A clinical briefing of (not so) rare chronic pain syndromes in gynecology: Interstitial cystitis and vulvodynia

Abstract

Chronic pain has been currently defined as a pain that persists more than six weeks, despite of prescribed treatments. Interstitial cystitis or bladder pain syndrome is a chronic pain syndrome which implies urinary and pelvic pain, accompanied by voiding symptoms. The discomfort persists for more than six weeks and is apparently not related to any infectious or other identifiable causes. Patients complain of different voiding symptoms, which coexists with variable located pelvic pain. The voiding symptoms vary from urinary frequency, urgent need to void to pelvic pressure related filling to emptying of the urinary bladder. The unpleasant sensations described by the patients are: pain, pressure or discomfort and they are inevitably related to the urinary bladder. Many of these patients have associated pain syndromes, like: chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia or other emotional conditions as depression and anxiety. Vulvodynia (or localized vulvar pain syndrome or vestibulodynia or vulvar vestibulitis) is defined as a vulvar pain that lasts for more than three months and has no identifiable cause and is considered a diagnostic of exclusion. Patients present with vulvar pain as major complaint. This pain is related to contact with the vestibular region of the vulva: during intercourse, prolonged sitting, bike riding, tight clothing, tampon insertion. Clinical diagnosis is based on several criteria: pain with vestibular localization (with or without clitoridean pain), provoked by pressure-point testing, with no other established cause and lasts for more than three months.