Persistent Genital Arousal Disorder in 18 Dutch Women: Part I. MRI, EEG, and Transvaginal Ultrasonography Investigations

Authors

  • Marcel D. Waldinger MD, PhD,

    1. Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, The Hague, The Netherlands;
    2. Department of Psychopharmacology, Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht, The Netherlands;
    Search for more papers by this author
  • Ad P.G. Van Gils MD, PhD,

    1. Department of Radiology and Nuclear Medicine, HagaHospital Leyenburg, The Hague, The Netherlands;
    Search for more papers by this author
  • H. Pauline Ottervanger MD, PhD,

    1. Department of Obstetrics and Gynaecology, HagaHospital Leyenburg, The Hague, The Netherlands;
    Search for more papers by this author
  • Waldina V.A. Vandenbroucke MD, PhD,

    1. Department of Obstetrics and Gynaecology, HagaHospital Leyenburg, The Hague, The Netherlands;
    Search for more papers by this author
  • Dénes L.J. Tavy MD

    1. Department of Neurology and Clinical Neurophysiology, HagaHospital Leyenburg, The Hague, The Netherlands
    Search for more papers by this author

Marcel D. Waldinger, MD, PhD, Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, Leyweg 275, 2545 CH The Hague, The Netherlands. Tel: (31) 70-210-2086; Fax: (31) 70-210-4902; E-mail: md@waldinger.demon.nl

ABSTRACT

Introduction.  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.

Aim.  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.

Main Outcome Measures.  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. Waldinger MD, van Gils APG, Ottervanger HP, Vandenbroucke WVA, and Tavy DLJ. Persistent genital arousal disorder in 18 Dutch women: Part I. MRI, EEG, and transvaginal ultrasonography investigations. J Sex Med 2009;6:474–481.

Ancillary