(097) Psychosocial Factors in PGAD/GPD Patients Who Underwent Spine Surgery for Lumbosacral Annular Tear-Induced Sacral Radiculopathy
Authors: Hartzell-Cushanick R , Goldstein SW , Goldstein I , Komisaruk BR , Kim NN , Yee A , Kim CW 
Published: February 2024

Abstract

Introduction
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is characterized by persistent or recurrent, unwanted or intrusive, distressing sensations of genital arousal not associated with concomitant sexual interest, thoughts, or fantasies and/or other symptoms of GPD (e.g. itching, burning, throbbing, pain) that persist for ≥3 months. Multiple psychological and medical factors may contribute to the development and maintenance of PGAD/GPD. Concerning psychologic factors, women afflicted with PGAD experience more than double the rate of suicidal ideation (54%) compared to a control group, difficulty with mental health issues such as depression, high rates of negative emotions, and substantial difficulties with psychosocial adjustment.

Objective
This study focuses on psychosocial factors identified in a cohort of PGAD/GPD patients diagnosed with lumbosacral annular tear-induced sacral radiculopathy.

Methods
Using our multidisciplinary spine-sexual medicine management algorithm, 20 patients (15 cisgendered women, 5 cisgendered men, mean age 40.3 ± 16.8 years) diagnosed with PGAD/GPD fulfilled criteria for lumbosacral annular tear-induced sacral radiculopathy. A total of 22 lumbar endoscopic spine surgery (LESS) procedures were performed in these 20 patients. Validated instruments administered included the Sexual Distress Scale-Revised, Perceived Stress Scale, and Patient Health Questionnaire-9. The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy.

Results
Ninety percent of patients were advised to undergo therapy. Our study cohort exhibited high levels of anxiety, depression, and/or obsessive-compulsive disorder as well as suicidal ideation. The Sexual Distress Scale–Revised revealed significant distress in 14 patients (82%). The Perceived Stress Scale showed 2 (12%) having high stress, 12 (70%) having moderate stress, and 3 patients (18%) having low stress. As assessed by item 1 of the Patient Health Questionnaire-9, 3 patients had a score consistent with warranting treatment for depression while an additional 10 had a score consistent with the possible need for treatment based on clinical judgment. As assessed by item 2 (“How difficult is it for you to do your work, take care of things at home, or get along with other people?”), 13 (65%) reported difficulties, with 3(15%) extremely difficult, 5 (25%) very, and 5 (25%) somewhat difficult. Overall, 7 (35%) showed improvement on the Patient Global Impression of Improvement after 3 months and by one year post-operatively, 80% (16/20) reported improvement.

Conclusions
There are many recognized triggers for PGAD/GPD. While this subgroup was diagnosed with lumbosacral annular tear-induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS, psychological factors likely contributed to the development, continuation, and consequences of PGAD/GPD. We believe that the significant mental health issues in this PGAD/GPD patient population made recovery from LESS more protracted than typically experienced after this surgery for sciatica alone. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Eliquence.