Application of International Society for the Study of Women's Sexual Health consensus algorithm for persistent genital arousal disorder/genito-pelvic dysesthesia to 10 cases and use of epidural spinal injections as long term management.

Abstract

Introduction: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a debilitating, but poorly understood disorder. To address the lack of knowledge regarding mechanism and treatments, the International Society for the Study of Women's Sexual Health (ISSWSH) consensus statement proposed a region-based approach for management of PGAD/GPD, including possible etiologies. Annular tears of the lumbar intervertebral disc are a recently acknowledged etiology of PGAD/GPD, and current evidence suggests that management of symptomatic tears resistant to non-invasive treatment may require lumbar endoscopic spinal surgery.

Aim: This case series offers 10 cases of PGAD/GPD symptoms, in order to describe resource efficient management, including use of epidural spinal injections to reduce barriers to care for this debilitating condition.

Methods: Individuals were identified by investigators in clinical practice. Electronic medical record notes and relevant imaging from the past 3 years were reviewed.

Results: Half of the patients tried three or more treatments before finding any symptomatic relief. Two patients, with annular tears evident on magnetic resonance imaging (MRI), found complete relief with epidural spinal injections. A patient with hypertonic pelvic floor found total relief with pelvic floor physical therapy. Two patients found alleviation of symptoms with discontinuation of triggering medications, and four patients had palliation of symptoms with gabapentin and/or pregabalin.

Conclusion: These cases demonstrate the utility of the ISSWSH consensus algorithm in guiding initial diagnosis and treatment of PGAD/GPD. However, flexibility is important in management to choose the appropriate treatment pathway to provide the most effective symptom management. Current evidence suggests the use of epidural spinal injections for temporary symptom relief, however, this case series suggests its use for long term management.