Abstract: PD44-04
Sources of Funding: None

Introduction

There is wide clinical overlap between PVD and IC/BPS as both conditions may include dyspareunia, chronic pelvic pain, and lower urinary tract symptoms. Unlike with IC/BPS evaluation, PVD patients are distinguished by having confined vestibular pain and positive cotton swab (Q-tip) testing, often with erythema and tenderness at 1:00 and 11:00 peri-urethral Skene's vestibular glands. Successful treatment of PVD has been anecdotally observed to resolve IC/BPS patient bladder symptoms. In addition, treatment of PVD often leads to resolution of gland pathology. The goal of this study was to advance our knowledge concerning the association of successful treatment for PVD and subsequent bladder symptom improvement.

Methods

An IRB-approved anonymous multi-question internet-based survey was sent to 233 consecutive women who were diagnosed and successfully treated for PVD by two sexual medicine physicians.

Results

73 (31%) women responded: 55% were 21 - 35 years old. Most common symptoms were dyspareunia (93%), feelings of burning, raw or cutting in the pelvis (75%), pain with tampons (52%), urinary frequency (38%), urgency (30%), bladder pain (26%), and relief of bladder pain with voiding (10%). Prior to being diagnosed with PVD, 71% were seen by 3-10 physicians; 89% were managed by a urologist. Of the 37% diagnosed with IC/BPS, 67% reported <20% improvement in bladder symptoms with various IC/BPS treatments: 74% followed behavioral modifications, 70% used pentosan polysulfate sodium or amitriptyline, and 59% underwent bladder instillations or hydrodistention. 52% of patients were diagnosed with hormonally associated PVD treated with cessation of hormonal contraceptives (if currently using), and topical estradiol/testosterone creams. Other PVD pathophysiologies included neuro-proliferative PVD (30%) treated with vulvar vestibulectomy, and pelvic floor hypertonicity (74%) treated in part with physical therapy. Successful treatments for PVD improved bladder symptoms by ≥ 80% in 56% of patients and by ≥ 40% in 93% of patients. 78% of patients felt misdiagnosed with IC/BPS.

Conclusions

Women with IC/BPS may have underlying PVD as pathophysiology and not an intrinsic bladder pathology. Urologic training should include vestibular examination and cotton swab testing, along with education concerning PVD management options (hormone treatment, pelvic floor physical therapy, and vestibulectomy) to best manage women with IC/PBS symptoms.

Funding

None