Sexual Pain Disorders, Vestibulodynia, and Recurrent Cystitis: The Evil Trio: A Clinical Conversation on the Uroandrological Perspective

Abstract

Sexual pain/penetration disorders are often comorbid with recurrent/post-coital cystitis and spontaneous or provoked vestibulodynia or vulvar pain. The figures vary from 34.7–60%, Uropathogenic Escherichia coli (UPEC) is responsible for 85–90% of recurrent cystitis cases. Antibiotic treatment is becoming ineffective in the long term. To maximize therapeutic outcomes, a different strategy is worth considering. Common pathophysiological denominators of the three clusters of symptoms present in a patient should be identified. These include (1) predisposing factors: endocellular pathogenic biofilm of the uropathogenic Escherichia coli (UPEC), hyperactive pelvic floor, bowel problems, including irritable bowel syndrome and constipation, intestinal and vaginal dysbiosis, diabetes/familiarity with diabetes, and loss of sexual hormones after menopause; (2) precipitating factors: intercourse, constipation, and cold; and (3) maintaining factors: diagnostic omissions and minimalistic treatment approach. A targeted multimodal therapeutic strategy should then be based on accurate diagnosis. A comprehensive and skilled approach can optimize anticipation of comorbidities and offer better clinical outcomes for women, where sexual pain/penetration disorders, comorbid recurrent and/or post-coital cystitis, and vestibulodynia/vulvar pain are addressed synergistically, the sooner the better.