Chronic Urogenital Pain

Vulvodynia – Bladder Pain Syndrome/Interstitial Cystitis


Definition and Classification


Definition. Female chronic urogenital pain refers to a spectrum of chronic pain syndromes that lack well-defined pathophysiology but give rise to a wide range of symptoms that compromise the functional capacity of the urinary and reproductive systems. Women report symptoms of urge, frequency, suprapubic pressure, nocturia, dyspareunia, abdominal and lower back pain. Several studies have estimated that approximately 15% of women are affected by chronic urogenital pain. In addition sufferers present with a range of common co-morbidities that include irritable bowel syndrome (IBS), chronic fatigue, allergies, food sensitivities, immune system dis-regulation, as well as headaches, migraines, and myofascial pain that often extends beyond the pelvic region.

Given that the presenting symptoms are functional in nature, the diagnosis of chronic urogenital pain is based on the account of symptoms given by the individual and on the exclusion of all medical causes of chronic urogenital pain. As mentioned earlier women report symptoms of urge, frequency, suprapubic pressure, nocturia, dysuria and often dyspareunia (painful intercourse), abdominal and lower back pain.

Classification. CUP syndromes constitute a sub group of the broader chronic pelvic pain syndrome complex.  Chronic pelvic pain refers to any chronic pain condition, of whatever origin, that affects the lower abdominal region between the umbilicus and the upper thighs. It is defined as a “persistent pain perceived in structures related to the pelvis of either men or women” (Engeler et al. 2014) and not occurring exclusively with menstruation or intercourse and not associated with pregnancy (Baranowski, A 2007). As syndromes both chronic urogenital pain and chronic pelvic pain are often associated with negative cognitive, behavioural, sexual and emotional consequences. The relationship and classification of chronic urogenital pain is best presented graphically as forming a subset of the chronic pelvic pain complex, in which conditions such as bladder pain syndrome and vulvodynia form a subgroup of chronic pelvic pain conditions, as shown in the figure below.

CPP diagram