Skip to main content

Advertisement

SpringerLink
Log in

Bladder pain syndrome and sexual function: a systematic review and meta-analysis

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Bladder pain syndrome (BPS)/interstitial cystitis can adversely affect physical, mental, and sexual health. The aim of the systematic review is to compare sexual function between patients with BPS and healthy controls and to examine whether or not treatment of BPS improves sexual function.

Methods

A literature search was conducted on Embase, Medline, and other databases. Studies comparing sexual function in BPS patients with healthy controls and before/after treatment were included. Where appropriate, data were pooled in a meta-analysis, using a random effects model and the standardised mean difference (SMD) was used for comparison.

Results

Out of 384 studies initially identified, 26 studies met the inclusion criteria for the systematic review and 11 for the meta-analysis. Six studies compared sexual function in BPS cases with healthy controls. All studies found that the Female Sexual Function Index (FSFI) was worse in BPS cases than in controls. Pooled data from 5 studies showed that the SMD was −1.02 (CI −1.64, −0.4) in total FSFI scores between the cases and controls, p=0.001. Further analysis showed better sexual function in all FSFI subdomains in healthy controls. Five studies compared sexual function in BPS patients before treatment with after treatment. Pooled data from 3 studies showed an overall improvement in total FSFI score after intravesical treatment: SMD=0.69 (CI 0.23, 1.14), p=0.003. Further analysis showed improvement in all subdomains.

Conclusion

Our review suggests that sexual function might be worse in BPS patients than in the general population, but it seems to improve with intravesical BPS treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162–70. https://doi.org/10.1016/j.juro.2011.03.064.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dawson TE, Jamison J. Intravesical treatments for painful bladder syndrome/interstitial cystitis. Cochrane Database Syst Rev. 2007;(4):CD006113 https://doi.org/10.1002/14651858.CD006113.pub2.

  3. Tirlapur S, Birch JV, Carberry CL, et al. Management of bladder pain syndrome. BJOG 2017;124(2):e46–72. https://doi.org/10.1111/1471-0528.14310

    Article  Google Scholar 

  4. Tonyali S, Yilmaz M. Sexual dysfunction in interstitial cystitis. Curr Urol. 2017;11(1):1–3. https://doi.org/10.1159/000447186.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9, w264. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.

    Article  PubMed  Google Scholar 

  6. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Arslan B, Gönültaş S, Gökmen E, Özman O, Avci MA, Özdemir E. Outcomes of intravesical chondroitin-sulfate and combined hyaluronic-acid/chondroitin-sulfate therapy on female sexual function in bladder pain syndrome. Int Urogynecol J. 2019;30(11):1857–62. https://doi.org/10.1007/s00192-019-04036-2.

    Article  PubMed  Google Scholar 

  8. Nickel JC, Tripp DA, Pontari M, et al. Psychosocial phenotyping in women with interstitial cystitis/painful bladder syndrome: a case control study. J Urol. 2010;183(1):167–72. https://doi.org/10.1016/j.juro.2009.08.133.

    Article  PubMed  Google Scholar 

  9. Corina S, Berger K, Müller M, Silke J, Mueller MD, Kuhn A. Painful bladder syndrome: management and effect on sexual function and quality of life. Ginekol Pol. 2011;82(2):96–101.

    Google Scholar 

  10. Abernethy MG, Rosenfeld A, White JR, Mueller MG, Lewicky-Gaupp C, Kenton K. Urinary microbiome and cytokine levels in women with interstitial cystitis. Obstet Gynecol. 2017;129(3):500–6. https://doi.org/10.1097/aog.0000000000001892.

    Article  CAS  PubMed  Google Scholar 

  11. Agrawal A, Tripathy S, Kumar D. Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: a case-control study. Indian J Urol. 2020;36(3):212–5. https://doi.org/10.4103/iju.IJU_145_20.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arslan B, Cilesiz NC, Onuk O, et al. Female sexual function after intravesical therapy in patients with interstitial cystitis/bladder pain syndrome. Eur Urol Suppl. 2017;16:e1554.

