Dear Alice,

I have a really big problem. I have orgasms all the time! Some people might like this, but I don't. And, it's really embarrassing when I get one in the middle of class. It's not because I get turned on, it just happens. If someone sits on my lap, I get one! It's very embarrassing, and I don't know why it happens. Also, my vagina sometimes hurts and itches and sometimes has a foul odor. I want to go to the gyno to get this checked out, but I'm afraid I'll have an orgasm while the doctor is examining me! Please help! I'm too embarrassed to tell anyone about this.

Dear Reader,

You’re not alone in experiencing orgasms (a release of the build-up of sexual tension) or other symptoms of sexual arousal even without being “turned on.” In fact, these symptoms may be a sign of persistent genital arousal disorder (PGAD), sometimes referred to as persistent sexual arousal syndrome (PSAS). PGAD is a disorder primarily experienced by those assigned female at birth (although those assigned male at birth may also experience it), in which people have sudden and frequent genital arousal that is different from sexual arousal associated with desire. PGAD is sometimes confused with hypersexuality, but it’s worth highlighting that these are two separate phenomena. While hypersexuality is considered excessive desire with or without persistent genital arousal, PGAD is defined as persistent arousal or orgasm that’s unrelated to sexual desire. PGAD is often triggered by nonsexual stimulation (such as someone sitting on your lap) or have no apparent cause at all. To answer your question about vaginal itching and odor, you may want to see a health care provider, as pain, itching, or unusual odors may be the result of an infection (more on this in a bit). Read on for more information, tips for managing your symptoms, and about ways health care providers may be able to help with the symptoms you're experiencing.

This disorder is associated with the following symptoms:

  • The bodily responses that are associated with sexual arousal last for hours or days and they don't go away on their own.
  • Even after one or more orgasms, genital arousal doesn't go away completely.
  • The genital arousal isn't wanted and intrusive to the person experiencing it.
  • Activities that are nonsexual, such as bumpy car rides, can trigger genital arousal or orgasm.
  • The experience causes feelings of distress.

Unfortunately, there are only theories (both physical and psychological) about the potential causes of PGAD, making treatment challenging. Just because there’s no causal understanding of or traditional treatment for PGAD, that's not to say symptom management is a lost cause. There are ways by which you can try to address the orgasms, such as monitoring the onset to investigate potentially avoidable triggers. For example, if you think tight clothing could be a trigger, consider wearing looser bottoms, dresses, or skirts. Being able to predict when an orgasm might occur may also allow you to be prepared, or excuse yourself to somewhere more private, such as the bathroom. You mentioned that you orgasm if someone sits on your lap. Have you considered letting them know that you find this to be uncomfortable and prefer that they sit somewhere else? Another option is to do Kegel exercises, in which you relax your pelvic muscles and then release any tension as you notice it building. Keep in mind that these tips may require some trial and error — consider taking some time to figure out which, if any, will work for you.

In addition to some of the do-it-yourself options for symptom management, it’s good to talk with a health care provider for additional insight into and assistance with your symptoms. Medical professionals may be able to offer a diagnosis or recommend a specialist to address potential underlying causes of PGAD, and mental health professionals may be able to assist with the frustration and embarrassment those with PGAD often experience. The idea of consulting with a professional may be distressing, but ideally, you'd leave with more information than you have now and increasing your quality of life. They can also help with your concerns regarding vaginal pain, itching, and odor, as these symptoms could be signs of an infection and may in fact be unrelated to your frequent orgasms. While potentially uncomfortable to discuss with a professional, it’s worth noting that many patients pass gas, urinate, orgasm, and have erections during physical examinations. Providers know that it’s impossible to control certain bodily functions, but letting them know about your frequent orgasms can prepare them, if you experience one during your visit.

Best of luck on your quest for relief,

Alice!

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