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Examining vaginal and vulvar health and sexual dysfunction in patients with interstitial cystitis (UNICORN-1 study)

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Abstract

Introduction and hypothesis

The Vaginal Health Index Score (VHIS) and vulvodynia swab tests are used to assess vaginal health and vulvodynia. However, few studies have used these tests in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS is a chronic, debilitating disorder, characterised by urinary frequency, urinary urgency and pelvic pain. It adversely affects organs adjacent to the urinary system, leading to complications of sexual dysfunction. This study was aimed at understanding sexual dysfunction in patients with IC/BPS, as well as deterioration of vaginal health and vulvodynia.

Methods

This study compared the vaginal health of IC/BPS patients with that of asymptomatic control individuals. The Pain Urgency Frequency (PUF) score, Female Sexual Function Index (FSFI), VHIS, and vulvodynia swab tests, were used as tools. The PUF and FSFI are questionnaire-based surveys of bladder symptoms and sexual function respectively. VHIS evaluation and vulvodynia swab tests are performed by physicians. The PUF was used to assess baseline IC/BPS symptoms to validate the patient population, and FSFI, vulvodynia swab tests and VHIS were used to determine between-group differences.

Results

Thirty-seven patients were recruited in each group. The IC/BPS group had a higher PUF score (18.19±3.51 vs 3.56±2.35; p<0.05), worse total FSFI (15.72±4.46 vs 26.3±4.93; p<0.05), and worse vulvodynia swab test and total VHIS (11.59±2.87 vs 22.05±3.05; p<0.05) scores than those of the control group.

Conclusions

Asian women with IC/BPS experienced greater sexual dysfunction, worsened vaginal health and increased vulvodynia compared with control individuals. Information on vaginal and vulva health is very useful in evaluating IC/BPS patients.

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References

  1. Bogart LM, Suttorp MJ, Elliott MN, Clemens JQ, Berry SH. Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis. Urology. 2011;77:576–80. https://doi.org/10.1016/j.urology.2010.10.016.

    Article  PubMed  Google Scholar 

  2. Hanno P, Lin A, Nordling J, et al. Bladder pain syndrome committee of the international consultation on incontinence. Neurourol Urodyn. 2010;29:191–8. https://doi.org/10.1002/nau.20847.

    Article  PubMed  Google Scholar 

  3. Edwards L. New concepts in vulvodynia. Am J Obstet Gynecol. 2003;189 Supplement:S24–30. https://doi.org/10.1067/s0002-9378(03)00790-7.

    Article  PubMed  Google Scholar 

  4. Kim SJ, Kim J, Yoon H. Sexual pain and IC/BPS in women. BMC Urol. 2019;19:47. https://doi.org/10.1186/s12894-019-0478-0.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction—a case-control study. J Sex Med. 2011;8:1726–34. https://doi.org/10.1111/j.1743-6109.2011.02251.x.

    Article  PubMed  Google Scholar 

  6. Stanford EJ, Koziol J, Feng A. The prevalence of interstitial cystitis, endometriosis, adhesions, and vulvar pain in women with chronic pelvic pain. J Minim Invasive Gynecol. 2005;12:43–9. https://doi.org/10.1016/j.jmig.2004.12.016.

    Article  PubMed  Google Scholar 

  7. Lee MH, Chen WC, Chiu CD, Wu HC. Dyspareunia and chronic pelvic pain in patients with interstitial cystitis/bladder pain syndrome. Urol Sci. 2015;26:206–9. https://doi.org/10.1016/j.urols.2015.07.004.

    Article  Google Scholar 

  8. Agrawal A, Tripathy S, Kumar D. Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: a case-control study. Indian J Urol. 2020;36:212–5. https://doi.org/10.4103/iju.IJU_145_20.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fenton BW. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain. Med Hypotheses. 2007;69:282–6. https://doi.org/10.1016/j.mehy.2006.12.025.

    Article  PubMed  Google Scholar 

  10. Alvisi S, Gava G, Orsili I, et al. Vaginal health in menopausal women. Medicina (Kaunas). 2019;55:615. https://doi.org/10.3390/medicina55100615.

