Persistent genital arousal disorder (PGAD), also known as persistent sexual arousal syndrome (PSAS) or restless genital syndrome (ReGS), is a recently recognized sexual health condition characterized by spontaneous and intrusive feelings of genital arousal in the absence of sexual thoughts or stimuli. PGAD is not included in DSM IV or ICD 10. Although predominantly reported in women, cases in men are rare. This case report describes a 54-year-old male with PGAD who presented with constant physical arousal and distressing symptoms of spontaneous genital sensations, exacerbated by anxiety and partially relieved by ejaculation. Despite a full urological and neurological workup, no organic cause was identified. Treatment with diazepam and pregabalin resulted in significant symptom relief. This case supports the hypothesis that PGAD may have both physical and psychological components, possibly as a psychosomatic condition affecting the peripheral nerves of the genito-urinary system. Further research is needed to explore the pathophysiology and management of PGAD.