    Article  Google Scholar 

  13. Cardenas-Trowers OO, Abraham AG, Dotson TK, Houlette BA, Gaskins JT, Francis SL. Bladder instillations with triamcinolone acetonide for interstitial cystitis-bladder pain syndrome: a randomized controlled trial. Obstet Gynecol. 2021;137(5):810–9. https://doi.org/10.1097/aog.0000000000004348.

    Article  CAS  PubMed  Google Scholar 

  14. Chen A, Shahiyan RH, Anger JT. Interstitial cystitis/bladder pain syndrome treatment: a systematic review of sexual health outcomes. Sex Med Rev. 2022;10(1):71–6. https://doi.org/10.1016/j.sxmr.2020.12.005.

    Article  PubMed  Google Scholar 

  15. Nickel JC, Tripp DA, Pontari M, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358–63. https://doi.org/10.1016/j.juro.2010.06.005.

    Article  PubMed  Google Scholar 

  16. Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ. Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol. 2008;179(1):177–85. https://doi.org/10.1016/j.juro.2007.08.170.

    Article  CAS  PubMed  Google Scholar 

  17. El-Hefnawy AS, Soliman HMM, Abd-Elbary SOM, Shereif WI. Long-standing nonulcerative bladder pain syndrome: impact of Thiele massage on bladder and sexual domains. Low Urin Tract Symptoms. 2020;12(2):123–7. https://doi.org/10.1111/luts.12291.

    Article  PubMed  Google Scholar 

  18. Elzevier HW, Nieuwkamer BB, Pelger RC, Lycklama à Nijeholt AA. Female sexual function and activity following cystectomy and continent urinary tract diversion for benign indications: a clinical pilot study and review of literature. J Sex Med. 2007;4(2):406–16. https://doi.org/10.1111/j.1743-6109.2006.00257.x.

    Article  PubMed  Google Scholar 

  19. FitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–8. https://doi.org/10.1016/j.juro.2012.01.123.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Gardella B, Porru D, Ferdeghini F, et al. Insight into urogynecologic features of women with interstitial cystitis/painful bladder syndrome. Eur Urol. 2008;54(5):1145–51. https://doi.org/10.1016/j.eururo.2008.01.079.

    Article  PubMed  Google Scholar 

  21. Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction—a case-control study. J Sex Med. 2011;8(6):1726–34. https://doi.org/10.1111/j.1743-6109.2011.02251.x.

    Article  PubMed  Google Scholar 

  22. Hacad. ICS 2019 Gothenburg scientific Programme. Neurourol Urodyn. 2019;38(S3):S1–532. https://doi.org/10.1002/nau.24118.

  23. Hung M, Tsai C, Su T. Impact of intravesical hyaluronic acid on sexual function of women with interstitial cystitis: a prospective multicenter study on 103 patients. Neurourol Urodyn. 2013;32(6):603.

    Google Scholar 

  24. Hung MJ, Su TH, Lin YH, et al. Changes in sexual function of women with refractory interstitial cystitis/bladder pain syndrome after intravesical therapy with a hyaluronic acid solution. J Sex Med. 2014;11(9):2256–63. https://doi.org/10.1111/jsm.12507.

    Article  CAS  PubMed  Google Scholar 

  25. Hung MJ, Tsai C. Discrepancy of the impacts of intravesical hyaluronic acid on pain and urinary symptoms in women with refractory interstitial cystitis/bladder pain syndrome and predictors of treatment outcomes: results from a multicenter study including 103 patient. Neurourol Urodyn. 2016;32(6):603.

    Google Scholar 

  26. Ingber MS, Ibrahim IA, Killinger KA, Diokno AC, Peters KM. Neuromodulation and female sexual function: does treatment for refractory voiding symptoms have an added benefit? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1055–9. https://doi.org/10.1007/s00192-009-0900-3.