    Article  Google Scholar 

  11. Reed BD, Plegue MA, Harlow SD, Haefner HK, Sen A. Does degree of vulvar sensitivity predict vulvodynia characteristics and prognosis? J Pain. 2017;18:113–23. https://doi.org/10.1016/j.jpain.2016.10.006.

    Article  PubMed  Google Scholar 

  12. Gardella B, Iacobone AD, Porru D, et al. Effect of local estrogen therapy (LET) on urinary and sexual symptoms in premenopausal women with interstitial cystitis/bladder pain syndrome (IC/BPS). Gynecol Endocrinol. 2015;31:828–32. https://doi.org/10.3109/09513590.2015.1063119.

    Article  CAS  PubMed  Google Scholar 

  13. Yoon HS, Yoon H. Correlations of interstitial cystitis/painful bladder syndrome with female sexual activity. Korean J Urol. 2010;51:45–9. https://doi.org/10.4111/kju.2010.51.1.45.

    Article  PubMed  PubMed Central  Google Scholar 

  14. GIBS clinical guidelines for IC/BPS version 1.0. Accessed 5 June 2020. https://gibsociety.com/wp-content/uploads/2017/11/GIBS-Guidelines.pdf

  15. Hanno PM, Erickson D, Moldwin R, Faraday MM, American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193:1545–53. https://doi.org/10.1016/j.juro.2015.01.086.

    Article  PubMed  Google Scholar 

  16. Ens G, Garrido GL. Role of cystoscopy and hydrodistention in the diagnosis of interstitial cystitis/bladder pain syndrome. Transl Androl Urol. 2015;4:624–8. https://doi.org/10.3978/j.issn.2223-4683.2015.09.04.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Van de Merwe JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008;53:60–7. https://doi.org/10.1016/j.eururo.2007.09.019.

    Article  PubMed  Google Scholar 

  18. Parsons CL, Dell J, Stanford EJ, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002;60:573–8. https://doi.org/10.1016/s0090-4295(02)01829-0.

    Article  PubMed  Google Scholar 

  19. Homma Y, Akiyama Y, Furuta A, et al. Clinical guideline for interstitial cystitis/bladder pain syndrome. In: The Society of Interstitial Cystitis of Japan. Tokyo: RichHill Medical; 2019. p. 25.

    Google Scholar 

  20. Ng CM, Ma WK, To KC, Yiu MK. The Chinese version of the pelvic pain and urgency/frequency symptom scale: a useful assessment tool for street-ketamine abusers with lower urinary tract symptoms. Hong Kong Med J. 2012;18:123–30.

    CAS  PubMed  Google Scholar 

  21. Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208. https://doi.org/10.1080/009262300278597.

    Article  CAS  PubMed  Google Scholar 

  22. Takahashi M, Inokuchi T, Watanabe C, Saito T, Kai I. The Female Sexual Function Index (FSFI): development of a Japanese version. J Sex Med. 2011;8:2246–54. https://doi.org/10.1111/j.1743-6109.2011.02267.x.

    Article  PubMed  Google Scholar 

  23. Ma J, Pan L, Lei Y, Zhang A, Kan Y. Prevalence of female sexual dysfunction in urban Chinese women based on cutoff scores of the Chinese version of the Female Sexual Function Index: a preliminary study. J Sex Med. 2014;11:909–19. https://doi.org/10.1111/jsm.12451.

    Article  PubMed  Google Scholar 

  24. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537–44. https://doi.org/10.1001/jama.281.6.537.

    Article  CAS  PubMed  Google Scholar 

  25. Ottem DP, Carr LK, Perks AE, Lee P, Teichman JM. Interstitial cystitis and female sexual dysfunction. Urology. 2007;69:608–10. https://doi.org/10.1016/j.urology.2006.12.024.

    Article  PubMed  Google Scholar 

  26. Kahn BS, Tatro C, Parsons CL, Willems JJ. Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity. J Sex Med. 2010;7:996–1002. https://doi.org/10.1111/j.1743-6109.2009.01550.x.

    Article  PubMed  Google Scholar 

  27. Okumura K, Takeda H, Otani T. Evaluation of temporal changes in the sexual function among Japanese women using the female sexual function index: an Internet survey. Womens Health (Lond). 2021;17:17455065211009103. https://doi.org/10.1177/17455065211009103.

