New Insights into Restless Genital Syndrome: Static Mechanical Hyperesthesia and Neuropathy of the Nervus Dorsalis Clitoridis |
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| Authors: | Marcel D Waldinger Pieter L Venema Ad PG Van Gils Dave H Schweitzer |
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| Institution: | 2. Department of Psychopharmacology, Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht, The Netherlands;3. Outpatient Department of Continence, HagaHospital Leyenburg, The Hague, The Netherlands;4. Department of Radiology and Nuclear Medicine, Haga Hospital Leyenburg, The Hague, The Netherlands;5. Department of Internal Medicine and Endocrinology, Reinier de Graaf Groep Hospital, Delft-Voorburg, The Netherlands;1. Department of Medicine, McGill University, Montréal, QC;2. The Ottawa Hospital Research Institute, Ottawa, ON;3. Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON;4. Department of Medicine, University of Ottawa, Ottawa, ON;5. Department of Anesthesiology, The Ottawa Hospital, Ottawa, ON;1. Department of Neuroscience, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA;2. Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA |
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| Abstract: | IntroductionSystematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management.AimTo investigate distinct localizations of ReGS.MethodsTwenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test).Main Outcome MeasuresSensitivity of RIPB, GTM test.ResultsOf 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination.ConclusionsReGS is highly associated with pelvic varices and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of persistent restless genital arousal in absence of sexual desire. Waldinger MD, Venema PL, van Gils APG, and Schweitzer DH. New insights into restless genital syndrome: Static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis. J Sex Med 2009;6:2778–2787. |
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