Spontaneous orgasms (Persistent Genital Arousal Disorder)

This is a rare condition in which some women suffer from the opposite end of Female Sexual Dysfunction and actually have a problem with sudden, spontaneous, persistent, and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. Unfortunately, often these feelings are unpleasant and may be severe enough to make it impossible for them to live normally. This condition of spontaneous orgasms is also called Persistent Genital Arousal Disorder (PGAD). In some of the cases the women have orgasms that last for several minutes which can be triggered by such things as the vibrations of being in a car but sometimes appear completely out of the blue and cause them significant distress, embarrassment and awkwardness. In some cases the women attempt to relieve themselves by masturbating or having sex but normally this only provides a temporary relief and can in some cases actually make the problem worse. The condition of Persistent Genital Arousal Disorder was first described and properl y medicalised in 2001 by Dr Sandra R. Leiblum and Dr Sharom G Nathan, but obviously women have been suffering from this condition for a long time. The embarrassing nature of it means that very few women actually report it, therefore it is not known how many women actually suffer from PGAD. In recent years more and more women have confessed to having it. Most women go through their lives not telling anyone about it.

Furthermore, physical arousal caused by this syndrome can be very intense and persist for ext ended periods, days or weeks at a time. Orgasm can sometimes provide temporary relief, but within hours the symptoms return. The return of symptoms, with the exception of known triggers, is sudden and unpredictable. Failure or refusal to relieve the symptoms often results in waves of spontaneous orgasms. The symptoms can be debilitating, preventing concentration on mundane tasks.

Possible causes and treatment

There is not enough known about persistent genital arousal disorder to definitively pinpoint a cause. Medical professionals think it is caused by an irregularity in sensory nerves, and note that the disorder has a tendency to strike post-menopausal women, or those who have undergone hormonal treatment. However, it can affect a person at any age. Some drugs such as trazodone may cause the side-effect of priapism (which is similar, but not the same condition seen in men), in which case discontinuing the medication may give relief. Additionally, the condition can sometimes start only after the discontinuation of SSRI anti-depressants.

Some of the theories advanced include:

• Neurological hypersensitivity – in which normal sensation from areas such as clitoris or pelvic organs gets amplified and result in a persistent or permanent state of arousal at the brain level. Treatment with anti-depressants is advocated. The hypersensitivty may also result after minor trauma to pelvic nerves
• Venous congestion of pelvic organs – Women with PGAD may have some form of pelvic venous congestion syndrome. The pelvic and sexual organs are rich in blood supply and sometimes the chronically dilated varicose veins do not respond well to neurologic and hormone signals to contract to normal size especially after the resolution phase of the sexual cycle leading to persistent arousal.
• Hormonal Cause – Women who suffer from PGAD after menopause or during a few days before the onset of menstrual cycle may have problems related to hormones such as progesterone. This maybe caused due to over-sensitivity to the arousal effect of Progesterone.
• Disorder of Prolactin Release – Prolactin is release during orgasm and it has a role in maintaining the refractory and relief phase after orgasm. Men usually have a much larger release of prolactin after orgasm than women and hence they take time to be aroused the second time. Women have a shorter refractory period due to a smaller release of the hormone. In PGAD, it is possible that there maybe no release or delayed release of the prolactin hormone.
• Oxytocin Deficiency – Oxytocin release from pituitary in orgasm gives the calming effect. It reduces stress and its release in clitoral orgasm is even more. There is likelihood of deficiency in the amount of oxytocin released in women suffering from PGAD.
• Variant of Tourette’s Syndrome – Tourette’s syndrome is a compulsive tic disorder and the most common tics are of eye blinking, coughing, throat clearing, sniffing, and facial movements. PGAD may be a variant of such a disorder that is associated with compulsive masturbation, intrusive thoughts, and there may be a family history of Tourette’s syndrome or a similar disorder.

In situations where the cause of PGAD is unknown or less easily treatable, the symptoms can sometimes be reduced by the use of antidepressants, antiandrogenic agents, and anaesthetising gels. Psychotherapy with cognitive reframing of the arousal as a healthy response may also be used.

Where the symptoms of the condition have also been linked with pudendal nerve entrapment, regional nerve blocks (and less commonly) surgical intervention have demonstrated varying degrees of success in most cases. There is, however, no evidence for the long-term efficacy of surgical intervention. However, an association of PGAD, with clitoral mass (or swelling) has been described, with relief of symptoms, following surgical removal. In one recent case, accidental discovery of relief of symptoms was noted from treatment with varenicline, a treatment for nicotine addiction