-
The Journal of Sexual Medicine Apr 2021Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial...
International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD).
BACKGROUND
Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood.
AIM
To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management.
METHODS
A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment.
OUTCOMES
The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed.
RESULTS
The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress.
CLINICAL IMPLICATIONS
The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment.
STRENGTHS AND LIMITATIONS
Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion.
CONCLUSION
We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665-697.
Topics: Arousal; Consensus; Female; Genitalia; Humans; Paresthesia; Pelvis; Sexual Dysfunctions, Psychological; Sexual Health
PubMed: 33612417
DOI: 10.1016/j.jsxm.2021.01.172 -
The Journal of Spinal Cord Medicine 2009Tarlov cysts or spinal perineurial cysts are uncommon lesions. These are mostly incidental findings on magnetic resonance imaging or myelograms. The objectives of this... (Review)
Review
BACKGROUND/OBJECTIVE
Tarlov cysts or spinal perineurial cysts are uncommon lesions. These are mostly incidental findings on magnetic resonance imaging or myelograms. The objectives of this study were to describe Tarlov cysts of the sacral region as a potential cause for retrograde ejaculations and review available management options.
METHODS
Case report and literature review.
RESULTS
A 28-year-old man presented with back pain and retrograde ejaculations resulting in infertility. After microsurgical excision of large perineurial cysts, back pain resolved, but semen quality showed only marginal improvement. Later, the couple successfully conceived by intrauterine insemination. To the best of our knowledge, this is the first reported case of Tarlov cyst associated with retrograde ejaculation and infertility.
CONCLUSIONS
Despite being mostly asymptomatic and an incidental finding, Tarlov cyst is an important clinical entity because of its tendency to increase in size with time. Tarlov cysts of the sacral and cauda equina region may be a rare underlying cause in otherwise unexplained retrograde ejaculations and infertility. Microsurgical excision may be a good option in a select group of patients.
Topics: Adult; Humans; Infertility, Male; Laminectomy; Magnetic Resonance Imaging; Male; Microsurgery; Tarlov Cysts
PubMed: 19569467
DOI: 10.1080/10790268.2009.11760771 -
International Journal of Surgery Case... 2017Tarlov cysts were first described in 1938 as an incidental finding at autopsy. The cysts are usually diagnosed on MRI, which reveals the lesion arising from the sacral...
Tarlov cysts were first described in 1938 as an incidental finding at autopsy. The cysts are usually diagnosed on MRI, which reveals the lesion arising from the sacral nerve root near the dorsal root ganglion. Symptomatic sacral perineural cysts are uncommon and it is recommended to consider Tarlov cyst as a diagnostic of exclusion. We report a case of a patient with voluminous bilateral L5 and S1 Tarlov cyst, and right hip osteonecrosis to increase the awareness in the orthopaedic community. A 57-year-old female, in good health, with chronic low back pain since 20 years, presented suddenly right buttock pain, right inguinal fold pain and low back pain for two months, with inability to walk and to sit down. X-ray of the lumbo-sacral spine revealed asymmetric discopathy L5-S1 and L3-L4. X-ray of the right hip did not reveal anything. We asked for an MRI of the spine and it revealed a voluminous fluid-filled cystic lesion, arising from the first sacral nerve root on both side and measuring 3,3cm in diameter. The MRI also show a part of the hip and incidentally we discovered an osteonecrosis Ficat 3 of the right femoral head. The patient was taken for a total hip arthroplasty, by anterior approach. Patient appreciated relief of pain immediately after the surgery. The current case show that even if we find a voluminous cyst we always have to eliminate other diagnosis (especially the frequent like osteonecrosis of the femoral head) and mostly in the case of unclear neurological perturbation.
PubMed: 28787671
DOI: 10.1016/j.ijscr.2017.07.045 -
Journal of Spine Surgery (Hong Kong) Dec 2019Tarlov cyst disease is a collection of cerebrospinal fluid between the endoneurium and perineurium of spinal, usually sacral, nerve roots. These cysts can become...
