoms, the trigger for the onset of symptoms and the specific nerve areas involved may vary from person to person.
Therefore, rather than focusing solely on the genital area where symptoms appear, it is necessary to examine the spine, pelvis, nerves, muscles, medications, and sleep and stress levels as well.
Hypersensitivity of the pelvic and perineal nerves
Sensations from the genitals and perineum are transmitted to the spinal cord and brain via various nerves. If the nerves become compressed or overly sensitive during this process, even minor stimuli that would normally cause no discomfort can be perceived as intense sensations.
Even in the absence of specific stimuli, you may experience a pulsating sensation, numbness, a burning sensation, or sensations similar to sexual arousal. In particular, if nerves around the pelvis—including the pudendal nerve—are compressed or irritated, abnormal sensations may occur in the perineum, genital area, and around the anus.
Sensations may intensify even when the pelvic floor muscles are tense.
The pelvic floor muscles are the muscles at the base of the pelvis that support organs such as the bladder, uterus, and rectum. If these muscles remain tense for a long time, it can affect the surrounding nerves, blood vessels, and soft tissues.
If you experience a lot of stress, spend long periods of time sitting, or have a habit of unconsciously tensing your abdomen and pelvis, your pelvic floor muscles may not relax sufficiently. Tension in the pelvic floor muscles can cause a feeling of pressure, heaviness, numbness, or throbbing in the genital area and perineum, or it can worsen existing symptoms.
However, not all PGAD patients have pelvic floor muscle tension. If you repeatedly perform exercises to strengthen the pelvic floor muscles—such as Kegel exercises—without first assessing your current condition, you may actually put additional strain on muscles that are already tense. Therefore, rather than starting exercises on your own, it is important to first get evaluated to determine whether your pelvic floor muscles are weak or excessively tense.
You should also check your lower back and the sacral nerves.
Sensations in the genital area and pelvis are transmitted via nerves in the lower back and sacral region. Therefore, lumbar disc herniation, compression of the sacral nerve roots, and changes resulting from pelvic trauma or surgery may sometimes be associated with sensory abnormalities in the genital area and pelvis.
Because patients feel symptoms in their genitals, it is easy to assume that the problem lies in the genitals themselves. However, the point where the sensory signals actually originate or are excessively amplified may be in the lower back or the sacral nerves.
If you experience lower back pain, buttock pain, numbness in the legs, or changes in sensation in the anus or perineum, you should also consider the possibility of issues related to the spine and nerves.
Tarlov cysts are also cited as one of the causes.
A Tarlov cyst is a perineural cyst that primarily develops around the sacral nerves. Although most cases are asymptomatic, depending on the size and location of the cyst, it may irritate the surrounding nerve roots, causing pain or sensory abnormalities in the pelvis and perineum.
There are also reports that Tarlov cysts have been found in some patients with PGAD. However, the presence of a Tarlov cyst or a herniated disc on imaging does not necessarily mean that it is the direct cause of PGAD.
The relationship between the test results, the location of symptoms, changes based on posture, and neurological findings must be evaluated together to determine their correlation.
Symptoms may also begin after taking or stopping a medication.
There have been reports of PGAD symptoms beginning in some patients before or after taking or discontinuing certain medications, including antidepressants. In particular, abruptly discontinuing medications that affect neurotransmitters can cause temporary instability in the nervous system, potentially leading to various sensory abnormalities.
However, even if you suspect a link between your medication and your symptoms, you should not stop taking your medication or reduce the dosage on your own. Abruptly stopping medication can worsen existing symptoms or cause other withdrawal symptoms. You must consult with the healthcare provider who prescribed the medication to adjust the dosage safely.
Why Symptoms Worsen When Sitting or Driving for Long Periods
PGAD symptoms may be influenced by posture, pressure, and vibration. Sitting in a chair for long periods of time can cause body weight to concentrate on the pelvis and perineum, which may compress the surrounding nerves and soft tissues.
“My symptoms get worse when I sit for a long time.”
“When vibrations are transmitted while driving, the pulsating sensation becomes more intense.”
If your symptoms worsen after sitting for long periods at work or using a hard chair, it’s a good idea to keep a record of how your symptoms change based on how long you’ve been sitting and your posture.
When driving for long periods, you experience pressure from the seat along with constant vibrations. For some people, these vibrations stimulate the already sensitized nerves in the pelvis and perineum, intensifying the sensations.
During periods when your symptoms are severe, it’s best not to sit in one position for too long; instead, get up and move around from time to time as much as possible.
Tight-fitting clothes and underwear can also have an effect.
Underwear or pants that constantly put pressure on the genital area and perineum may increase discomfort in some patients. In particular, when sitting, if the seams or stiff fabric of the clothing repeatedly press against the perineum, the sensation of sensitivity may feel more intense.
During periods when symptoms are severe, it is recommended to wear comfortable clothing that is not too tight and to try to reduce pressure on the pelvis and perineum. However, changing your clothing alone will not cure PGAD. This is one of the lifestyle management strategies designed to reduce irritants that worsen symptoms.
