Effect of local estrogen therapy (LET) on urinary and sexual symptoms in premenopausal women with interstitial cystitis/bladder pain syndrome (IC/BPS)

Abstract The association between vulvodynia and interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic, debilitating disease of unknown etiology, may involve sex hormone-dependent mechanisms regulating vulvo-vaginal health. We aimed to prospectively investigate the effects of 12 weeks of local estrogen therapy (LET) on urinary/bladder and sexual symptoms in premenopausal women with IC/BPS. Thirty-four women (mean age: 36.1 ± 8.4) diagnosed with IC/BPS were treated vulvo-vaginally three-times/week with estriol 0.5 mg cream and tested by validated questionnaires (ICSI/ICPI, pain urgency frequency [PUF], female sexual function index [FSFI]) and by cotton swab testing, vaginal health index (VHI) and maturation index (MI) before and after treatment. Vulvodynia was present in 94.1% of IC/BPS women. A significant positive effect of LET was evident on urinary and sexual function (p < 0.001, for both) following 12 weeks, as well as an improvement of the VHI (p < 0.001) and the MI (p < 0.04). The results of this open study indicate that 12 weeks of local estriol cream at vaginal and vestibular level may ameliorate urinary/bladder pain symptoms, as well as may improve domains of sexual function. The association between vulvar pain and bladder pain could, therefore, be related to a vaginal environment carrying signs of hypoestrogenism, but further studies are needed to clarify this issue.

[1]  M. Faraday,et al.  Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. , 2015, The Journal of urology.

[2]  D. Portman,et al.  Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. , 2014, Maturitas.

[3]  I. Goldstein,et al.  Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. , 2014, The journal of sexual medicine.

[4]  P. Bosch,et al.  Examination of the significant placebo effect in the treatment of interstitial cystitis/bladder pain syndrome. , 2014, Urology.

[5]  C. Brady,et al.  Interstitial cystitis/painful bladder syndrome: epidemiology, pathophysiology and evidence-based treatment options. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[6]  A. Blomqvist,et al.  Estrogenic influences in pain processing , 2013, Frontiers in Neuroendocrinology.

[7]  U. Capitanio,et al.  Secondary provoked vestibulodynia in sexually active women with uncomplicated recurrent urinary tract infections. , 2013, The journal of sexual medicine.

[8]  L. Burrows,et al.  The Treatment of Vestibulodynia with Topical Estradiol and Testosterone , 2013, Sexual medicine.

[9]  Panus Chalermsanyakorn,et al.  Estrogen and progesterone receptors in patients with bladder pain syndrome. , 2013, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[10]  A. Bradford.  Listening to placebo in clinical trials for female sexual dysfunction. , 2013, The journal of sexual medicine.

[11]  L. Burrows,et al.  The effects of hormonal contraceptives on female sexuality: a review. , 2012, The journal of sexual medicine.

[12]  S. Davis,et al.  The use of hormone therapy for the maintenance of urogynecological and sexual health post WHI , 2012, Climacteric : the journal of the International Menopause Society.

[13]  L. Cardozo,et al.  Interstitial cystitis: diagnosis and management. , 2012, European journal of obstetrics, gynecology, and reproductive biology.

[14]  D. Klumpp,et al.  Gender specific pelvic pain severity in neurogenic cystitis. , 2012, The Journal of urology.

[15]  R. Nappi,et al.  Interstitial cystitis is associated with vulvodynia and sexual dysfunction--a case-control study. , 2011, The journal of sexual medicine.

[16]  F. Howard,et al.  Sexuality and reproductive risk factors for interstitial cystitis/painful bladder syndrome in women. , 2011, Urology.

[17]  T. Ness,et al.  Effect of estrogen on bladder nociception in rats. , 2010, The Journal of urology.

[18]  J. Keast,et al.  Effects of estrogens and bladder inflammation on mitogen-activated protein kinases in lumbosacral dorsal root ganglia from adult female rats , 2009, BMC Neuroscience.

[19]  R. Nappi,et al.  The use of estrogen therapy in women's sexual functioning (CME). , 2009, The journal of sexual medicine.

[20]  R. Nappi,et al.  Insight into urogynecologic features of women with interstitial cystitis/painful bladder syndrome. , 2008, European urology.

[21]  A. Salonia,et al.  Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice , 2008, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology.

[22]  Z. Ben-Aroya,et al.  Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. , 2007, The journal of sexual medicine.

[23]  Leslie M. Klein,et al.  Validity of Pelvic Pain, Urgency, and Frequency questionnaire in patients with interstitial cystitis/painful bladder syndrome. , 2007, Urology.

[24]  J. Gustafsson,et al.  Estrogen receptor β-deficient female mice develop a bladder phenotype resembling human interstitial cystitis , 2007, Proceedings of the National Academy of Sciences.

[25]  C. Parsons,et al.  The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. , 2007, Urology.

[26]  M. Tek,et al.  The effect of tamoxifen on bladder functions and histology, and the role of estrogen receptor β in a rat chemical cystitis model , 2007, Neurourology and urodynamics.

[27]  R. Nappi.  New attitudes to sexuality in the menopause: clinical evaluation and diagnosis , 2007, Climacteric : the journal of the International Menopause Society.

[28]  R. Fillingim,et al.  Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis. , 2005, The Journal of urology.

[29]  R. Rosen,et al.  The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores , 2005, Journal of sex & marital therapy.

[30]  A. Ting,et al.  Estrogen Regulates Vaginal Sensory and Autonomic Nerve Density in the Rat1 , 2004, Biology of reproduction.

[31]  C. Butrick.  Interstitial Cystitis and Chronic Pelvic Pain: New Insights in Neuropathology, Diagnosis, and Treatment , 2003, Clinical obstetrics and gynecology.

[32]  F. Sampaio,et al.  Analysis of the modifications in the composition of bladder glycosaminoglycan and collagen as a consequence of changes in sex hormones associated with puberty or oophorectomy in female rats. , 2003, The Journal of urology.

[33]  C. Riedl,et al.  Comparative assessment of maximal bladder capacity, 0.9% NaCl versus 0.2 M Kcl, for the diagnosis of interstitial cystitis: a prospective controlled study. , 2003, The Journal of urology.

[34]  D. Bjorling,et al.  Estrogen and neuroinflammation. , 2001, Urology.

[35]  J. A. van der Laak,et al.  Development and validation of a computerized cytomorphometric method to assess the maturation of vaginal epithelial cells. , 1999, Cytometry.

[36]  G. Sant,et al.  The interstitial cystitis symptom index and problem index. , 1998, Urology.

[37]  K. Berkley,et al.  Estrous cycle variation of afferent fibers supplying reproductive organs in the female rat , 1992, Brain Research.