Hemda Giora, 65, is a psychotherapist and certified couples and sex therapist. She is married, has four children and seven grandchildren, and lives in the Israeli city of Modi'in.
Hemda, let's talk about PGAD. What exactly is it?
"PGAD stands for Persistent Genital Arousal Disorder. It involves unwanted physical sensations in the genital area, such as throbbing, tingling, pressure or a feeling of fullness. These sensations are not triggered by sexual thoughts or sexual stimulation. They can last for hours or even days, either continuously or in waves, and a woman may masturbate several times a day in an attempt to relieve them."
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'Even in the middle of a workday, a woman may be preoccupied with trying to relieve the sensations'
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And doesn't having an orgasm solve the problem?
"Not always. Sometimes an orgasm brings temporary relief, but the sensations may persist or return shortly afterward. In some cases, orgasm can even make them worse. A woman may find herself repeatedly trying to achieve relief, only to discover that it doesn't last."
How common is the condition?
"It's considered rare, although its exact prevalence is unknown. It occurs mainly in women, but men can experience it too. In my own experience, over 20 years of working as a sex therapist, I've encountered just one patient with this condition."
How does it affect everyday life?
"When the sensations are intense, it can be difficult to concentrate on anything else. Even in the middle of a workday, a woman may be preoccupied with trying to relieve the sensations. The constant need to find relief can interfere with daily functioning and cause considerable distress."
Does that mean she wants to have sex more often?
"No. It doesn't necessarily mean she wants more sex with her partner. Sexual intercourse involves an encounter and interaction with another person, beyond sexual satisfaction. In this case, she's simply seeking relief through clitoral stimulation. She may also feel ashamed of what's happening to her."
Hemda Giora
What causes PGAD?
"There are several possible factors. One possibility is irritation or compression of nerves in the pelvic region, including the pudendal nerve, which carries sensory information from the genital area. Problems in the lower back may also be associated with the symptoms. In some cases, researchers have identified a connection with Tarlov cysts, which develop around nerve roots in the sacral region of the spine and may place pressure on them.
"Another possible factor is excessive, persistent tension in the pelvic floor muscles. Doctors may also investigate vascular causes, such as venous congestion in the pelvis."
So it isn't necessarily a psychological condition or the result of sexual trauma?
"Not necessarily. With the patient I treated, we explored different possibilities and found no connection to sexual trauma. It's important to consider a person's emotional background, but that doesn't replace a medical evaluation. Anxiety, stress and constantly worrying about when the sensations will return can increase the distress and help perpetuate it."
How can PGAD be treated?
"Treatment varies from one woman to another, depending on the symptoms and their underlying cause, and sometimes involves several healthcare professionals. For example, if the pelvic floor muscles are excessively tense, physical therapy can help relax them. Biofeedback can also be useful, allowing patients to recognize when they're tightening their muscles and learn how to release that tension.
"Doctors may examine whether medications a woman is already taking need to be changed or consider treatments for nerve-related pain. In some cases, local anesthetic preparations, nerve blocks or Botox injections to relax the muscles may be considered.
"If a cyst or pressure on a nerve is found to be responsible for the symptoms, treating that underlying problem may be an option, sometimes even through surgery. The choice depends on the findings and what is most likely to help the individual patient."
What about psychological treatment?
"Cognitive behavioral therapy, or CBT, can provide tools for coping with the sensations, the anxiety they cause and the repeated urge to masturbate in search of relief. Relaxation exercises and mindfulness can also help women learn to shift their attention to other things so that the sensations don't dominate their thoughts all the time. The goal is to reduce distress while also addressing the physical factors involved."
What makes it difficult for women to seek help?
"Shame and fear are the two emotions that dominate this experience. On one hand, a woman asks herself, 'What's happening to me?' On the other, she wonders, 'How can I be sexually aroused all the time?' There's also the fear of how others will perceive her. That's why it's so important to talk about it, share what you're experiencing and seek help."
Sex tip: "Make room for physical intimacy that doesn't necessarily lead to penetrative sex."