(064) Trigger Point Release of Post Partum Pudendal Compression Relieves Persistent Genital Arousal: Case Report

Abstract

Abstract Introduction There is very little literature available on Persistent Genital Arousal Disorder (PGAD). Recent consensus definitions have emerged from the ISSWSH working group on PGAD to expel the myth that PGAD is merely in the minds of those who suffer from it. Dr. Goldstein, et al have published research and criteria for diagnosis, and management of this condition which can be a very distressing one. Novel Non-Invasive treatment modalities are needed for the management of PGAD to prevent distress, and/or unnecessary surgery, in these patients. Objectives To determine if local trigger point treatment of the area surrounding the Pudendal Nerve as it passes the piriformis muscle, will cause relief of Persistent Genital Arousal Disorder (PGAD) in a patient suffering for the 8 months since childbirth. Methods I present a case of a new mother who suffered from severe PGAD emerging following a precipitous and somewhat traumatic childbirth. The persistent arousal was distracting, upsetting, intolerable, and only somewhat (10-20%) temporarily mitigated by very regular self-stimulation, and also with regular pelvic floor physio, in a busy new mom, who had had no such concerns before-hand. She presented to me at 8 months post-partum, with an 8 month history of PGAD. Based on history of presenting illness, the source of problem was determined to be most likely in pelvis, and potentially caused by entrapment/compression of the Pudendal Nerve. Informed Consent was obtained to attempt trigger point release of the tissues surrounding the Pudendal Nerve posteriorly, as it enters the pelvis. Using a posterior approach, using a 27g 1.5cm bevelled needle, to an area cleaned by alcohol swab, micro-dissection release was performed of area surrounding tissue the Pudendal N as it passes the piriformis muscle. Patient reported immediate and sustained relief of symptoms. Results Trigger point needling to the tissue superior to, surrounding, and including the piriformis muscle via the posterior approach caused immediate and sustained relief of the patient’s symptoms. Repeat needle treatment to this area, alternating with physiotherapy for guided relaxation and release of surrounding tissues, resolved patient’s PGAD symptoms by >95% during treatment and >85% 1 year after treatment cessation. Conclusions Trigger Point needle treatment of tissues of the muscles and piriformis muscles relieved PGAD symptoms initially caused by Pudendal Nerve entrapment/compression second to precipitous childbirth. This non-invasive approach for immediate and sustained relief of Persistent Genital Arousal Disorder should be widely taught to practitioners of Sexual Medicine, and considered in patients with neurological causes for their distressing symptoms, arising from the pelvic area. Disclosure No.