    Article  CAS  Google Scholar 

  28. Peters KM, Killinger KA, Carrico DJ, Ibrahim IA, Diokno AC, Graziottin A. Sexual function and sexual distress in women with interstitial cystitis: a case-control study. Urology. 2007;70:543–7. https://doi.org/10.1016/j.urology.2007.04.037.

    Article  PubMed  Google Scholar 

  29. Nickel JC, Parsons CL, Forrest J, et al. Improvement in sexual functioning in patients with interstitial cystitis/painful bladder syndrome. J Sex Med. 2008;5:394–9. https://doi.org/10.1111/j.1743-6109.2007.00686.x.

    Article  PubMed  Google Scholar 

  30. Okui N, Okui M, Vizintin Z. Effects of non-ablative vaginal erbium: YAG laser treatment for interstitial cystitis/bladder pain syndrome: a case series (UNICORN-2 study). Climacteric. 2020;23:S14–7. https://doi.org/10.1080/13697137.2019.1703940.

    Article  CAS  PubMed  Google Scholar 

  31. Gambacciani M, Cervigni M, Gaspar A, et al. Safety of vaginal erbium laser: a review of 113,000 patients treated in the past 8 years. Climacteric. 2020;23:S28–32. https://doi.org/10.1080/13697137.2020.1813098.

    Article  CAS  PubMed  Google Scholar 

  32. Robbins A, Berkley KJ, Sato Y. Estrous cycle variation of afferent fibers supplying reproductive organs in the female rat. Brain Res. 1992;596:353–6. https://doi.org/10.1016/0006-8993(92)91572-v.

    Article  CAS  PubMed  Google Scholar 

  33. Amandusson Å, Blomqvist A. Estrogenic influences in pain processing. Front Neuroendocrinol. 2013;34:329–49. https://doi.org/10.1016/j.yfrne.2013.06.001.

    Article  CAS  PubMed  Google Scholar 

  34. Acar D, Cayan S, Aktaş S, Tek M, Akbay E. The effect of tamoxifen on bladder functions and histology, and the role of estrogen receptor beta in a rat chemical cystitis model. Neurourol Urodyn. 2007;26:309–16. https://doi.org/10.1002/nau.20247.

    Article  CAS  PubMed  Google Scholar 

  35. Imamov O, Yakimchuk K, Morani A, et al. Estrogen receptor beta-deficient female mice develop a bladder phenotype resembling human interstitial cystitis. Proc Natl Acad Sci U S A. 2007;104:9806–9. https://doi.org/10.1073/pnas.0703410104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Cabral CA, Sampaio FJ, Cardoso LE. Analysis of the modifications in the composition of bladder glycosaminoglycan and collagen as a consequence of changes in sex hormones associated with puberty or oophorectomy in female rats. J Urol. 2003;170:2512–6. https://doi.org/10.1097/01.ju.0000088776.17126.93.

    Article  CAS  PubMed  Google Scholar 

  37. Okui N. Efficacy and safety of non-ablative vaginal erbium: YAG laser treatment as a novel surgical treatment for overactive bladder syndrome: comparison with anticholinergics and β3-adrenoceptor agonists. World J Urol. 2019;37:2459–66. https://doi.org/10.1007/s00345-019-02644-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Gambacciani M, Fidecicchi T. Short-term effects of an erbium/neodymium laser combination in superficial dyspareunia: a pilot study. Climacteric. 2022;25:208–11. https://doi.org/10.1080/13697137.2021.2014809.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Editage for language editing.

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No research funding was received for this study.

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Contributions

N. Okui: research inspiration or design, data collection, data analysis and interpretation, writing a dissertation and approval of the final draft; M. Okui: data collection, writing a dissertation and approval of final draft; M. Gambacciani: significant revision of the dissertation and approval of the final draft.

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Correspondence to Nobuo Okui.

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All authors declare that no support, financial or otherwise, has been received from any organisation that may have an interest in the submitted work; and that there are no other relationships or activities that could appear to have influenced the submitted work.

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Informed consent was obtained from all patients included in this study.

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Okui, N., Okui, M. & Gambacciani, M. Examining vaginal and vulvar health and sexual dysfunction in patients with interstitial cystitis (UNICORN-1 study). Int Urogynecol J 33, 2493–2499 (2022). https://doi.org/10.1007/s00192-022-05220-7

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