Persistent Sexual Arousal Syndrome (PSAS): Understanding and Treatment Options

Overview

Persistent Sexual Arousal Syndrome (PSAS) is a complex pelvic health condition that can significantly impact daily life and wellbeing. Characterized by unwanted physical sensations of arousal occurring without sexual desire or stimulation, PSAS presents unique challenges that require specialized care and understanding. These persistent symptoms can last for extended periods, creating both physical discomfort and emotional distress for those affected.

While PSAS was once considered rare, growing awareness has revealed that it affects people across various age groups and demographics. Though exact statistics remain limited due to underreporting, research suggests that this condition impacts quality of life significantly, affecting everything from work performance to personal relationships. The good news is that with proper diagnosis and treatment, including specialized pelvic floor physical therapy, many individuals find relief and improved symptom management.

At Mendwell Pelvic Health, we recognize that discussing PSAS can be challenging. Our team of experienced pelvic health physical therapists provides compassionate, evidence-based care in a safe and supportive environment. We understand that each person's experience with PSAS is unique, and we're committed to developing personalized treatment approaches that address both the physical and emotional aspects of this condition.

Symptoms

Living with PSAS can be physically and emotionally challenging. Common symptoms include:

• Persistent genital arousal sensations that occur spontaneously and without desire, potentially lasting hours or days. These sensations can be particularly distressing as they don't respond to typical relief measures and may interfere with daily activities.
• Physical discomfort ranging from mild to severe, often including sensations of pressure, engorgement, or throbbing. Many patients report that these symptoms worsen with prolonged sitting or specific movements, making routine activities challenging.
• Associated pelvic floor dysfunction symptoms such as muscle tension, lower back pain, and hip discomfort. These secondary symptoms can develop as the body responds to ongoing discomfort and stress.

Beyond these physical manifestations, PSAS often creates significant emotional and psychological challenges. Many individuals experience:

• Anxiety and distress about symptom occurrence, particularly in public or professional settings
• Sleep disruption due to persistent symptoms
• Difficulty maintaining focus during daily activities
• Impact on personal relationships and intimacy
• Potential social isolation due to symptom management needs

Causes

Understanding the underlying causes of PSAS is crucial for effective treatment. This condition typically results from a complex interplay of physical, neurological, and sometimes psychological factors. Recent research has highlighted several key mechanisms that may contribute to PSAS development:

Neurological Factors often play a central role in PSAS development:

• Central nervous system sensitization can lead to heightened response patterns, causing the brain and nervous system to maintain arousal signals inappropriately. This process may be similar to other chronic pain conditions where normal sensations become amplified.
• Pudendal nerve involvement, whether through compression, irritation, or entrapment, may trigger or maintain PSAS symptoms. This important pelvic nerve carries sensation from the genital region and can become sensitized under certain conditions.

Physical contributors can include:

• Pelvic floor muscle dysfunction, particularly involving muscle tension or spasm, which can affect blood flow and nerve function in the pelvic region. This may create a cycle of tension and discomfort that maintains symptoms.
• Vascular changes affecting pelvic blood flow, potentially related to medications, underlying health conditions, or anatomical variations. These changes can impact how blood flows through the pelvic region and influence symptom patterns.

Additional factors that may contribute to or exacerbate PSAS include:

• Hormonal fluctuations or imbalances, particularly during significant life changes such as perimenopause or postpartum periods
• Medication side effects, especially from certain antidepressants or blood pressure medications
• Recent pelvic surgery or trauma that may have affected local nerve or tissue function
• Chronic stress impact on the autonomic nervous system, which can influence pelvic floor function and sensation

How Pelvic Floor Physical Therapy Can Help

At Mendwell Pelvic Health, we take a comprehensive approach to treating PSAS through specialized pelvic floor physical therapy. Our evidence-based treatment strategies focus on addressing both the primary symptoms and any contributing factors that may be maintaining the condition.

Our treatment approach begins with a thorough evaluation to understand your specific symptoms, their impact on your daily life, and any factors that may be contributing to your condition. This comprehensive assessment allows us to develop a personalized treatment plan that may include:

Manual Therapy Techniques:

• Gentle soft tissue mobilization to address muscle tension
• Specialized nerve mobilization techniques when appropriate
• Myofascial release to improve tissue mobility and reduce discomfort
• Joint mobilization to address any contributing biomechanical factors

Neuromuscular Retraining:

• Real-time ultrasound biofeedback to improve awareness and control of pelvic floor muscles
• Breathing exercises coordinated with pelvic floor relaxation
• Progressive muscle relaxation techniques
• Movement pattern retraining to optimize pelvic function

Education and Self-Management Strategies:

• Understanding pain science and nervous system regulation
• Practical strategies for symptom management in daily life
• Activity modification guidance to reduce symptom triggers
• Stress management and relaxation techniques

Treatment Outcomes and Expectations

While every individual's experience with PSAS is unique, many patients experience significant improvement through dedicated pelvic floor physical therapy. Treatment typically progresses through several phases:

Initial Phase:

• Focus on symptom management strategies
• Introduction to gentle manual therapy techniques
• Beginning education about pain science and pelvic floor function
• Implementation of basic home program elements

Progressive Phase:

• Advancement of manual therapy techniques as appropriate
• Integration of more complex movement patterns
• Refinement of self-management strategies
• Progress in activity modification and return to daily activities

Maintenance Phase:

• Development of long-term management strategies
• Focus on prevention of symptom recurrence
• Integration of wellness strategies for overall pelvic health
• Planning for continued self-management

Frequently Asked Questions

What should I expect during my first pelvic floor physical therapy appointment for PSAS?
‍Your initial visit will focus on understanding your symptoms, medical history, and specific concerns. We'll discuss your goals for treatment and perform appropriate assessments to develop your personalized treatment plan. All examinations are conducted with your comfort and consent as our primary concern.

How does physical therapy treatment for PSAS differ from other pelvic health conditions?
‍Treatment for PSAS specifically targets the nervous system, pelvic floor muscle tension, and associated symptoms through specialized techniques while considering the unique impact of persistent arousal symptoms on daily function.

How often will I need to attend physical therapy sessions for PSAS?
‍Treatment frequency typically begins with weekly sessions and adjusts based on your progress and response to treatment. Most patients attend sessions for 8-12 weeks, though this can vary based on individual needs and symptom severity.

Can PSAS symptoms completely resolve with physical therapy?
‍While complete resolution is possible, many patients experience significant improvement in symptom management and quality of life, even if some symptoms persist. Our goal is to help you develop effective management strategies and improve your overall function and comfort.

Are there specific activities I should avoid with PSAS?
‍Activity modifications are highly individual. During treatment, we'll help you identify any specific triggers and develop strategies to maintain an active lifestyle while managing symptoms effectively.