    Article  PubMed  Google Scholar 

  27. Kanter G, Komesu YM, Qaedan F, et al. Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. Int Urogynecol J. 2016;27(11):1705–11. https://doi.org/10.1007/s00192-016-3022-8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim A, Lim B, Song M, Choo M-S. Pretreatment features to influence effectiveness of intravesical hyaluronic acid instillation in refractory interstitial cystitis/painful bladder syndrome. Int Neurourol J. 2014;18(3):163–7. https://doi.org/10.5213/inj.2014.18.3.163.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lazar DS, Plas E, Pflüger H. Painful bladder syndrome/interstitielle cystitis und sexuelle Funktionsstörung bei der Frau. Fertil Reprod J. 2006;16(2):13–6

    Google Scholar 

  30. Liang CC, Lin YH, Hsieh WC, Huang L. Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment. Taiwan J Obstet Gynecol. 2018;57(3):360–3. https://doi.org/10.1016/j.tjog.2018.04.006.

    Article  PubMed  Google Scholar 

  31. Mirkin Y. PS-07-006 Does transurethral cryosurgery of the bladder can treat bladder pain syndrome and related FSD? J Sex Med. 2016;13(2):S110.

    Article  Google Scholar 

  32. Morrissey, et al. Patients with bladder mucosal cracks in IC/BPS: who are they and can they benefit from corticosteroid treatment? Female Pelvic Medicine & Reconstructive Surgery: The Official Journal of the American Urogynaecologic Society. 2013:19.

  33. Nickel JC, Parsons CL, Forrest J, et al. Improvement in sexual functioning in patients with interstitial cystitis/painful bladder syndrome. J Sex Med. 2008;5(2):394–9. https://doi.org/10.1111/j.1743-6109.2007.00686.x.

    Article  PubMed  Google Scholar 

  34. Ottem DP, Carr LK, Perks AE, Lee P, Teichman JM. Interstitial cystitis and female sexual dysfunction. Urology. 2007;69(4):608–10. https://doi.org/10.1016/j.urology.2006.12.024.

    Article  PubMed  Google Scholar 

  35. Overholt, et al. Female sexual dysfunction: a West Virginia university clinical experience. J Urol. 2017;197(4, Supplement).

  36. Panunzio A, Tafuri A, Mazzucato G, et al. Botulinum toxin-A injection in chronic pelvic pain syndrome treatment: a systematic review and pooled meta-analysis. Toxins (Basel). 2022;14(1):25. https://doi.org/10.3390/toxins14010025.

    Article  CAS  PubMed  Google Scholar 

  37. Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology. 2007;70(1):16–8. https://doi.org/10.1016/j.urology.2007.02.067.

    Article  PubMed  Google Scholar 

  38. Peters KM, Jaeger C, Killinger KA, Rosenberg B, Boura JA. Cystectomy for ulcerative interstitial cystitis: sequelae and patients' perceptions of improvement. Urology. 2013;82(4):829–33. https://doi.org/10.1016/j.urology.2013.06.043.

    Article  PubMed  Google Scholar 

  39. Rolston R, Stephens-Shields A, Clemens JQ, et al. PD20-07: predictors of female sexual dysfunction in interstitial cystitis/bladder pain syndrome, other chronic pain conditions and healthy controls in the MAPP Research Network. J Urol. 2019;201(Suppl 4):e379-80. https://doi.org/10.1097/01.JU.0000555739.90606.d1

    Article  Google Scholar 

  40. Schrepf A, O'Donnell M, Luo Y, Bradley CS, Kreder K, Lutgendorf S. Inflammation and inflammatory control in interstitial cystitis/bladder pain syndrome: associations with painful symptoms. Pain. 2014;155(9):1755–61. https://doi.org/10.1016/j.pain.2014.05.029.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Simsir A, Kizilay F, Ozyurt C. The effect of hydrodistension in combination with pentosan polysulfate on treatment outcomes and compliance in the treatment of bladder pain syndrome. Pak J Med Sci. 2019;35(1):189–94. https://doi.org/10.12669/pjms.35.1.172.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wein AJ. Re: Long-term follow-up after cystectomy for bladder pain syndrome: pain status, sexual function and quality of life. J Urol. 2019;202(6):1101–2. https://doi.org/10.1097/ju.0000000000000562.

