Restless Genital Syndrome

What is Restless Genital Syndrome?

Restless Genital Syndrome is somatosensory disorder involves genital organs in pelvis region with the occurrence of meddling, impetuous and unwanted genital arousal in the absence of libido¹.

Restless Genital Syndrome History

Restless Genital Syndrome is a relatively newer disorder first described by  Sandra Leiblum in 2001. Initially, it is termed as “persistent sexual arousal syndrome”. After the incessant study, it has been understood that the characteristic features of this syndrome not related to sexual arousal, but related to abnormal genital sensation and in 2003 the name of the syndrome switched to “persistent genital arousal disorder”. In 2009, the Prof. Waldinger referred this abnormality as Restless Genital Syndrome, because he found restless legs has a close association with this syndrome^1,2.

Symptoms

Patients with Restless Genital Syndrome usually complain following symptoms arise around the external genital organs, although they unable to explain the intrusive and unwanted symptoms.

• Burning sensation
• Tingling
• Pain
• Itching
• Throbbing
• Pulsating
• Close to orgasm sensation
• Urgent urge to masturbate
• restless legs
• Repeated urge to void

The symptoms persist for a whole day or longer period. The patients suffering from Restless Genital Syndrome usually do not free to discuss their trouble due to embarrassment and fear of social isolation.

The symptoms get aggravated after masturbation and sexual intercourse. Sitting down position can also exacerbate the symptoms^2,3.

Causes

Researchers conducted research to evaluate the cause of the RGS development. The research reported stated that a sensory neuropathy is responsible behind this symptom. Dorsal nerve, a tiny nerve present around the clitoris mainly affected. Anatomically, Dorsal nerve is a distant branch of the pudendal nerve, which is sited at the left and right side of the adjoined part of the vagina and clitoris. Researchers expected following are the different conditions when Hormonal alterations occur and produce favorable pathophysiological condition involves in Restless Genital Syndrome development:

1. Hormonal alteration

• Estrogen level changes before onset of menstruation
• At the last trimester of the pregnancy
• Before and after onset of menopause
• Treatment of anti-estrogens therapy in medical condition like breast cancer

2. Treatment with antidepressant drugs can cause this syndrome during the treatment or dose reduction, or after discontinuation of the therapy.

The following pathophysiology may have a role in RGS development:

• More pathophysiological investigational studies provide more about the progression of Restless Genital Syndrome. The involved mechanism may include an iron deficiency in the CNS (central nervous system); circadian rhythm abnormality and defective functionality of neurotransmitters, such as opioids, dopamine, and glutamate.
• Researchers also expected abnormal genetic mutation may involve in this syndrome, as 40% to 60% affected patients have a family history of Restless leg syndrome. Yet now six genes have been recognized as risk factors of Restless Genital Syndrome.
• Apart from genetic involvement, some acquired conditions like iron deficiency, neuropathy, renal impairment, pregnancy, myelopathy, Parkinson disease and multiple sclerosis have possessed a role in Restless Leg Syndrome, though the exact correlation with Restless Genital Syndrome is not clearly understood. The involvement of this acquired conditions with the Restless Genital Syndrome is still undiscovered^1,2,3.

Who are Affected?

Previously, it is assumed that women only get affected with Restless Genital Syndrome after the onset of menopause. But later continuous research discovered that both men and women can get this abnormality at any age. Children can even affect with RGS.

Patients with Parkinson’s disease have greater tendency to develop Restless Genital Syndrome. The estimated value showed that approximately eleven percent to twenty five percent patients with Parkinson’s disease have suffered from RGS. Though all the patients having RGS do not have Parkinson’s disease. It has been found that anti-parkinsonian drugs attributed genital pain and may cause RGS progression^2,3.

Treatment

The therapeutic agents, which are used for Restless Leg Syndrome may effective in RGS also, as both the diseases are probably shared the same spectrum. Clinicians found that dopamine agonists like rotigotine, ropinirole and pramipexole are efficiently treated Restless Genital Syndrome.

Other drugs like gabapentin, levodopa and pregabalin do not usually recommended due to their side effects and also causes spreading of the symptoms to other adjoined parts of the body. In some cases, drugs like clonazepam and Opioids gives the successful result. The clinician also prescribes iron supplementation in a patient with decreased level of ferritin.

Human case study report showed that only medical therapy is not the only option to treat a patient with Restless Genital Syndrome. A combination therapy means transcutaneous electrical nerve stimulation with drugs like oxazepam, clonazepam, lidocaine or tramadol along with psychotherapeutic counseling is the most suitable treatment approach for Restless Genital Syndrome.

Ongoing research on a pudendal block by injecting anesthetizes medicine on the targeted nerve may provide the effective result to treat RGS^1,2,4.

References

1. Bret S. Stetka; What Is Restless Genital Syndrome? Online available at http://www.medscape.com/viewarticle/840692_2
2. Restless Genital Syndrome; Online available at http://www.restlessgenitalsyndrome.com/en/Restless Genital Syndrome (ReGS); Online available at http://www.psas.nl/en/
3.  Marygrace Taylor; ‘Restless Genital Syndrome’: A New Medical Disorder for Men; http://www.menshealth.com/health/restless-genital-syndrome-defined
4. Spoelstra SK, Waldinger M, Nijhuis ER, Weijmar Schultz WC.; [A woman with restless genital syndrome: a difficult-to-treat condition]; Ned Tijdschr Geneeskd. 2013;157(16):A5805.; https://www.ncbi.nlm.nih.gov/pubmed/23594872