(004) Using Genital Anesthesia Testing (GAT) in the Management of Bothersome Genital Dysesthesia

Abstract Introduction For women experiencing bothersome genital arousal, pain, or other dysesthesia symptoms (e.g. feelings of itching, burning, pulsating, tearing), it is important to ascertain whether are secondary pathology in the area, referred from upstream pelvis perineum, cauda equina, spine, and/or brain regions. Specific understanding location trigger associated with critical directing treatments for disease modification management. Objectives The aim this study review methodology minimally-invasive anesthesia testing including clitoral test (CAT – Figures 1a, 1b), vestibular (VAT Figure 2), urethral (UAT) Bartholin cyst (BAT). Methods Prior patient documents symptom score intensity on a scale 0 10 where most severe. It that have significant specific region(s) (clitoris, vestibule, meatus Bartholin’s cyst); may need perform some maneuvers reduce discontinue medications offer relief dysesthesia. area be tested demarcated under vulvoscopic examination marking pen. Using cotton swab as an applicator, benzocaine (20%), lidocaine (8%), tetracaine (BLT) first applied inner arm assess allergies. Assuming there no allergic reaction, BLT generously region. If needed, local subcutaneous administration 1% using 30-gauge needle can supplement anesthesia. After minutes, provocative performed determine not clinically reduction pre-genital score. Results A positive consistent intensity. implies region cyst) so appropriate treatment strategies offered. example, CAT require lysis adhesions. VAT hormone management mediated vestibulodynia, vestibulectomy neuro-proliferative vestibulodynia. UAT surgical reconstruction meatus. BAT marsupialization. negative leading integrity pudendal nerve assessment equina neuro-genital and lumbar/sacral MRI. Conclusions Genital excellent minimally invasive, office diagnostic help localize Recognizing emanating rather than region, will allow clitoris, cyst. Disclosure No.