Urinary Frequency and Pelvic Pain

Abstract

A 41-yr-old woman complains of urinary frequency and pelvic pain. Three years earlier, she began to have “recurrent urinary tract infections.” Cultures were always negative. Since then, she has developed significant urinary frequency and pelvic pain that seems to intensify when she needs to void. She also has significant dyspareunia and says this is ruining her life. She has had a normal office cystoscopy, normal pelvic magnetic resonance imaging (MRI), and urodynamic studies that show early sensation of need to void but no detrusor overactivity or emptying problems. She has been on Elmiron, Atarax, multiple anticholinergics, amitriptylene, and occasionally narcotics for the pain—all without any significant improvement. On exam, she has no prolapse but does have diffuse tenderness throughout the vagina and appears to have a tense pelvic floor by palpation.