Lack of sleep and stress make you more on edge.
If you don’t get enough sleep, the nervous system’s ability to regulate pain and sensation may be impaired. Even minor sensations that you would normally be able to tolerate may feel more intense and uncomfortable on days when you’re sleep-deprived.
Furthermore, if you constantly check your body for sensations out of fear that the symptoms might return, your nervous system remains in a state of alert.
“What if my symptoms come back?”
“I’m anxious that I might suddenly appear in front of people.”
When a sensation arises, it can trigger anxiety; as anxiety causes the body to tense up, the sensation may intensify, creating a vicious cycle. This does not mean that the symptoms are caused by the mind. Rather, it means that anxiety and a state of alertness, combined with a sensation that actually exists, can make the nervous system even more sensitive.
Therefore, in the treatment of PGAD, it is necessary to address physical causes while also managing sleep, stress, and anxiety related to the symptoms.
Should I cut back on caffeine?
Coffee, energy drinks, and other high-caffeine beverages can stimulate the sympathetic nervous system, increase your heart rate, and interfere with sleep. If your anxiety or palpitations worsen after consuming caffeine and your PGAD symptoms also increase, it’s a good idea to try reducing your intake.
However, caffeine is not the direct cause of symptoms for all patients. Rather than blindly restricting all foods, it is more practical to track the timing and amount of caffeine intake along with changes in symptoms to determine whether it affects you.
Is it okay to try to relieve myself through repeated sexual stimulation?
Because the sensation is so uncomfortable, some people repeatedly seek sexual stimulation in an effort to get rid of it quickly.
“I thought things would be okay once I worked through it, but it starts all over again right away.”
“At first, it seemed to decrease slightly, but now it’s not working anymore.”
Although symptoms may seem to subside temporarily, in some cases the sensation does not completely disappear even after orgasm, or the relief may diminish over time. For some patients, the repeated stimulation itself can contribute to physical fatigue, pain, and psychological stress.
Therefore, rather than repeatedly trying to forcefully suppress the sensation, the first step is to observe the situations in which the symptoms begin and worsen. Recording the situations, postures, sleep patterns, medications you are taking, and accompanying symptoms when the symptoms are severe can help identify the cause during your medical evaluation.
What is assessed during a PGAD evaluation?
Many people who want to visit a hospital for PGAD symptoms feel unsure of where to start or how to explain their situation.
“How should I describe these symptoms when I go to the hospital?”
“Is it okay if I don’t go into detail right from the start?”
You don’t need to have everything perfectly organized from the very beginning. Just start by describing, in your own words, when the most bothersome sensations and symptoms first began.
During the examination, we assess when the symptoms first appeared, how often they occur throughout the day, how long they last once they begin, and specific sensations such as throbbing, tingling, or a feeling of pressure. We also examine whether symptoms vary depending on posture—such as sitting, walking, or lying down—and whether they are related to driving, vibration, or tight-fitting clothing.
We can also determine whether you have a history of herniated discs, pelvic trauma, childbirth, or surgery, and whether you are experiencing any other symptoms involving the bladder, anus, or perineum. Other important factors to assess include any medications you are currently taking or have recently stopped taking, your sleep patterns and stress levels, and whether there is significant tension in your pelvic floor muscles and overall musculature.
If necessary, depending on your symptoms, we may consider coordinating tests and consultations with departments such as Obstetrics and Gynecology, Urology, Neurology, Radiology, and Pain Medicine.
At our clinic, we don’t just treat genital symptoms.
With PGAD, it may be difficult to fully explain the cause by examining only the genital area where symptoms appear. At our clinic, we do not approach PGAD as merely a sexual symptom; instead, we also consider the possibility that the nervous system responsible for transmitting sensations in the genitals and pelvis is in a state of excessive arousal.
We conduct a comprehensive assessment that takes into account not only the onset and nature of symptoms, but also tension in the lower back, sacral nerves, and pelvic floor muscles, as well as sleep patterns, stress levels, the body’s overall tension response, and the state of the autonomic nervous system.
Not all patients have the same underlying cause, nor do they all require the same treatment. Therefore, it is important to carefully assess the patient’s sensations, accompanying symptoms, and factors that exacerbate their condition before establishing a treatment plan and lifestyle management strategy tailored to their current condition.
How is PGAD treated?
Since PGAD and GPD have diverse causes and symptom patterns, rather than attempting to resolve them with a single treatment, a step-by-step approach should be taken to identify the factors affecting the patient.
Depending on the patient’s condition, treatment options may include medication to control excessive nerve excitation, physical therapy to reduce tension in the pelvic floor muscles, and counseling to alleviate fear and psychological distress related to the symptoms. In some cases, nerve blocks, nerve modulation therapy, or treatment targeting the underlying spinal and neural structures may be necessary.
