Jennifer Yonaitis Fariello

Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction

To study intravaginal diazepam suppositories as adjunctive treatment for high-tone pelvic floor dysfunction (HTPFD) and sexual pain. A retrospective chart review was conducted on 26 patients who received diazepam suppositories as adjuvant therapy to pelvic physical therapy and intramuscular trigger point injections for bladder pain, sexual pain, and levator hypertonus. Pelvic floor muscular tone and pain were assessed by palpation and perineometry; sexual pain was objectively rated by Female Sexual Function Index (FSFI) and the Visual Analog Scale for Pain (VAS-P). Twenty-five out of 26 patients reported subjective improvement with suppository use; six out of seven sexually active patients resumed intercourse. Sexual pain as assessed on FSFI and serial VAS-P improved with diazepam (by 1.44 on 10-point scale, p = 0.14). PFM tone improved during resting (p < 0.001), squeezing (p = 0.014), and relaxation (p = 0.003) phases. Vaginal diazepam suppositories gave a clinically significant improvement in the treatment of HTPFD compared with the usual treatment regimen alone.

Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction

This study aims to review the use of sacral neuromodulation in the patient population with painful bladder syndrome/interstitial cystitis (PBS/IC), chronic pelvic pain (CPP), and sexual dysfunction. A literature review of the current research was carried out. This article highlights the current research findings and uses of sacral neuromodulation in patients with PBS/IC, CPP, vulvar vestibulitis, and erectile dysfunction. Current research on sacral neuromodulation on the abovementioned patient population has shown potential efficacy in pilot studies, though larger, multi-centered trials with long-term follow-up are needed.

Minimally invasive therapies for chronic pelvic pain syndrome

Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial cystitis/painful bladder syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis or treatment of CPPS. The diagnosis is often challenging and is determined by elimination. Multiple treatment modalities exist, ranging from physical therapy to surgery. We discuss minimally invasive therapies for treatment of this complex of symptoms. Although data suggest reasonable efficacy of several medications, multimodal therapy remains the mainstay of treatment. We review the following minimally invasive therapeutic modalities: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation. We report data supporting their use and efficacy and highlight the limitations of each.

Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management

Interstitial cystitis/bladder pain syndrome (IC/BPS) and vulvodynia are chronic pain syndromes that appear to be intertwined from the perspectives of embryology, pathology and epidemiology. These associations may account for similar responses to various therapies.

Bladder Pain Syndrome and Sexuality

The pain associated with interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions may alter the sexual response, resulting in frequent complaints of decreased arousal, decreased libido, difficulty with orgasm or anorgasmia, and less frequent sexual encounters. Psychological factors, whether primary or secondary, such as fear, anxiety, and depression tend to exacerbate the problem, leaving the patient and his or her partner with decreased sexual interest, feelings of inadequacy, isolation, and increased depression.

Clinical Evaluation and Diagnosis of Bladder Pain Syndrome

The diagnosis of bladder pain syndrome (BPS), a chronic bladder condition in which patients characteristically report symptoms of urinary frequency, urgency, and pelvic pain/pressure, remains a challenge to many clinicians. Symptom overlap with other disorders of the gastrointestinal, genitourinary, and gynecological systems may further confound the diagnosis. Despite the absence of a “definitive diagnostic test” and specific biological markers, there are tools available for the clinician to recognize and diagnose these patients. Early diagnosis and treatment initiation are salient in improving the overall physical and mental quality of life of the BPS patient.

Complementary and Alternative Medical Treatments of Bladder Pain Syndrome

Complementary and alternative therapies (CAM) may offer adjuvant treatment options for patients with bladder pain syndrome (BPS) for which “traditional” therapies alone have failed. The goal of CAM therapies is improved quality of life through patient education and empowerment. CAM therapy is individualized to the need of the patient. Support groups, behavioral techniques, lifestyle modification, and psychotherapy are some examples of different types of CAM therapies employed in the treatment of patients with BPS.