    Article  PubMed  Google Scholar 

  43. Welk BK, Teichman JM. Dyspareunia response in patients with interstitial cystitis treated with intravesical lidocaine, bicarbonate, and heparin. Urology. 2008;71(1):67–70. https://doi.org/10.1016/j.urology.2007.09.067.

    Article  PubMed  Google Scholar 

  44. Yih JM, Killinger KA, Boura JA, Peters KM. Changes in sexual functioning in women after neuromodulation for voiding dysfunction. J Sex Med. 2013;10(10):2477–83. https://doi.org/10.1111/jsm.12085.

    Article  PubMed  Google Scholar 

  45. Zambon J, Hemal K, Evans R, et al. MP47-18 simple cystectomy for female patients with refractory interstitial cystitis/bladder pain syndrome: is there any long-term impact on quality of life, body image, and sexual function? J Urol. 2019;201:e695 https://doi.org/10.1097/01.JU.0000556482.45742.4b.

    Article  Google Scholar 

  46. Zaslau S, Brown ET, Fooks H, et al. Sexual dysfunction in patients with painful bladder syndrome. W V Med J. 2008;104(6):18–21.

    PubMed  Google Scholar 

  47. Zhang P, Zhang JZ, Wu LY, Niu HQ, Yang YB, Zhang XD. Short-term outcome of sacral neuromodulation on refractory interstitial cystitis/pelvic pain syndrome. Zhonghua Yi Xue Za Zhi. 2016;96(48):3875–8. https://doi.org/10.3760/cma.j.issn.0376-2491.2016.48.005.

    Article  CAS  PubMed  Google Scholar 

  48. Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J. 2010;21(12):1553–8. https://doi.org/10.1007/s00192-010-1281-3.

    Article  PubMed  Google Scholar 

  49. Liberman D, Singh R, Siegel SW. Neuromodulation for pelvic pain and sexual dysfunction. Curr Bladder Dysfunct Rep. 2016;11(2):187–93. https://doi.org/10.1007/s11884-016-0366-3.

    Article  Google Scholar 

  50. Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol. 2007;177(2):450–6. https://doi.org/10.1016/j.juro.2006.09.032.

    Article  PubMed  Google Scholar 

  51. Wehbe SA, Whitmore K, Kellogg-Spadt S. Urogenital complaints and female sexual dysfunction (part 1). J Sex Med. 2010;7(5):1704–13; quiz 1703, 1714–5. https://doi.org/10.1111/j.1743-6109.2010.01769.x.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Carol McCormick and David Watson (South Tees Hospitals NHS Foundation Trust) for helping with the database search.

Author information

Authors and Affiliations

  1. South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK

    A. Sobti, S. Shawer, P. Ballard & A. Khunda

Authors
  1. A. Sobti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Shawer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Ballard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Khunda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Alka Sobti: collected data, analysed data, wrote and approved the final version; Sami Shawer: co-wrote and edited the manuscript and approved the final version; Aethele Khunda: conceived the idea, analysed data, edited and approved the final version; Paul Ballard: edited and approved the final version.

Corresponding author

Correspondence to A. Sobti.

Ethics declarations

Conflicts of interest

Aethele Khunda received educational grants and/or speaker fees from Medtronic, Axonic, Olympus and international conference organising committees. Alka Sobti, Sami Shawer and Paul Ballard had no conflicts of interest to declare.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sobti, A., Shawer, S., Ballard, P. et al. Bladder pain syndrome and sexual function: a systematic review and meta-analysis. Int Urogynecol J 34, 2359–2371 (2023). https://doi.org/10.1007/s00192-023-05633-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-023-05633-y

Keywords

Search

Navigation