Case notes
A 25-year-old woman, gravida 0, who had an 18-month history of severe swelling of the labia minora during and after intercourse was examined. This was extremely painful and associated with intense pelvic pressure and urinary urgency during intercourse only. Swelling usually resolved approximately 12 hours later. The patient also experienced unwanted persistent genital arousal.
She reported that, before the previous 18 months, intercourse had been symptom-free, and she could not identify any new inciting factors. Her medical history was unremarkable. On physical examination, her external genitalia were exceedingly edematous and tender ( Figure 1 ). A grade 2 cystocele and hypertonicity and tenderness of the levator ani muscles were identified. The uterus and cervix were unremarkable with no apical prolapse. No urinary incontinence was noted with cough.
Conclusions
The patient received a diagnosis of intermittent edema of the labia minora, hypertonic pelvic floor muscle dysfunction, and persistent genital arousal disorder. In addition, the patient was referred to a specialist in adult genetics for evaluation of suspected Ehlers-Danlos Syndrome (EDS). In a focused review of systems during the genetics consultation, she reported easy bruising, joint pain, and costochondritis. Her family history revealed a fatal brain aneurysm at age 53 in her maternal grandfather and hyperextensible skin in her mother and brother.
Physical examination showed joint hypermobility with a Beighton score of 5 and hyperextensibility of the skin, which are findings that, combined with a positive family history, led to a diagnosis of EDS, hypermobility type, or EDS type III. The patient was referred for intravaginal pelvic floor physical therapy, a specialized form of rehabilitation that involves myofascial trigger-point release, mobilization, and massage, that helped to decrease the severity and frequency of labial edema ( Figure 2 ). Treatment with sertraline was initiated to alleviate persistent genital arousal.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
