(074) Low-Grade Papillary Urothelial Carcinoma of the Bladder Presenting as Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: A Case Report

Abstract Introduction Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) is a distressing condition characterized by unwanted genital arousal in the absence of sexual desire. Its etiology spans multiple anatomical and neurological regions, from end-organ dysfunction to central nervous system dysregulation. While prior research has linked PGAD/GPD to conditions such as interstitial cystitis, urethritis, and pudendal neuropathy, an association with bladder cancer has not previously been described. Objective This case report presents the first documented case of papillary urothelial carcinoma of the bladder presenting as PGAD/GPD in a young female patient. This presentation aims to describe the clinical presentation, diagnostic evaluation, and pathophysiological mechanism underlying PGAD/GPD secondary to bladder cancer, as well as to highlight implications for diagnostic vigilance in young female patients with complex pelvic sensory symptoms. Methods The research consisted of retrospective chart review and prospective analysis. The patient underwent comprehensive medical evaluation including urinalysis, bladder imaging, cystoscopy, and transurethral resection of bladder tumor (TURBT). Clinical data were supplemented by patient interviews and validated symptom questionnaires, including the Persistent Genital Arousal Scale Questionnaire (PGASQ), Pain Catastrophizing Scale (PCS), and Beck Depression Inventory (BDI). Results A 26-year-old female with a history of pelvic floor hypertonicity, vulvodynia, and recurrent dysuria presented with a three-month history of persistent clitoral throbbing, urinary urgency, and dysesthesia radiating to the legs and lower back. Initial workup, including lumbosacral MRI, was unremarkable. Bladder ultrasound and cystoscopy identified a 7 × 5 × 6 mm papillary lesion on the left posterior bladder wall, subsequently confirmed as low-grade, non-invasive papillary urothelial carcinoma (Ta). Following TURBT, the patient’s PGAD/GPD symptoms completely resolved within three months, with no recurrence on follow-up cystoscopies at 3 and 9 months. Symptom relapse at eight months correlated with squamous metaplasia at the left trigone but no tumour recurrence. Two years post-fulguration, she remained free of cancer and severe genito-pelvic symptoms, with significantly improved PGASQ, PCS, and BDI scores. Conclusions This case represents the first reported instance of PGAD/GPD secondary to papillary urothelial carcinoma of the bladder. The findings suggest that localized bladder pathology can trigger widespread sensory and motor disturbances through central cross-sensitization of pelvic, pudendal, and sciatic nerve pathways at the conus medullaris. Recognition of bladder cancer as a potential underlying etiology of PGAD/GPD, even in young, low-risk patients, expands the diagnostic framework for genito-pelvic dysesthesia and highlights the need for interdisciplinary collaboration in evaluating complex sexual medicine presentations. Further research is warranted to elucidate the neurophysiologic mechanisms linking urological malignancy and central sensitization syndromes. Disclosure No.