Interstitial Cystitis is Associated with Vulvodynia and Sexual Dysfunction—A Case-Control Study

Abstract

Introduction Dyspareunia and sexual dysfunction are common in women with urological disorders. The study of comorbidity between interstitial cystitis (IC) and vulvodynia seems to be relevant to understand the mechanism generating pain in these conditions. Aim To conduct a case-control study for evaluating vulvodynia and sexual dysfunction in women with IC. Methods Forty-seven women with new diagnosis (National Institutes of Health [NIH]/National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] Criteria) of IC were compared with 188 age-matched, negative controls. Each woman completed a semi-structured interview and the Female Sexual Function Index (FSFI). A gynecological examination to assess vulvodynia (cotton swab testing) and genital health (vulvoscopy, Pap smear, culture, and vaginal health index score [VHIS]) was performed. Main Outcome Measures Prevalence of vulvodynia, sexual function, and sociodemographic/gynecological variables significantly associated with IC. Results Spontaneous or provoked vulvodynia was reported by 23.4% and 74.5% of IC cases, respectively. Sexual function was significantly impaired (median total FSFI score: IC cases 16.85 ± 8.73 vs. controls 27.34 ± 6.41; P <0.0001) in sexually active women, and 23.4% of IC cases as compared to 9% of controls reported no sexual activity in the year preceding the study (χ2 for trend=38.2, P <0.0001). VHIS was highly impaired in women with IC in comparison with controls (P <0.0001). Variables significantly associated with IC were a diagnosis of menopause (odds ratio [OR]=31.2, 95% confidence interval [CI]=8.1–120.5), past (OR=4.6, 95% CI=1.74–12.1) or current (OR=6.9, 95% CI=2.1–22.1) oral contraceptive use, and a histologically confirmed diagnosis of endometriosis (OR=3.7, 95% CI=1.1–12.7). Conclusion We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormone-dependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted.

Stress and Chronic Pelvic Pain

“…28,127,169,[181][182][183][184][185] Strong evidence has linked early life adverse events with an increased likelihood of vulvodynia in adulthood, which has been attributed to dysfunctional regulation of the HPA axis. 28,30,175,186 Vulvodynia patients demonstrate blunted serum cortisol cycles 186 and acute stress exposure has been shown to increase symptom severity.…”

Effect of local estrogen therapy (LET) on urinary and sexual symptoms in premenopausal women with interstitial cystitis/bladder pain syndrome (IC/BPS)

“…Patients were recruited among women with IC/BPS diagnosed according to the criteria of National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Disease (NIDDK), as previously described [13]. Briefly, all patients were diagnosed by the modified Parsons potassium sensitivity test and 21 patients (61.76%) by hydrodistension cystoscopy with bladder biopsy under sedation or spinal anesthesia at the discretion of the urologist (D. P.) [14].…”

“…Given the evidence that IC/BPS symptoms are associated with an impairment of vulvo-vaginal health and vulvodynia [12,13], regardless of the menopausal state, it is likely that sex hormone-dependent mechanisms may be involved into the association between vulvar and bladder pain leading to female sexual dysfunction (FSD) even in premenopausal women.…”

Is a Sexual Dysfunction Domain Necessary to UPOINT System for Women with Interstitial Cystitis/ Bladder Pain Syndrome-A Comment

“…Strikingly, sexual dysfunction is present in 88% of female patients with IC/BPS [2]. These women experience dyspareunia, often in conjunction with other forms of chronic pelvic pain [3]. Patients with IC/BPS avoid sex because of a fear of the pain experience [4].…”