021 The Role of Office-Based Somatic and Autonomic Neuro-Genital Testing of Persistent Genitourinary Numbness in Women

Abstract

In women with sexual dysfunction, a bothersome/distressing symptom is persistent numbness in the genitourinary region, the clitoris, vagina and urethra. Women with persistent numbness often find it difficult to feel their clitoris when touched, or feel objects placed within their vagina, or feel urine flowing in their urethra. This symptom often leads to orgasmic dysfunction and limited sexual pleasure. Using office-based neuro-genital testing, we examined the integrity of the somatic and autonomic neurologic pathways of genitourinary sensation to better understand the etiology of female genitourinary sensory impairment. Office-based neuro-genital testing includes quantitative sensory testing, sacral and foot dermatome testing, bulbocavernosus reflex latency testing, vaginal pelvic afferent nerve testing and urethral pelvic afferent nerve testing. Quantitative sensory testing measures somatic vibration, cold, and heat perception threshold values in the glans clitoris, right and left inner surface of labia minora, and uses the right pulp index finger threshold values as the control. Sacral and foot dermatome testing measures somatic vibration perception in the right and left gluteal, thigh, calf, heel, arch, medial and lateral aspects of the foot, using the right pulp index finger threshold values as the control. Bulbocavernosus reflex latency testing with electromyographic monitoring of the external anal sphincter muscle contraction measures the integrity of the somatic sensory and motor neural pathways in response to mechanical stimulations of the glans clitoris. The vaginal pelvic afferent neural pathway test measure visceral awareness of distension of an anorectal (up to 60 ml) balloon within the vagina. The urethral pelvic afferent neural pathway test measure visceral awareness of distension of a Foley catheter (up to 0.4 ml) balloon within the urethra.