019 Neurogenic Persistent Genital Arousal Disorder (PGAD) Secondary to Radiculopathy of Sacral Spinal Nerve Roots (SSNR): Treatment Outcome Following Spine Surgery

PGAD may be considered a chronic GU dysesthesia disorder characterized by persistent unwanted, intrusive, distressing feelings of genital arousal, or genital itch, or genital pain not associated with concomitant sexual interest, thoughts, or fantasies. PGAD is associated with despair, emotional lability, catastrophizing, and/or suicidality. First described in 2001, numerous biopsychosocial pathophysiologies of PGAD have been remained described. In general, PGAD management has been traditionally focused on symptom-reduction with conservative strategies versus disease modification strategies and surgical-based cure. Neurogenic-based PGAD may result, in part, from irritated sensory/afferent nerves, either from neuropathy of dorsal, perineal, inferior rectal or pudendal nerves, or radiculopathy of sacral (S2,3,4) spinal nerve roots (SSNR) within the cauda equina. When appropriate, the latter may be managed by spine surgery. The aim of this study was to review PGAD treatment outcomes of those patients considered to have radiculopathy of SSNR within the cauda equina. 16 women and 6 men with PGAD (mean age 30 years) secondary to radiculopathy of SSNR within the cauda equina underwent spine surgery and had at least 3 months follow-up. Spine surgery included repair of lumbar/sacral pathologies (one had 2 pathologies) such as an annular tear (n=16), facet cyst (n=1), spinal stenosis (n=1), spondylolisthesis (n=1) and/or Tarlov cyst (n=3). Pre-operative evaluation included: abnormalities on neurogenital testing, identification of treatable spinal abnormalities on lumbar/sacral MRI, and significant symptom reduction during lidocaine/steroid transforaminal epidural spine injection (TFESI) of suspected lumbar pathology or caudal block for suspected sacral pathology. The main outcome was patient global impression of improvement (PGI-I) based on “much improved” or “very much improved” post spine surgery. Secondary outcomes included multiple patient reported outcome questionnaires.