(270) Application of ISSWSH Consensus PGAD/GPD Diagnostic Algorithm to Eight Cases

Abstract

Abstract Introduction Persistent Genital Arousal Disorder/Genito-Pelvic Dysthesia (PGAD/GPD) is a debilitating, but the mechanism of disease and treatment are poorly understood. To address this gap in knowledge, the ISSWSH consensus statement proposed a diagnostic and treatment algorithm for PGAD/GPD. The algorithm proposes five possible regions of etiologies for the purposes of diagnosis and treatment. These regions include end organ (clitoris, vagina, vulva, etc), pelvis/perineum, spinal cord, cauda equina and brain. Objective The purpose of this retrospective case series is to apply the ISSWSH diagnostic and treatment algorithm to nine cases, in order to demonstrate the efficacy of the algorithm, as well as present uniform manner for reviewing PGAD/GPD cases. Methods Individuals were identified by the Principal Investigator and colleagues. ISSWSH diagnostic and treatment algorithm was used to note pertinent positives and negatives in history and physical exam, as well as analyze treatment. Results Cases of eight patients are reviewed using the algorithm to analyze the treatments and possible etiologies of each patient. Patients presented anywhere from experiencing symptoms for five days to three years. Half of the patients experienced relief of symptoms with treatment of lumbar pathology demonstrated on MRI. Four of the patients found relief with spinal epidural injections performed by a pain medicine physician, two found relief with pelvic floor physical therapy and two found relief with medications including gabapentin and pregabalin. Conclusions These cases demonstrate the utility of the ISSWSH consensus algorithm in guiding initial diagnosis and treatment of PGAD/GPD. However, it has limitations due to the multifactorial nature of PGAD/GPD, it is helpful in guiding initial treatment of the disorder. The cases in this series illustrate the importance of MRI in diagnosis of PGAD/GPD etiologies. Fifty percent of the cases in this series included an MRI that revealed lumbar pathologies that could be managed by pain management physician. As shown in these cases, PGAD/GPD can have a significant negative impact on mental health and activities of daily living, therefore it is critical to be systematic and efficient. The steps demonstrated to be most important in these cases include review of recent medication changes, physical examination (with anesthesia testing, if possible), lumbar MRI and referral to pain medicine specialist. The primary limitation of this study is that it is a retrospective chart review and as such, there was no standardization of the work up for each patient and information on each patient was limited to the notes in their charts. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson and Johnson.