title: Persistent genital arousal disorder in 18 Dutch women: Part I. MRI, EEG, and transvaginal ultrasonography investigations.
abstract: BACKGROUND
  Systematic blood analysis and electroencephalographic (EEG) and magnetic resonance imaging (MRI) study in women with persistent genital arousal disorder (PGAD) are needed to get more insight into the syndrome's etiology and pathogenesis.
  
  
  OBJECTIVE
  To investigate possible causes of PGAD.
  
  
  METHODS
  Eighteen women fulfilling all five criteria of PGAD were included in the study. In-depth interviews and routine blood and hormonal investigations, together with EEG and MRI scans of the brain and pelvis, were performed in all women. Transvaginal ultrasonography (TVUS) and MRI scans with contrast were performed in subjects who had indications of abnormalities on MRI scans.
  
  
  METHODS
  Detailed descriptions of blood, neurophysiological, and (neuro)anatomical findings.
  
  
  RESULTS
  The majority of women experienced PGAD symptoms during early menopause without existing laboratory abnormalities, besides those belonging to menopause. The EEG studies showed no severe diffuse or focal abnormalities. The MRI scans of the brain did not show any specific abnormalities, apart from an already known pericallosal aneurysm in one patient and postoperative findings of meningioma surgery in another patient. MRI scans of the pelvis showed clear to moderate-clear indications of pelvic varices in 55% of the women. TVUS confirmed the existence of pelvic varices in nine women; these had a mild, moderate, and severe extent in two, three, and four women. In three of the latter four patients, an additional MRI with gadolinium contrast disclosed mild to moderate dilation of ovarian veins; 39% of the women were known with varices of one or both legs.
  
  
  CONCLUSIONS
  The current study did not show overt pathology that could causally explain PGAD sensations. As pelvic varices are a common finding in adult women, the current findings do not allow the conclusion that PGAD is causally related to pelvic varices. However, the high prevalence of pelvic and lower limb varices in the current group of women warrants further research of their role in PGAD.
authors.affiliation: Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, The Hague, The Netherlands. md@waldinger.demon.nl
authors.forename: Marcel D
authors.initials: MD
authors.lastname: Waldinger
authors.forename: Ad P G
authors.initials: AP
authors.lastname: van Gils
authors.forename: H Pauline
authors.initials: HP
authors.lastname: Ottervanger
authors.forename: Waldina V A
authors.initials: WV
authors.lastname: Vandenbroucke
authors.forename: Dénes L J
authors.initials: DL
authors.lastname: Tavy
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography; D005260:Female; D005836:Genitalia, Female / Q000033:anatomy & histology* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009426:Netherlands; D012720:Severity of Illness Index; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis* / Q000503:physiopathology*; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging*