New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis.
BACKGROUND
Systematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management.


OBJECTIVE
To investigate distinct localizations of ReGS.


METHODS
Twenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test).


METHODS
Sensitivity of RIPB, GTM test.


RESULTS
Of 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination.


CONCLUSIONS
ReGS is highly associated with pelvic varices and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of persistent restless genital arousal in absence of sexual desire.
Waldinger
Marcel D
MD
Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, Leyweg 275, The Hague2545 CH, The Netherlands. md@waldinger.demon.nl
Venema
Pieter L
PL
van Gils
Ad P G
AP
Schweitzer
Dave H
DH
D000328:Adult; D000368:Aged; D001143:Arousal; D002987:Clitoris / Q000294:innervation / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006941:Hyperesthesia / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009948:Orgasm; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology*; D014621:Vagina / Q000503:physiopathology; D016387:Women's Health