The other day, a few media outlets in the New York region covered the story of a woman who can’t seem to stop having orgasms, which would seem joke-ready but can actually be a nightmare.

While the New Jersey woman’s condition has not been formally diagnosed, it appears she has persistent genital arousal disorder (PGAD), something we explored years ago. 

The syndrome usually manifests as a constant blood engorgement of the female genitals, mainly the clitoris. This creates a sensation of needing “relief.” Cue the jokes. But imagine constantly sensing the need for orgasm at work, on the bus, while visiting with friends, and then finding no relief, or only very temporary relief, if you masturbate. Genitals can become highly sensitive, and sore. Sufferers describe feelings of isolation and mental anguish.

Unfortunately, nobody is quite sure what causes it or how to treat it, but, according to Jim Pfaus, a researcher at Montreal’s Concordia University who studies the neuroscience of sexual response, and who is currently engaged in studying persistent genital arousal, there are enough clues to develop a working theory.

“The root cause,” he explained, “may be an irritation of the clitoral sensory nerves.” The brain interprets this sensation and sets off a cascade of events.

A brain region called the pro-optic area responds to dopamine signaling by sending out instructions for the body to prepare for sex, as if a woman has been engaged in foreplay when, in fact, she’s not remotely in a sexual context. Blood flows to the genitals. “So we think that this blood flow is in a state of hyperarousal in women with PGAD,” Pfaus said. “They get engorgement quickly, reach orgasm quickly when they try to relieve themselves. It shares features with premature ejaculation and priapism” in men.

That’s consistent with observations others have made. For example, Barry Komisaruk at Rutgers University found that of a group of 18 women with PGAD, 12 had cysts on nerves in the sacral region of their spines. The cysts may be stimulating clitoral nerves.

A variety of drug therapies (there’s even one report of a physical therapy involving manipulation of muscles in the region) have shown to help. SSRIs, commonly used for depression, seem to provide some relief. But Pfaus believes the drug varenicline (Chantix, commonly used for smoking cessation) is most promising. It works by interrupting the signaling that leads to dopamine release. Blood stops flowing.

While the therapy has worked in scores of women, Pfaus said, the drug isn’t perfect. “Unfortunately it comes back when they go off it.” 

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com) to be published Sept. 13.

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