Restless genital syndrome before and after clitoridectomy for spontaneous orgasms: a case report.

INTRODUCTION: Females despairing of restless genital syndrome (ReGS) may request clitoridectomy for treatment of unwanted genital sensations. Aim. The aim of this study was to report persistence of ReGS despite clitoridectomy. METHODS: Following a clitoridectomy for spontaneous orgasms, a 77-year-old woman was referred to our clinic for persistent unwanted genital sensations and feelings of imminent orgasm. An in-depth interview, routine and hormonal investigations, electroencephalography (EEG) and magnetic resonance imaging (MRI) of the brain and pelvis were performed. The localizations of genital sensations were investigated by manual examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab. MAIN OUTCOME MEASURES: The main outcome measures included sensitivity of dorsal nerve of the clitoris in RIPB and MRI-pelvis. RESULTS: Genital dysesthesias, paresthesias, intolerance (allodynia) for tight clothes, aggravation of symptoms during sitting, restless legs, and overactive bladder were diagnosed. Laboratory assessments, and EEG and MRI of the brain were in agreement with aging, but all results were within the normal range. MRI of the pelvis disclosed varices of the uterus and of the left ovarian vein, and a visible scar in the region of the clitoris. Sensory testing of the genital area showed various points of static mechanical hyperesthesia at the left dermatome of the pudendal nerve. Manual examination of the RIPB also elicited the genital sensations at the left side of the vagina at about the 3 o'clock position. CONCLUSIONS: This patient fulfilled all clinical criteria of ReGS that is believed to be caused by neuropathy of the left pudendal nerve. Clitoridectomy abolished spontaneous orgasms for a great part but not completely, and it did not diminish the typical dysesthesias, paresthesias, and feelings of imminent orgasms that typically belong to ReGS. Clitoridectomy is no optional treatment of ReGS. There is a need for publications of ReGS in general medical journals.

The Union between gracilis and sartorius muscles in leontopithecus: morphofunctional analysis

RESUMEN: El Tití León Dorado, (Leontopithecus rosalia) es un primate (especie de los Tamarinos y Titíes) de la foresta atlántica brasileña en serio riesgo de extinción. Poco se conoce acerca de su anatomía, específicamente de las uniones musculares. Debido a ello, con el objetivo de comprender la locomoción de éste y otros primates, estudiamos la morfología y morfometría de los músculos grácil y sartorio y la relación entre ellos, en 3 especies de Leontopithecus rosalia. Se examinaron 18 animales adultos, de ambos sexos, sin anormalidades físicas en la región estudiada. El material pertenece a la colección del Centro de Primatología de Rio de Janeiro, Brasil. Los miembros posteriores fueron disecados hasta el nivel de los músculos grácil y sartorio, donde se efectuó la morfometría, obteniéndose, entre los músculos mencionados un área para su análisis histológico. Describimos la morfología de los músculos grácil y sartorio. Se obtuvieron valores promedio de la morfometría muscular y se estudió histológicamente la unión entre esos músculos. El análisis morfológico y morfométrico permite sugerir parámetros descriptivos de esos músculos. El análisis histológico permite concluir que las fibras del músculo grácil y del músculo sartorio no están fusionadas sino que se mantienen juntas a través de tejido conjuntivo, así, se insertan en el lado medial de la tibia. Funcionalmente, creemos que los músculos grácil y sartorio contribuyen a una activa contención de la articulación de la rodilla y sobre la biomecánica de los miembros posteriores de esos primates, conocidos como corredores.

[Traction on the orthopedic table and pudendal nerve injury. Importance of electrophysiologic examination]. / Tractions sur table orthopédique et atteinte du nerf pudendal. Intérêt des explorations électrophysiologiques.

PURPOSE OF THE STUDY: We performed a retrospective study about perioperative pudendal nerve palsy following fracture table tractions. MATERIAL: Six palsies were investigated. Mean age was 26 years. All of them presented sensitive and motor dysfunctions secondary to nerve compression following tractions on the fracture table. METHODS: All of them had complete electrophysiological recordings including perineal electromyogram, measurement of sacral roots latencies, sensory velocity of the dorsal nerve of the penis, somatosensory evoked potentials of the pudendal nerve and measurement of its terminal branches. RESULTS: Neurological symptoms were stereotyped associating sensory signs and sexual disorders, must of them being transient. Perineal electrophysiological examination always confirmed reality of pudendal nerve palsy. DISCUSSION: We discuss incidence, mechanism, etiology and prevention of this pudendal nerve palsy. CONCLUSION: Emergence of stereotyped perineal symptoms following orthopaedic surgery, especially after tractions on fracture table, must prevail on physicians to search for pudendal nerve palsy. Usual outcome is good in the six months following surgery, but definitive aftermath does occur. Perineal electrophysiological examination can confirm pudendal nerve palsy and give prognosis elements.

An electrophysiological study of somatic and visceral convergence in the reflex control of the external sphincters.

1. Mass wave and single unit discharges have been recorded from pudendal efferents innervating the external anal and urethral sphincters in chloralose anaesthetized or decerebrate cats.2. Reflex discharges in these neurones were elicited by electrical stimulation of the contralateral pudendal nerve, the posterior cutaneous nerve of thigh, or the vesical or colonic branches of the pelvic nerve. The latencies of the evoked responses were 5.5-20 msec. The vesical branches of the pelvic nerve produced discharges less consistently than the other nerves.3. Irrespective of whether afferent stimulation produced an early evoked response there was always a prolonged period of depression of pudendal nerve excitability following the stimulus. Condition-test interactions showed that this depression began within 50 msec of the stimulus and that its duration varied between 150 and 2500 msec in single units, with a modal value of 500 msec.4. No evoked response or depression of excitability was seen when afferents in the hypogastric or lumbar colonic nerves were stimulated.5. Increasing intravesical or intracolonic pressure, within physiological limits, produced a graded reduction in the size of evoked discharges.6. Short trains of stimuli (four shocks in 20 msec) applied to the raphé nucleus, were capable of inhibiting test responses in pudendal efferents for periods of up to 800 msec.7. The possible functional roles of two groups of sphincteric reflex interneurones, with either excitatory or inhibitory receptive fields, are discussed.