Dysasthetic penile scrotodynia - a psychosexual somatoform disorder
Long, V1; Elpern, DJ2
1: Department of General Medicine, Singapore; 2: Skin Clinic, Williamstown, Massachusetts, USA
Objectives: Dysaesthetic Penile Scrotodynia (DPSD), first coined in 2002, is a similar condition to vulvodynia, whereby men present with a sensation of burning genitalia skin without dermatoses or physical signs. It is poorly understood with no clear underlying aetiology. We propose that DPSD may be a manifestation of psychosexual disorder, and may be relieved by treatment of underlying psychological conditions. We report a case arising in a 23 year-old male with review of existing literature.
Material and Methods: Articles from year 2000- present were retrieved from PubMed using the search terms “penile scrotodynia”, “male genital pain” and “penoscrotal pain”.
Case details: A 23 year-old male reports of persistent penoscrotal pain extending to his perineum over 2 years with unusual sensations over his upper limbs. He has no significant medical history, however has moderately severe depression on long term sertraline. Examination reveals scattered Fordyce spots on his lips, with normal genitalia and perineum. He was diagnosed with DPSD and brachioradial pruritus.
Results: There is a paucity of literature on DPSD. Anyasodor et al(2016) proposed that DPSD may be linked to underlying psychopathology, and that psychodermatological treatment may improve genital symptoms. In their review of 10 patients, 4 had underlying psychiatric disorders. Seven patients had been treated with antidepressants/antipsychotics, and 100% had improved or had near resolution of symptoms. The experience with our patient is similar – with improvement reported on continued antidepressant therapy and bland moisturizer applied to his genitalia.
Conclusion: Recognizing that DPSD may be intrinsically linked to psychological somatoform/somatization disorders may facilitate opportune treatment with mood modulators. Whilst previous studies have shown only variable success with amitriptyline, gabapentin and medications used for neuropathic pain, a new paradigm shift in thinking would be to treat DPSD with antidepressants. More studies with validated questionnaires can assist with defining and tailoring therapy for this disorder.
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