Most American adults are undersexed and lead lives of quiet sexual desperation. Who wouldn't want to experience more orgasms in their day-to-day lives, right? Neurotransmitters such as the arousing noradrenaline, and those that make you feel warm and fuzzy such as oxytocin, dopamine, prolactin [1] reach their zenith during the symphony of rhythmic contractions of the pubococcygeus muscle [2] in women brought on by persistent stimulation of the pudendal nerve [3]. However, just as pudendal neuralgia can cause an array of sexual pathologies ranging from erectile dysfunction, to vulvodynia, to premature ejaculation [3] one of the most notable pathologies is Persistent Genital Arousal Disorder (PGAD).
People hear "orgasm" and they think it is a good thing.
The quote above is from Kim Ramsay who was interviewed by The Guardian in 2014 [4].
The condition, predominantly experienced by women, manifests as an unrelenting sensation of genital congestion and pelvic discomfort. Those affected frequently endure a perpetual sensation akin to being on the brink of orgasm without the ability to climax—a form of enduring clitoral congestion[4]. Imagine for a second if you will. You're waking up with a raging erection and you think, "Well, this is nice." and you quickly find the means to relieve that physiological demand.
...but a heaviness remains centered in your testicles and anal sphincter. It is also cyclical happening roughly every 30 minutes or so for the rest of the day as you attempt to get your kids off to school, ready yourself for work, drive or take the subway, conduct meetings, and so forth. Will you suddenly climax against your will in front of your boss, or is it during the squash game you have later with a 100M client you have been seeking to close for the company? Actually, it depends. It may reach completion, or it will drag you unwillingly to the edge and wane wistfully away only for the rollercoaster to begin once again. Oh and...masturbation makes it worse. This is what PGAD sufferers experience.
The condition typically has two clinical presentations: Those who experience arousal but no orgasms and others who experience cyclical orgasms that are usually 30--90 minutes apart [5], however; all suffers of PGAD experience pain. The sudden genital arousal is markedly different from what one experiences during desire, also known as subjective arousal. Discovery Life's, "Body Bizarre", dedicated an episode to discussing this rare disorder.
As of yet, there are few efficacious treatments. Pharmacological approaches have encompassed antidepressants, antipsychotics, mood stabilizers, and analgesics. Additionally, techniques such as validation, psycho-education, trigger identification, distraction methods, and pelvic massage have been explored [5].
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 unremitting nature of the symptoms, predisposes them to become severely depressed and even suicidal [5].
I am able to count myself among the fortunate. I am multi-orgasmic once the initial one is out of the way, but I would not want to have an orgasm just because someone bumped into me on the subway, flight turbulence during, or a bumpy Uber ride.
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