Value of Quantitative Sensory Testing in the Evaluation of Genital Sensation: Its Application to Female Sexual Dysfunction

Introduction: Female sexual dysfunction (FSD) is multifactorial, with psychological and organic elements. Genital sensation, an important component of sexual response, has until recently not been subjected to adequate clinical appraisal. During the past 15 years we have performed Quantitative Sensory Testing (QST) to assess genital sensation in healthy women and women with FSD. Aim: To review available evidence of QST in the investigation of genital sensation in women with FSD. Methods: We examined data obtained from assessment of genital sensation in normal women and those with different conditions, including multiple sclerosis, pelvic floor disorders, effect of hysterectomy, and vulvar vestibulitis. Main Outcome Measure: Use of QST for assessment of FSD. Results: Normograms for healthy women were used to measure parameters during arousal, orgasm, and the refractory phase. Using QST, genital sensation was found to be impaired in women with multiple sclerosis. Clitoral vibratory sensation most significantly correlated with FSD parameters. Women with greater deficit in vibratory sensation encountered more sexual dysfunction. Women with urinary incontinence had a significant decrease in sensitivity to warm, cold, and vibratory thresholds in the anterior vaginal wall and clitoral area. A study comparing women with and without pelvic organ prolapse showed mean thresholds for vibratory and warm stimuli to be significantly higher and mean thresholds for cold stimuli to be significantly lower in the group with prolapse. QST of women undergoing hysterectomy showed a significant decrease in sensation to cold, warm, and vibratory stimuli at the anterior and posterior vaginal wall; clitoral thermal and vibratory sensation thresholds remained unchanged after surgery. In a study of vulvar vestibulitis, patients reported significantly lower heat pain thresholds compared with controls. Conclusion: QST appears useful for evaluating various gynecologic disorders associated with disturbed sexual function and with multiple sclerosis, which might be accompanied by disturbed genital sensation.