BACKGROUND
Tarlov cyst disease is a collection of cerebrospinal fluid between the endoneurium and perineurium of spinal, usually sacral, nerve roots. These cysts can become symptomatic in 20% of patients, causing lower back pain, radiculopathy, bladder and bowel dysfunction necessitating medical or surgical intervention. Different surgical and non-surgical modalities have been described for the treatment of symptomatic Tarlov cysts. However, there has been no published study that examined types of surgical techniques side by side. Our study presents a preliminary experience in the surgical management of symptomatic Tarlov cysts using two surgical techniques: cyst fenestration and nerve root imbrication.
METHODS
Retrospective chart review and analysis was done for all patients who underwent surgical intervention for symptomatic Tarlov cyst(s) in the period 2007-2013. Operative reports, preoperative and postoperative clinic visit reports were reviewed. The surgical techniques of cyst fenestration and nerve root imbrication were each described in terms of intraoperative parameters, hospital course and outcome. Modified MacNab criteria were used for evaluation of the final clinical outcome.
RESULTS
Thirty-six surgical patients were identified. Three had repeat surgery (total of 39 operations). The median age was 51 years (range, 26-84 years). Eighty-six percent were females. The presenting symptoms were low back pain (94%), sensory radiculopathy (69%), bladder and bowel dysfunction (61%), sexual dysfunction (17%) and motor dysfunction (8%). Cyst fenestration was performed in 12 patients (31%) and nerve root imbrication was done in 27 (69%). All patients in the fenestration group but only 67% in the imbrication group had fibrin glue injection into the cyst or around the reconstructed nerve root. The overall surgery-related complication rate was 28%. The complication rate was 5/12 (42%) in the fenestration group and 6/27 (22%) in the imbrication group. At the time of the last clinic visit, improved clinical outcome was noted in 9/11 (82%) and 20/25 (80%) in the fenestration and the imbrication group, respectively.
CONCLUSIONS
Cyst fenestration and nerve root imbrication are both surgical techniques to treat symptomatic Tarlov cyst(s), and both can result in clinical improvement.
PubMed: 32043000
DOI: 10.21037/jss.2019.11.11 -
European Journal of Medical Research May 2021Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a Tarlov cyst with spermatorrhea and review the...
BACKGROUND
Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a Tarlov cyst with spermatorrhea and review the pertinent literature.
CASE PRESENTATION
A 42-year-old male patient had a history of spermatorrhea for > 10 years, but was incorrectly diagnosed as the patient and the doctors consistently mistook the symptoms for a genitourinary disease. Magnetic resonance imaging showed that two cysts in the sacral canal. The diagnosis was Tarlov cyst. We performed surgery to remove the cyst and the symptoms of spermatorrhea disappeared after the operation.
CONCLUSIONS
This case demonstrates that orthopedics and urologists should improve their understanding of Tarlov cysts to avoid misdiagnosis and mistreatment.
Topics: Adult; Diagnostic Errors; Genital Diseases, Male; Humans; Male; Tarlov Cysts
PubMed: 33964972
DOI: 10.1186/s40001-021-00514-w -
Acta Medica Portuguesa 2008Tarlov's cyst or perineurial cyst is disease on portion of the posterior nerve root in lumbo-sacral region. The lack of knowledge of physicians around the world about... (Review)
Review
Tarlov's cyst or perineurial cyst is disease on portion of the posterior nerve root in lumbo-sacral region. The lack of knowledge of physicians around the world about Tarlov's cyst as to their nature, significance and treatment also with differential diagnostics to radiculopathy in legs. With review of literature discuss about definition, etiopathogenesis, diagnostic investigation and treatment clinic and/or surgery. The pathogenesis Tarlov's cyst remains unclear; several cases have history of the trauma, old hemorrhage, congenital and iatrogenic. Cysts provoke low back pain, sacral radiculopathy, dyspareunia, urinary incontence. The magnetic resonance imaging is now the gold standard to diagnose cysts. The treatment is clinic or surgery depending neurologics finding and neuroimage.
