Interstitial Cystitis = Female Sexual Dysfunction - by Christopher Jayne, M.D.
Chronic pelvic pain (CPP) is a term used to describe a persistent or recurrent pain in or around the pelvis. Women are more likely to suffer from CPP than men with clinical studies reporting as many as 15% of women having CPP. Twenty percent of women with CPP report having symptoms greater than one year. CPP accounts for 10% of the referrals for the average gynecologist. Forty percent of the laparoscopies (minor surgical procedure using a camera placed through the belly button) done by gynecologists are for CPP. Twenty percent of hysterectomies are done for CPP.
As gynecologists, we have diagnoses we are likely to make for causes of CPP in our patients. Examples include vulvodynia, vestibulitis, pelvic inflammatory disease, pelvic adhesive disease, recurrent vaginal infection, recurrent urinary tract infections, and the most common of all, endometriosis. These diagnoses may be made even when the subjective complaints of the patient are not consistent with the objective medical findings. In addition, when improperly diagnosed, treatments have high failure rates. If the subjective complaints are not consistent with the objective findings and the treatments recurrently fail to eliminate the symptoms, we must consider another diagnosis for the cause of CPP. That diagnosis often is interstitial cystitis (IC).
IC is a chameleon of sorts able to fool both patient and doctor. The bladder is the most innervated organ in the pelvis. When it is broken, it can disrupt the entire region, confusing the body. This concept is not new in medicine. A common example of the body being confused (familiar to many) is that of left arm or jaw pain during a heart attack. It is not the arm or jaw that is causing the symptoms, it is the heart. Still, the patient perceives the pain as if truly coming from these other locations.
The same is true for the various symptoms of IC. What should be pleasurable like vaginal intercourse is instead painful like vulvodynia. What should be relaxing like the time just after sex is instead complicated with a sense of a vaginal or urinary tract infection. In these examples, the exams and laboratory findings are often normal except for tenderness at the urethra, bladder, or vulva. The body fools the patient and the patient fools the doctor and the diagnosis of IC is missed.
A woman’s sexual response is a complex dynamic non-linear process whereby the inherent need to connect intimately with a partner results in her satisfaction. Each aspect of a woman’s sexual response not only affects the next aspect but can affect preceding aspects as well in a seemingly give and take or ebb and flow process. This concept is based on the work done by Dr. Rosemary Basson. If this concept defines the normal sexual response for women, then sexual dysfunction is defined as a perceived abnormality in a woman’s sexual response that causes personal distress. There are four categories for female sexual dysfunction (FSD): 1. difficulty with desire, 2. difficulty with arousal, 3. difficulty with orgasm, and 4. pain.
Interstitial cystitis can interfere with every aspect of a woman’s sexual response because of the ebb-and-flow nature previously mentioned. When it comes to pain or a recurrent sense of vaginal or urinary tract infection or anything negative as it relates to sexual activity, women tend not to want to engage in that activity. So having pain as a specific sexual dysfunction will often lead to all the other sexual dysfunctions.
Just the thought of sexual activity and the exacerbation of IC symptoms will decrease a woman’s desire for sex. With the lack of desire, engaging in sex will often be followed by concerns with poor lubrication and arousal. Finally, as the orgasmic response is a mind-body response for women the distractions of the first three dysfunctions often lead to orgasmic dysfunction as well. This is why I say IC equals female sexual dysfunction.
As gynecologist, we are the champions of women’s pelvises. We must do a better job in helping our patients with CPP. We will never make the diagnosis if we do not first think of it. If the diagnosis of IC is considered and ultimately made, successful treatment is possible for that subset of CPP patients. For IC patients with sexual dysfunction, successful treatment of IC often results in a return of normal sexual function.
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