Physical arousal caused by PGAD can be very intense and persist for extended periods, days or weeks at a time.[3][4] Symptoms include pressure, pain, irritation, clitoral tingling, throbbing, vaginal congestion, vaginal contractions, and sometimes spontaneous orgasms.[3] Pressure, discomfort, pounding, pulsating, throbbing or engorgement may include the clitoris, labia, vagina, perineum, or the anus.[8] The symptoms may result from sexual activity or from no identified stimulus, and are not relieved by orgasm except for cases where multiple orgasms over hours or days allow for relief.[4] The symptoms can impede on home or work life.[3][6] Women may feel embarrassment or shame, and avoid sexual relationships, because of the disorder.[3][4] Stress can make the symptoms worse.[6][8]