persistent genital arousal disorder ( pgad ) is a phenomenon relating mainly to women sexual health , in which afflicted women complain of sudden and frequent genital arousal that are qualitatively different from the kind of sexual arousal that is associated with desire , or subjective arousal . it is important not to confuse persistent sexual arousal syndrome ( psas ) with hypersexuality . the key difference between the two is that psas manifests as persistent genital arousal in the absence of desire . it is a very rare condition , and it is possible that the sufferers do not report the condition because of shame and embarrassment . pgad , was originally called psas and was also known as restless genital syndrome ( regs or rgs ) , it was documented by leiblum and nathan and only recently characterized as a distinct syndrome . the syndrome of priapism ( similar to pgad ) is a diagnosable medical condition by diagnostic and statistical manual of mental disorders fourth edition . the diagnosis of pgad is based on : 
 the physiological responses characteristic of sexual arousal ( genital vasocongestion and sensitivity ) persist for an extended period of time ( hours to days ) and do not subside completely on their own;the genital arousal does not resolve completely despite one or more orgasms;the persistent genital arousal is experienced as unbidden , intrusive , and unwanted;the persistent genital arousal may be triggered not only by sexual activity but by nonsexual stimuli as well ( e.g. , vibrations from a car ) ; and most importantly , there is at least a moderate or greater feeling of distress associated with the experience . the physiological responses characteristic of sexual arousal ( genital vasocongestion and sensitivity ) persist for an extended period of time ( hours to days ) and do not subside completely on their own ; the genital arousal does not resolve completely despite one or more orgasms ; the persistent genital arousal is experienced as unbidden , intrusive , and unwanted ; the persistent genital arousal may be triggered not only by sexual activity but by nonsexual stimuli as well ( e.g. , vibrations from a car ) ; and most importantly , there is at least a moderate or greater feeling of distress associated with the experience . the unremitting nature of the symptoms , predisposes them to become severely depressed and even suicidal . d , a 40-year - old flower vendor , was referred from the department of gynecology with the complaint of spontaneous sensations similar to that experienced during sexual intercourse since 3 months , lasting for -1 h. episodes spontaneously , not induced by any sexual thoughts or desires . they reduce spontaneously , leaving her fatigued , and she does not engage in intercourse or masturbation for relief . there is no history suggestive of any local infection , selective serotonin reuptake inhibitor use , neurological , endocrinological or psychiatric problems . she was investigated 7 years ago for similar episodes and was found to have a hemorrhagic right ovarian cyst for which oophorectomy was done , and she recovered gradually . she attained menarche at 13 years , had regular cycles , and her first sexual contact was with her husband . general physical and local examinations were unremarkable . during the interview , she expressed deep distress about the symptom and pleaded for help . her investigations were essentially normal ( hemogram , urine routine and culture , blood urea , serum creatinine , blood sugars , lipid profile , thyroid function tests , liver function tests ) . hormone assays which included estrogen , progesterone , follicle stimulating hormone , luteinizing hormone , and testosterone , were within normal limits . ultrasonography abdomen found an oophorectomised status ( right ) . a neurological opinion was sought . she was advised a magnetic resonance imaging brain , and an electroencephalography , which were within normal limits . a detailed psychometric assessment was done ( 16 personality factor , sentence completion test [ sct ] , rorschach , thematic apperception test [ tat ] ) . she has however also posed herself as being self - assured , assertive , independent - minded , and courageous with high moral standards . she was started on carbamazepine 600 mg / day , which she discontinued after a month as symptoms persisted . after supportive sessions over 2 months , symptoms reduced in frequency and intensity and the patient has maintained an asymptomatic status . increased soy intake exogenous medication , or tarlov cysts have been found in these women . central neurological changes ( e.g. , postinjury , specific brain lesion / anomaly ) peripheral neurological changes ( e.g. , pelvic nerve hypersensitivity or entrapment ) vascular changes ( e.g. , pelvic congestion ) , mechanical pressure against genital structures , medication - induced changes , psychological changes ( stress ) , initiation or cessation of treatment with antidepressant medication and other mood stabilizers , onset of menopause , physical inactivity , association with an overactive bladder have been implicated as being causal . one theory suggests that these women may be more vigilant in monitoring small changes in their physical well - being . evaluating psychological predictors of distress showed that conservative attitudes about sexuality could be expected to characterize women reporting high distress versus low distress , acting as a differentiator factor . it was speculated that women with low openness would possibly endorse a dogmatic and conservative thinking style regarding sexuality and that openness would affect the distress to the genital symptoms through a cognitive path rather than a psychopathological path . while there is no generally accepted treatment for pgad , current interventions focus on symptom management pharmacologic strategies have included the use of antidepressants , olanzapine , risperidone , carbamazepine , valproic acid , opioid agonist tramadol , varenicline . one had full remission ( duloxetine ) , and the other had a substantial improvement ( pregabalin ) . validation , psychoeducation , identification of triggers , distraction techniques , and pelvic massage to decrease the pelvic floor tension have been attempted . in the current case , no known etiological factors could be identified . the first episode was self - remitting , the association with the surgery being co - incidental . the personality profile of the patient being analytical , independent , and assertive , might have played a role in the early remission of symptoms . response in the current episode appears to be associated with the psychological support provided by the treating team , as there was no response to medication . living with pgad there is a lack of understanding of the problem , confusion , shame and embarrassment , and a hesitation to seek help . when they finally do approach the physician , it is important that the treating doctor should not feel uneasy if they are not familiar with this condition .
persistent genital arousal disorder ( pgad ) is a phenomenon , in which afflicted women experience spontaneous genital arousal , unresolved by orgasms and triggered by sexual or nonsexual stimuli , eliciting stress . 
 the current case is a 40-year - old female who experienced such orgasms for about a month 
 . physical examination , investigations , and psychological testing were noncontributory . 
 carbamazepine ( 600 mg ) was discontinued due to a lack of response . 
 she improved significantly with supportive therapy . 
 various neuropsychological conditions , pelvic pathology , medications , etc . , have been associated with this disorder . 
 pharmacologic strategies have included the use of antidepressants , antipsychotics , mood stabilizers , and analgesics . 
 validation , psycho - education , identifying triggers , distraction techniques , and pelvic massage have been tried . 
 living with pgad is very demanding . 
 there is a lack of understanding of the problem , shame , and hesitation to seek help 
 . the syndrome has been recently described , and understanding is still evolving .