Differences In Clinical Presentation Of Interstitial Cystitis/Painful Bladder Syndrome In Patients With Or Without Sexual Abuse History

Main Category: Urology / Nephrology
Article Date: 15 Nov 2008 - 1:00 PDT

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UroToday.com - From 18% to 33% of patients with BPS have a history of sexual abuse. Women who report a history of sexual traumatization or abuse have increased rates of subsequent pelvic pain, gastrointestinal complaints, vulvodynia and vasomotor symptoms. In an interesting study, Seth and Teichman from Vancouver tested the hypothesis that female patients with BPS, with or without a history of prior sexual abuse, have different clinical presentations.

In this retrospective, case-control study, a convenience sample was drawn from a prospectively collected database of consecutive subjects newly diagnosed with BPS. Of 121 consecutive subjects, 32 subjects reported sexual abuse. The abuse was described as vaginal penetration in 19, rape in 10, and inappropriate touching of the genitalia in 3. The 2 patients whose abuse post-dated onset of BPS symptoms were dropped from the study, yielding a 25% incidence of prior sexual abuse in this BPS population. Only 1 case of abuse had been previously documented in physicians' medical records.

Subjects with a history of sexual abuse had larger voided volumes, less daytime frequency, and less nocturia compared to those without a sexual abuse history. Interstitial Cystitis Symptom and Problem Indexes and Pelvic Pain, Frequency, and Urgency scores were similar. Though abuse victims had less symptoms of voiding dysfunction, they had more frequently demonstrated tenderness to palpation of the suprapubic area, vulva, posterior vaginal wall, cervical motion and rectum. Subjects with sexual abuse history had lower Female Sexual Function Index scores for all domains.

The authors surmise that a history of sexual abuse may lead to increased central sensitization and increased pelvic pain compared to those without that history. Certainly it appears that symptoms of pelvic floor dysfunction are common in patients with a history of sexual abuse, and would also be common in those diagnosed with bladder pain syndrome/interstitial cystitis. This might lead physicians to diagnose these patients earlier and/or in the absence of severe symptoms of voiding dysfunction. The fact that this history was overlooked in 97% of the medical records of this group is revealing and indicates that a higher level of awareness on the part of physicians in needed.

Seth A, Teichman JM
J Urol. 2008 Nov;180(5):2029-33
10.1016/j.juro.2008.07.053

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday

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