Chronic Urogenital Pain

Vulvodynia – Bladder Pain Syndrome/Interstitial Cystitis


Chronic Urogenital Pain


What is Chronic Urogenital Pain? The term refers to a group of pain conditions in which the symptoms are specifically linked to the genitourinary systems (reproductive and urinary systems and genital areas). The organs and anatomical regions commonly affected include the urinary bladder, urethra and vulvar areas as well as adjacent structures. This spectrum of disorders includes bladder pain syndrome/interstitial cystitis, vulvodynia as well as other less known conditions such as Persistent Genital Arousal Disorder. Most sufferers also report a range of coexisting conditions and comorbidities, like irritable bowl, allergies, skin and food sensitivities and a range of neuromuscular conditions that include headaches, migraines, lower back pain and fatigue. Chronic urogenital pain is poorly localised and there is little knowledge about its etiology, the mechanisms of pain and of its origins. Individuals commonly report discomfort during sexual activity, voiding problems, urinary urge and frequency, with symptoms varying in intensity. These pain conditions have a debilitating impact and interfere with activities of daily living, intimate relationships, vocational pursuits and reproductive potential. The convention of labeling various urogenital pain conditions by the organ affected (i.e., bladder pain and vulvar pain) has been conceptually misleading and often results in treatment that is misdirected. There is little evidence that the pelvic organs are the cause and source of pain. Often the organ affected by the pain is only an innocent bystander. According to current clinical trends the focus is moving away from the end organ, to the region most affected. These pain conditions are seen as regional pain syndromes, in which the pain is poorly localised, affects multiple sites and finds expression in areas outside of the pelvic cavity like the lower back, groin, legs and abdominal areas. The pain can be best described as “referred pain”. Chronic urogenital pain conditions pose a special challenge to the patient and clinician as the pain can be severe and occur in the absence of any visible pathology. The mechanisms of chronic pain are poorly understood. Most people can only think of pain in terms of acute pain, where a specific injury leads to pain, yet the nature of chronic as opposed to acute pain is vastly different. The onset of pain can on some occasions be traced to recurrent infections, tissue damage and irritation, though characteristically pain symptoms continue well beyond the resolution of such infections and the expected time of healing, consequently making these disorders chronic in their nature. Women suffering with chronic urogenital pain often report seeing multiple specialists before receiving a diagnosis. They also present with lists of inconclusive tests and investigations and a history of unsuccessful treatment attempts which may include antibiotics, antifungals, corticosteroids, hormone therapies, antidepressants, anticonvulsants, topical anaesthetics and surgical interventions. Failure to correctly diagnose and treat these conditions protracts the suffering of individuals and is disheartening to the patient and clinician, as well as costly to patients and the health care system. This website seeks to provide current up to date information on chronic urogenital pain and introduces innovative assessment protocols and pain management programs developed on the basis of research and clinical experience.