So we all understand what people mean when they say they feel sexually aroused, right? It means they feel “on”, “horny”, “hot” and so on. It means they feel ready to engage sexually, regardless of whether sexual behavior is imminent by themselves or with others (consensual, of course). Some people maintain these feelings without behaving sexually, called “simmering” by some sexual health experts (Castleman, 2018), and others may use these feelings as a signal to engage sexually. There are infinite variations in how people experience and express their sexual arousal. In general, people perceive the experience of sexual arousal as positive. By positive, we mean pleasurable and desirable, a definition supported by many magazine covers and other popular references to sexual arousal. By positive, we mean mind and body are in sync, working together, leading to that delicious feeling of sexual openness and aliveness. If you’re using this definition of sexual arousal, most of the time, you’d be right. But sometimes, you will be wrong.
Let’s agree that the process of sexual arousal is complex, much more complex than can be illuminated in this blog. It involves interactive processes of internal and external physiological, psychological, experiential and contextual factors (Basson, 2015) that are not fully understood by the brilliant minds of science or fully accounted for even by the most comprehensive models published to date. But that’s okay—we can work with the important and necessary information about sexual arousal that we’ve learned from sexuality researchers, clinicians, and others. A key message to take away is that sometimes, the mind and body are out of sync together in the experience of sexual arousal (Chivers et al., 2010) and this experience can lead to negative emotions such as distress and unpleasantness.
That’s right – sometimes, the mind and body aren’t in sync with each other or don’t agree on the experience of sexual arousal. So sometimes people can feel disruptive “in their head” and for some reason, this experience may not cross the threshold for the body to respond in a way that would normally be associated with feelings of sexual arousal, such as tingling sensations or warmth in the genital area. I’m sure most of you can relate to this experience and there are many reasons why this could be the case. Maybe the timing isn’t right (you’re about to leave for work and need to go into “work mode”), maybe the context isn’t “doing it for you” (you’re in the middle of a meeting or class and physical sexual arousal just isn’t right at the moment), or maybe you’re just feeling “meh” and sexy thoughts just float by without any traction in terms of physical response. The other side can also happen – perhaps some tingling and throbbing “down there” that has the potential to be delicious if it could cross the threshold to be welcomed and intellectually cultivated, but is not, given the context, of the disposition. of , etc. And that’s okay – most of us can relate to this experience too.
And in these cases, the disconnect between mind and body is likely not a big deal. If it doesn’t happen often, it doesn’t unduly distract us, and the feelings don’t overwhelm our senses or last an unreasonably long time. We seem to have some ability to suppress any feelings of arousal that might be inappropriate, or at least, put them aside until we can “deal” with them appropriately, whatever that might be.
It was not something.
But other sexual arousal “disconnects” may be significant in terms of symptom intensity and magnitude of distress experienced, and may therefore require clinical intervention. For example, in the case of erectile dysfunction, the physical manifestation of arousal does not occur at all or to the extent that the individual perceives it to be necessary to feel sexually fulfilled, even though there may be a lot of subjectively perceived “horns”. . The discomfort I experience may even begin to affect subjective arousal levels so that they decrease over time because “what’s the point of activating the feeling in my head when my body isn’t responding?”
The opposite can also occur, as in the case of Persistent Genital Arousal Disorder/Pelvic Genital Dysesthesia (PGAD/GPD) (Goldstein et al., 2021). PGAD/GPD is a condition in which people feel genital sensations of being turned on (such as throbbing, tingling), but do not experience subjective feelings of sexual arousal – that is, they do not feel sexually aroused ‘in their head’. Sensations of genital arousal are not fleeting, unfortunately. if it was, maybe it wouldn’t be a big deal for people who have these symptoms. PGAD/GPD symptoms, however, can persist for hours, days, weeks, and longer (Goldstein et al., 2021) and are not easily reduced by activities such as solitary or cooperative sexual engagement, distraction, exercise, relaxation, or a variety of therapeutic modalities. This experience overall can be very distressing and unpleasant (and sometimes, painful) (Goldstein et al., 2021), and both sexual and non-sexual stimuli (internal and/or external) can trigger these symptoms.
The key factors in PGAD/GPD are the important ones disconnect between the mind and the body where the body seems to be energized for sexual engagement but the mind certainly isn’t and the experience of these symptoms is distressing. Let’s be very clear: with PGAD/GPD, sensations of arousal can be triggered or heightened by mundane activities such as doing laundry, climbing stairs, riding a train, or you can always be present, regardless of whether there is something to to come back”. about’ about!
Additionally, some of you may be thinking that the symptoms of genital sexual arousal itself may not be that bad, and it is important to note that some people have persistent genital arousal sensations and are not bothered by them. In fact, they find these sensations pleasurable and fully embrace them (at least for a while). We don’t know much about this group of people, so we’ll focus on people with PGAD/GPD to make the point that the experience of sexual arousal is much more multifaceted than many people assume it is.
PGAD/GPD is a prime example of an experience that challenges our assumptions about sexual arousal. Sexual stimulation does not always represent the synergistic, stimulating, synchronization of mind and body that leads to sexual openness, and are not always experienced positively. Experiences of sexual arousal can be painful and it is important to integrate these experiences into the narrative we have, as a society, about sexual arousal to represent sexual arousal in its many forms.
Why is expanding this narrative important? Because health care providers and others may assume that all experiences of sexual arousal are inherently positive and desirable. When approached by someone who may experience painful persistent sensations of sexual arousal ‘down there’, the ‘right’ questions may not be asked. As a result, assumptions may be made that the person is “lucky” to have such intense sexual arousal, or alternatively, misdiagnosed as having excessive desire or subjective arousal, without considering disconnection, distress, etc. of our studies showed that health care providers’ dismissal of PGAD/GPD-related distress and lack of provider knowledge about PGAD/GPD were significant barriers to appropriate medical evaluation and treatment of individuals with PGAD/GPD (Jackowich et al., 2021).
SexLab will soon create a website with useful information for people with PGAD/GPD as well as healthcare providers so that we can begin to break down these barriers and ensure the effective assessment, diagnosis and treatment of those with PGAD/GPD. We will also be posting more blogs and social media information about PGAD/GPD to help get information about this condition out there. Stay tuned!
Caroline Pukall, PhD, CPsych
Évéline Poirier, MEd
bibliographical references
Basson R. (2015). Human sexual response. Handbook of clinical neurology, 130, 11–18. https://doi.org/10.1016/B978-0-444-63247-0.00002-X
Castleman, M. (2018, September 14). Simmering: An Easy, Enjoyable Way to Ignite Sexual Arousal Brief erotic fantasies hours before lovemaking can help ignite later. Psychology Today.
Chivers, ML, Seto, MC, Lalumière, ML, Laan, E., & Grimbos, T. (2010). Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Records of sexual behavior, 39(1), 5–56. https://doi.org/10.1007/s10508-009-9556-9
Goldstein, I., Komisaruk, BR, Pukall, CF, Kim, NN, Goldstein, AT, Goldstein, SW, Hartzell-Cushanick, R., Kellogg-Spadt, S., Kim, CW, Jackowich, RA, Parish, SJ , Patterson, A., Peters, KM, & Pfaus, JG (2021). International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). The Journal of Sexual Medicine, 18(4), 665–697. https://doi.org/10.1016/j.jsxm.2021.01.172
Jackowich, RA, Boyer, SC, Bienias, S., Chamberlain, S., & Pukall, CF (2021). Health care experiences of people with persistent genital arousal disorder/genital-pelvic dysesthesia. Sexual medicine, 9(3), 100335. https://doi.org/10.1016/j.esxm.2021.100335
