Persistent genital arousal disorder [PGAD] is a distressing physiologic arousal condition with no psychologic etiology. We highlight identification and treatment of PGAD and associated mental comorbidities in a 15-year-old male who presented to Pediatric Urology with PGAD with pain, and resultant depression and suicidal ideation. After failure of conservative pharmacologic management, MRI of the lumbosacral spine demonstrated an L5-S1 annular tear and herniation of the nucleus pulposus. The patient underwent transforaminal steroid injection with reduction in symptoms, and eventually lumbar discectomy with near complete resolution of symptoms. Management of this condition should include a focus on the mental health component.