So, we all understand what people mean when they say that they are feeling sexually aroused, right? It means they are feeling “turned on”, “horny”, “hot”, and so on. It means that they feel ready to engage sexually, whether or not sexual behaviour by themselves or with others (consensually, of course) is imminent. Some people hold on to 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 of how people experience and manifest their sexual arousal. Generally, people perceive the experience of sexual arousal as positive. By positive, we mean pleasurable and wanted, a definition that is supported by many magazine covers and other popular references to sexual arousal. By positive, we mean that mind and body are in sync, working together, leading to that yummy feeling of sexual openness and aliveness. If you use this definition of sexual arousal, most of the time, you will be right. But some of the time, 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 science’s brilliant minds or fully accounted for by even the most comprehensive models that have been published to date. But that’s ok – we can work with the significant and indispensable information about sexual arousal that we have learned from sexuality researchers, clinicians, and others. One main message to take away is that sometimes, the mind and body do not sync together in the experience of sexual arousal (Chivers et al., 2010), and this experience may result in negative feelings, like distress and unpleasantness.
That’s right – sometimes, the mind and body do not sync together or agree in the experience of sexual arousal. So, sometimes people may feel turned on “in their heads,” and for some reason, this experience may not pass a threshold for the body to respond in a way that one would usually associate with feelings of sexual arousal, like sensations of tingling or warmth in the genital area. I am sure that most of you can relate to this experience, and there are tons of reasons why this could happen. Perhaps the timing is just not right (you are about to leave for work and have to shift to “work mode”), maybe the context just isn’t “doing it for you” (you are in the middle of a meeting or class and being physically sexually aroused is just not appropriate at the moment), or maybe you are just feeling “meh” and the sexy thoughts just pass by without any traction in terms of bodily response. The flip side can also happen – perhaps some tingling and throbbing “down there” that has the potential to be delicious if only it could pass the threshold to be welcomed and cultivated mentally, but it just isn’t, given the context, one’s mood, etc. And that’s ok – most of us can relate to this experience as well.
And in these cases, the disconnect between mind and body is likely no big deal. If it doesn’t happen often, we are not unduly distracted by it, and the feelings are not overtaking our senses or lasting an unreasonably long amount of time. We seem to have some ability to suppress whatever arousal feelings may be out of place, or at least, put them aside until we can “deal” with them appropriately, whatever that may look like.
No big deal.
But other sexual arousal “disconnects” can be significant in terms of the intensity of symptoms and the amount of distress experienced, and as a result, may require clinical intervention. For example, in the case of erectile disorder, the physical manifestation of arousal doesn’t happen at all or to the degree that the person perceives to be needed to feel sexually fulfilled, even though there may be a lot of subjectively perceived “horniness”. The distress experienced may even start to affect the levels of subjective horniness experienced, such that they diminish over time because “what’s the point of feeling turned on in my head when my body doesn’t respond?”
The opposite may also happen, as in the case of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) (Goldstein et al., 2021). PGAD/GPD is a condition in which people experience genital sensations of feeling turned on (like throbbing, tingling), but they do not experience subjective feelings of sexual arousal – that is, they do not feel sexually aroused “in their heads.” The sensations of genital arousal are not fleeting, unfortunately; if they were, perhaps it would not be a big deal for the people who have these symptoms. The symptoms of PGAD/GPD, though, can persist for hours, days, weeks, and longer (Goldstein et al., 2021), and they are not easily diminished via activities like solitary or partnered sexual engagement, distraction, exercise, relaxation, or a variety of treatment regimens. This experience overall can be very distressing and unpleasant (and sometimes, painful) (Goldstein et al., 2021), and both sexual and nonsexual stimuli (internal and/or external) can trigger these symptoms.
The key factors in PGAD/GPD are the significant disconnect between mind and body in which the body seems revved up for sexual engagement, but the mind is most definitely not, and the experience of these symptoms is distressing. Let’s be very clear: with PGAD/GPD the arousal sensations can be brought on or ramped up by mundane activities like doing laundry, going up stairs, riding a train, or can be always present, regardless of whether there is anything to be “turned on” about!
As an aside, some of you might be thinking that the genital sexual arousal symptoms themselves may not be so bad, and it is important to note that some people have persistent genital arousal sensations and are not distressed by them. In fact, they find these sensations pleasurable and embrace them fully (at least for a while). We do not know much about this group of individuals, so we will focus on those with PGAD/GPD to make the point that the experience of sexual arousal is much more multifaceted than many people assume it to be.
PGAD/GPD is a prime example of an experience that challenges our assumptions of sexual arousal. Sexual arousal does not always represent the synergistic, stimulating, syncing of mind and body that leads to sexual openness, and it is not always experienced positively. Experiences of sexual arousal can be distressing, and it is important to incorporate these experiences to the narrative that we, as a society, have about sexual arousal to represent sexual arousal in its many forms.
Why is expanding this narrative important? Because healthcare providers and others may assume that all experiences of sexual arousal are inherently positive and wanted. When approached by someone who may experience distressing 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 strong sexual arousal, or alternatively, be misdiagnosed as having too much desire or subjective arousal, without considering the disconnect, the distress, etc. In fact, one of our studies indicated that invalidation of the distress associated with PGAD/GPD by healthcare providers and lack of provider knowledge about PGAD/GPD were significant barriers to appropriate medical assessment and treatment of those with PGAD/GPD (Jackowich et al., 2021).
SexLab will soon be building a website with useful information for those with PGAD/GPD as well as for healthcare providers so that we can start breaking down these barriers and ensure effective assessment, diagnosis, and treatment of those with PGAD/GPD. We will also be publishing more blogs and social media tidbits about PGAD/GPD to help get information on this condition out there. Stay tuned!
Caroline Pukall, PhD, CPsych
Évéline Poirier, MEd
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, Sept 14). Simmering: An Easy, Enjoyable Way to Kindle Sexual Arousal Brief erotic fantasies hours before lovemaking can help ignite later heat. Psychology Today. https://www.psychologytoday.com/ca/blog/all-about-sex/201809/simmering-easy-enjoyable-way-kindle-sexual-arousal
Chivers, M. L., Seto, M. C., Lalumière, M. L., Laan, E., & Grimbos, T. (2010). Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Archives of sexual behavior, 39(1), 5–56. https://doi.org/10.1007/s10508-009-9556-9
Goldstein, I., Komisaruk, B. R., Pukall, C. F., Kim, N. N., Goldstein, A. T., Goldstein, S. W., Hartzell-Cushanick, R., Kellogg-Spadt, S., Kim, C. W., Jackowich, R. A., Parish, S. J., Patterson, A., Peters, K. M., & Pfaus, J. G. (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, R. A., Boyer, S. C., Bienias, S., Chamberlain, S., & Pukall, C. F. (2021). Healthcare Experiences of Individuals With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia. Sexual medicine, 9(3), 100335. https://doi.org/10.1016/j.esxm.2021.100335
