Causes of Persistent Genital Arousal Disorder (PGAD)

There are several causes for Persistent Genital Arousal Disorder (PGAD), none of which include watching porn all day.

When you think about discerning PGAD from other pelvic pain diagnoses or symptoms, the causes truly don’t differ tremendously. So, why is there a splash of pleasure or arousal involved? Because the symptoms are coming from the genitals. The genitals are where you experience arousal.

Some say that, however, is not true, or not entirely true. Some say that there is a misfiring or even crosstalk in the brain’s pleasure and pain centers. I don’t doubt this. I think this, as in all cases, is likely true for some people.

The causes of PGAD differ for everyone. What I summarize are likely just some of the possible contributions.

The Why?

  1. Pelvic floor muscle overactivity
  2. Connective tissue restriction
  3. Trigger points
  4. Pressure from pelvic congestion or cysts
  5. Skeletal system

Does any of this sound familiar? If you’ve read every single post I’ve ever written about the why’s of diagnoses, they are pretty much all the same. That’s because the same culprits can cause different symptoms in different people. However, the same symptoms in different people can stem from a variety of combinations of these culprits and these culprits can be found at different aspects of the body.

For example, the pubrectalis muscle can be overactive in one person creating symptoms of PGAD, however the ischiocavernosus can be overactive in the next person, yet both people can feel the most intense PGAD symptoms in their clitoris.  Isn’t this horribly complicated? That’s why it’s so important for you to understand your symptoms, where they can be coming from and to have good communication with your providers. Sometimes, us providers, we are awesome and we can figure it out, but sometimes we are one-trick ponies. Make sure you aren’t being treated by a pony. Cuz that’s…weird.

Want another example? Okay.  Sometimes the PGAD symptoms are coming from the spine. Starting as high as where the thoracic spine meets the lumbar spine are nerves that can generate symptoms at the genitals. If you don’t know where the thoracic spine meets the lumbar spine, that’s just around where the back of the bra strap sits. Oh, you don’t wear a bra strap? Then use Google image. Don’t make this hard for me.   I’m writing this blog for free, dammit. Did I digress? I digressed. So spinal levels anywhere from up by the bra strap downward can cause problems with the nervous system that can create PGAD symptoms. But, if you only think to assess one or two spinal levels, then you might miss the root of the problem. The call could be coming from anywhere.

What to know why the possible causes are the possible causes? Okay again.

Pelvic Floor Muscle Overactivity:  Whenever you are in pain, your muscles will tense up to protect you.  Whenever you are stressed, your pelvic floor muscles, specifically, will tighten.  This tension can create a lot of unexpected symptoms.  Many people have made a habit out of holding their pelvic floor muscles tense for years and years.  This is what we call a “holding pattern”.  It’s your body’s own muscle memory to tense up the pelvic floor muscles.  But, really, it’s not just the pelvic floor muscles that we’re concerned with in this situation.  A “holding pattern” of holding your abdominals, buttocks or inner thighs is going to consequently tighten your pelvic floor as well.  It’s just how we’re all wired.  These overactive muscles can cause seemingly unexplained bladder, bowel and pelvic pain symptoms.  When the pelvic floor muscles tense up, this amps up the part of your nervous system that tells your brain that you have an urge to urinate.  This is a false urge.  When the pelvic floor muscles tense up, it can keep you from emptying your bladder completely or it can weaken your urine stream.  When the pelvic floor muscles tense up, bowel movements can become more painful and/or more difficult and/or less frequent.  And finally, when the pelvic floor muscles tense up, this can basically choke abdominal and pelvic nerves.  It’s like a nerve impingement in your neck that can cause a zinging down your arm.  It’s the same thing, but it’s in your pelvis and the zinging sensation can go through your labia, your clitoris, vagina…wherever.  Many people also say they feel pain down their leg or in a foot as well.

Connective Tissue Restriction (the cable knit, full body leotard):  Connective tissue* is a layer under the skin and over the muscle and it is the only part of our body that is literally connected from head to toe.  That bit of information is extremely important.  So think of your connective tissue like a cable knit, full body leotard.  Yes, that sounds really hot – temperature-wise, not sexy.  Actually…can we sit on that image for a second – a sexy cable knit leotard…picture it…did you get a little satisfaction from that? Really, the cable knit part is important in my analogy.  Imagine a loose string in cable knit.  If you pull that string, you are going to get puckering at a place not necessarily close to the string.  The puckering could be far away from the pull of the string.  This is exactly what can happen with connective tissue issues.  You may have some tension, scar tissue, tightness, poor blood flow to the surface in one specific area and you end up having pain somewhere else because of it.  What I see most often is that there are issues with the connective tissue in the abdomen or inner thighs that ends up effecting pelvic pain.  Does that make sense?  I love the cable knit and the leotard explanations.  Neither of them are originally mine – I combined two really great examples…into one fabulous fashion statement.

*I can’t think up a better definition than Pelvic Health and Rehabilitation Center’s definition of connective tissue.  I send some of my patients to read this post because it’s so thorough and well written.

Trigger Points:  Trigger points can be the cause of some pelvic pain symptoms, especially if they are on the abdomen, thighs, buttocks, low back, external pelvic floor muscles or internal pelvic floor muscles. When a trigger point is pressed on, the pain may be at that specific site under the finger or it may also go to another part of the pelvis.   Trigger points can be worked on by yourself or by your therapist.  Trigger points that are really stubborn might do well with trigger point injections.

Pressure: Anything placing pressure on a nerve can create pain along the course of that nerve. If the course of that nerve goes to the genitals, then you are going to have a problem. But, what causes pressure? I’m going to say for the case of PGAD, it’s going to be mainly a cyst or a hyperdilated blood vessel. A cyst can form and grow and eventually place pressure on a nerve anywhere in the body, anywhere along the course of the spine and sacrum. A hyperdilated blood vessel can be a sign of pelvic congestion. This means that pelvic blood vessels have created varicosities, like you often see in the legs. These varicosities are widened blood vessels and they can place pressure on pelvic nerves.

Skeletal System: The body needs a thorough skeletal exam from the thoracic to the sacral spine and from hip to shining hip. But, don’t stop there, if something wonky is happening at the neck, then that can affect the thoracic and lumbar spine and the hips. Hence my suggestion of a thorough skeletal exam. Don’t let someone suggest that your neck and shoulder issue are completely and absolutely unrelated to your spine. So, if one domino is not moving correctly, this can affect what happens to the nerves coming out of the spine that talk to the pelvis or the pull of the muscles coming from the hips and thereby affecting nerves in the pelvis.

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