Topics: Humans; Tarlov Cysts
PubMed: 18625096
DOI: No ID Found -
BMJ Case Reports Mar 2019A 65-year-old patient presenting with left labial and perirectal pain was diagnosed with bilateral Tarlov cysts. Upon treatment of the left Tarlov cyst (the right was...
A 65-year-old patient presenting with left labial and perirectal pain was diagnosed with bilateral Tarlov cysts. Upon treatment of the left Tarlov cyst (the right was asymptomatic) using image-guided aspiration and subsequent injection of the cyst with fibrin sealant, the cyst reduced in size. To our knowledge, there are currently no other documented cases in which the Tarlov cyst reduced in size following this procedure. This case would seem to suggest that clinicians are poorly informed with regard to Tarlov cysts. These cysts are more common in Caucasian women, many of whom are told their cysts are not responsible for their pain or that they are not treatable. However, there is clear evidence that some Tarlov cysts are symptomatic and minimally invasive procedures have been developed to treat them. As they primarily occur in women, it is possible gender bias may also play a role in the delayed diagnosis of the patient's pain.
Topics: Aged; Female; Fibrin Tissue Adhesive; Humans; Paracentesis; Tarlov Cysts; Tissue Adhesives; Treatment Outcome
PubMed: 30852497
DOI: 10.1136/bcr-2018-227256 -
International Journal of Surgery Case... Jan 2022Although asymptomatic Tarlov cysts (TCs) are reported in up to 13% of the population, symptomatic TCs are rare (less than 1%), making the management of the symptomatic...
INTRODUCTION AND IMPORTANCE
Although asymptomatic Tarlov cysts (TCs) are reported in up to 13% of the population, symptomatic TCs are rare (less than 1%), making the management of the symptomatic cysts controversial. The most common location of symptomatic TCs is sacral nerve roots where they can cause pelvic, perineal chronic discomfort and pain, and lower extremity sensory and motor changes. Ventral (intrapelvic retroperitoneal) sacral TCs are extremely rare with no management recommendations. Available surgical options include cyst resection, and inlet-obliteration, however, these methods are often considered invasive and not definitive.
CASE PRESENTATION
A 39-year-old woman presented with debilitating low back pain (LBP) radiating to her pelvis and the right lower extremity for 4 years. Magnetic Resonance Imaging (MRI) showed multiple sacral nerve root TCs including a large retroperitoneal right S3 TC. Surgical resection of the right S3 cyst was achieved utilizing a robot-assisted anterior approach which provided excellent visualization and maneuverability in the targeted retroperitoneal space. Postoperatively, the patient experienced significant pain relief, and she was able to perform activities of daily life and return to work.
CLINICAL DISCUSSION
Robotic-assisted pelvic surgery has gained widespread popularity in the last two decades due to its many potential benefits. Utilizing robotic systems in sacral nerve sheath lesions shows a promise to deliver effective minimally invasive surgical management without sacrificing good visualization or instrument maneuverability.
CONCLUSION
Robot-assisted resection of sacral nerve roots TCs represents a minimally invasive and safe surgical option to manage cysts located anterior to the sacrum in the pelvic retroperitoneal space.
PubMed: 34998266
DOI: 10.1016/j.ijscr.2021.106732 -
Archives of Sexual Behavior Apr 2024Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to...
Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to produce symptoms resembling disk herniation. We report a rare case of a sacral cyst resulting in premature ejaculation in a 32-year-old man who presented with pelvic pain and acquired premature ejaculation. Spinal nerve root decompression, excision of intraspinal Tarlov cyst, and spinal nerve root adhesion release surgery significantly improved his pain and premature ejaculation at a six-month follow-up.
Topics: Male; Humans; Adult; Tarlov Cysts; Premature Ejaculation; Pelvic Pain; Magnetic Resonance Imaging
PubMed: 38366312
DOI: 10.1007/s10508-024-02815-7