Treatment to regulate sleep and lifestyle habits and relieve excessive whole-body tension can also be administered. From a traditional Korean medicine perspective, after assessing the patient’s condition, we may consider a treatment plan that uses acupuncture, herbal acupuncture, herbal medicine, and relaxation therapy to simultaneously regulate nervous system hyperactivity, muscle tension, sleep, and the autonomic nervous system.
However, no single treatment guarantees the same results for all PGAD patients. Since no single standard treatment has yet been established for all PGAD patients, the treatment plan must be tailored to each individual after assessing the location of the symptoms and their possible causes.
The goal of treatment is not merely to suppress the sensation.
The goal of PGAD treatment is not merely to unconditionally suppress the sensations experienced in the moment. It is important to identify why the nerves are repeatedly becoming excited, reduce irritation around the spine and pelvis, and help the overly tense body regain a state of stability.
“Maybe I haven’t gone crazy—maybe my nerves are just on edge.”
“If I know when my symptoms are getting worse, I’ll be able to cope a little better.”
Simply understanding the causes of your symptoms can help alleviate vague fears. Identifying the factors that worsen your symptoms and developing a plan for necessary tests and treatment can be the first step toward regaining a sense of control over your body.
It cannot be assumed that treatment will yield the same results for everyone. However, by carefully examining possible causes and managing excessive stimulation of the nervous system and pelvis, as well as sleep deprivation and overall tension, you can find ways to manage your symptoms and improve your quality of life.
Please write down your symptoms before your visit.
If you suspect you have PGAD, please keep a record of the date your symptoms began and how many times they occur each day. It’s also a good idea to note how long the symptoms last once they start, as well as which sensation—throbbing, numbness, burning, or tightness—is the most bothersome.
See if your symptoms change on days when you’ve been sitting or driving for a long time, on days when you haven’t gotten enough sleep, or on days when you’re under a lot of stress. It’s also important to note whether your symptoms are related to your menstrual cycle or hormonal changes, and whether you’ve recently started or stopped taking any medications.
It’s also a good idea to note whether you experience lower back pain, pelvic pain, bladder irritation, or discomfort in the anal or perineal area. While these notes alone cannot determine the cause, they help identify symptom patterns and factors that worsen your symptoms during the course of your medical evaluation.
You should avoid stopping your current medication on your own or repeatedly irritating the affected area.
These are not symptoms you have to hide or endure on your own.
PGAD (Persistent Genital Arousal Disorder) is a condition that’s difficult to talk about. Some people hesitate even to type the symptoms into a search engine, and others endure it alone for a long time out of fear that others might misunderstand them.
“Am I the only one experiencing these symptoms?”
“What if the hospital doesn’t understand?”
However, these symptoms are neither fabricated by the patient nor caused by a lack of willpower. They are actual physical sensations and require medical evaluation.
Please don’t put off your appointment out of concern that “I might seem strange.” You don’t have to explain everything in detail right from the start. We can begin the consultation even if you just tell us what your most bothersome symptoms are and when they began.
Our goal is to return to a comfortable daily life.
An important goal of PGAD treatment is to help patients feel safe and comfortable in their daily lives again. The goal may include being able to fall asleep comfortably, refocus on work and studies, and go out or drive without excessive fear.
It’s also important to regain a sense of security—knowing that you can regain control of your body without constantly worrying that your symptoms might flare up when you’re with others.
“I just want to fall asleep tonight without worrying about my symptoms.”
“I want to be able to go out and work like normal again.”
We cannot guarantee the same treatment outcomes for everyone with PGAD. However, by identifying the likely source of the symptoms, reducing excessive stimulation of the nervous system and pelvic area, and managing both sleep and stress levels, we can help patients find a treatment approach that works for them.
A Word from Director Hwang Sang-cheol
PGAD is not a problem with sexual desire. It may be a condition in which unwanted nerve signals are repeatedly sent by the body, and the suffering experienced by patients is by no means exaggerated.
I hope you won’t feel anxious while searching the internet on your own.
“Is it just me who feels this way?”
“Am I starting to lose my mind?”
If you experience recurring sensations of arousal, throbbing, or pressure in the genital and pelvic areas that you do not desire, you should carefully investigate whether your current symptoms are related to spinal nerves, pelvic floor muscles, changes in medication, lack of sleep, or overstimulation of the autonomic nervous system.
Rather than trying to cope on your own because you find it difficult to describe your symptoms, please consult with a healthcare professional to determine the appropriate tests and treatment plan for your current condition.
You’re not the only one feeling this way. Recovery can begin by understanding your symptoms and seeking the right help.
Guidance on Counseling for PGAD and Genital-Pelvic Sensory Abnormalities
If you are experiencing recurring sensations of arousal, throbbing, tingling, or pressure in or around your genitals or pelvic area—regardless of your sexual desire—please do not suffer in silence; have your current symptoms checked.
You don’t have to go into detail about all the sensitive issues right from the start. You can start the consultation gradually by discussing when your symptoms began, which sensations are the most uncomfortable, and whether they worsen when you sit for long periods or drive.
