What We Know about Sexual Pain and IC/BPS in Women - Beyond the Abstract

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disease of chronic pain and its characteristics can be diverse. Patients with IC/BPS are categorized into 2 types based on their dominant symptoms: those with bladder-associated symptoms and those with other pelvic-organ symptoms. In addition, other chronic pain conditions, such as fibromyalgia and irritable bowel syndrome, often coexist with IC/BPS. A recent study reported that chronic pain conditions and psychological disorders, such as anxiety and mood disorder, could be risk factors of IC/BPS.1 These findings suggest potential organ cross talk or central sensitization mechanisms.  

Sexual dysfunction is a common problem observed in women with IC/BPS. Sexual pain disorders, such as vulvodynia and dyspareunia, are associated with low sexual activity and decreased quality of life (QoL) in women with IC/BPS.2 There are several reports showing a high prevalence of sexual pain disorder in women with IC/BPS and suggesting a relationship between sexual pain disorder and IC/BPS. However, much of these previous reports are not comprehensive. Therefore, we performed a review of the literature on sexual pain disorder and IC/BPS in women to elucidate the relationship between sexual pain and IC/BPS.3

Previous studies have demonstrated that a majority of women with IC/BPS experience some kind of sexual pain, such as vulvodynia. Interestingly, other studies have also shown a high prevalence of IC/BPS in women with vulvodynia. Based on these reports, we described several points in our recently published review paper:3 Does IC/BPS induce vulvodynia? Does vulvodynia induce IC/BPS? Or is it possible that IC/BPS and vulvodynia are one disease? Unfortunately, although there are several reports showing a strong relationship between IC/BPS and vulvodynia, an exact explanation is not possible yet. Pain hypersensitivity, peripheral and central mechanisms, and visceral nerve cross talk are currently proposed as underlying mechanisms. IC/BPS and vulvodynia are serious diseases that can impair normal daily activity and decrease QoL in women. Therefore, appropriate diagnosis and treatment are very important. However, because of its frequent overlap in symptom presentation, it is not easy to distinguish IC/BPS from vulvodynia or vulvodynia from IC/BPS. Based on these findings and the current situation, we propose a symptoms-based approach for diagnosing and treating women suspected of having IC/BPS and/or vulvodynia. Further studies are needed to develop more precise diagnosis and proper management for women with IC/BPS and vulvodynia. 

Written by:
1. Su Jin Kim, MD, Department of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea, Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
2. Hana Yoon, MD, Department of Urology, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
3. Jayoung Kim, Ph.D., Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA 

References:
  1. Cepeda MS, Reps J, Sena AG, Ochs-Ross R. Risk Factors for Interstitial Cystitis in the General Population and in Individuals with Depression. Int Neurourol J 2019;23:40-45.
  2. Yoon HS, Yoon H. Correlations of interstitial cystitis/painful bladder syndrome with female sexual activity. Korean J Urol. 2010;51:45–9.
  3. Kim SJ, Kim J, Yoon H. Sexual pain and IC/BPS in women. BMC Urol 2019;19:47.
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