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.

Chinese abstract

间质性膀胱炎（IC/BPS）是一种慢性、令人衰弱，病因不明的疾病，它与外阴疼痛可能与性激素依赖的外阴阴道健康的调节机制有关。我们的研究目的是前瞻性调查局部雌激素治疗12周对有间质性膀胱炎的绝经前女性泌尿系/膀胱及性功能症状的疗效。给予诊断有间质性膀胱炎的34名女性（平均年龄：36.1±8.4岁）外阴阴道0.5mg的雌三醇乳膏，每周用药3次，通过有效的问卷（ICSI/ICPI，尿频尿急尿痛，女性性功能指数[FSFI]）棉拭子试验，阴道健康指数（VHI）和成熟指数（MI）检测治疗前后的不同。94.1%的有间质性膀胱炎的女性有外阴疼痛。局部雌激素治疗12周后，对泌尿系和性功能有明显的疗效（p50.001，两组），同时阴道健康指数（p50.001）和成熟指数（p50.04）也有改善。本研究结果表明，连续12周的阴道和前庭局部雌三醇乳膏用药不仅改善泌尿系/膀胱疼痛的症状，而且改善性功能。因此，外阴疼痛和膀胱疼痛与雌激素过少的阴道环境有关，但仍需要进一步的研究来阐明这个问题。

• Estrogens
• genitourinary syndrome
• sexual function
• uro-genital system
• vagina

Acknowledgements

The authors thank Mrs. Raffaella Pampuri (Cytologic Service, Anatomic Pathology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy) for the careful analysis of vaginal specimens in order to quantify the MI.

Declaration of interest

The authors report no declarations of interest relevant to this article. The authors alone are responsible for the content and writing of this article.