Okui Nobuo, Okui Machiko A
Dentistry, Kanagawa Dental University, Kanagawa, JPN.
Urology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN.
Cureus. 2024 Jul 1;16(7):e63617. doi: 10.7759/cureus.63617. eCollection 2024 Jul.
This case report emphasizes the crucial role of psychological assessment in the management of patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia. A 48-year-old woman with a five-year history of refractory BPS/IC and vulvodynia presented with frequent urination, pelvic pain, and severe dyspareunia, which led to sexual aversion and divorce from her partner. Previous treatments, including lifestyle modifications, analgesics, anticholinergics, hydrodistension, intravesical dimethyl sulfoxide, and psychiatric interventions, had been ineffective. Psychological assessments using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Toronto Alexithymia Scale-20 revealed severe symptoms of depression, anxiety, and alexithymia. Due to the patient's sexual aversion and the absence of a partner, a complete Female Sexual Function Index (FSFI) could not be administered. Instead, a partial FSFI and artificial intelligence-translated reference value of the Female Sexual Distress Scale-Revised were used to assess aspects relevant to the patient's condition. The patient underwent three monthly sessions of Fotona laser therapy, erbium, and neodymium laser at one-month intervals. Treatment outcomes were evaluated using the Numeric Rating Scale-11, Vulvodynia Total, Interstitial Cystitis Symptom Index, and psychological assessment tools. At the six-month follow-up, all physical and psychological symptoms showed significant improvement and complete remission was achieved at 12 months. Despite the overall positive treatment outcomes, the patient's sexual aversion persisted, and accurate measurement was not possible, highlighting the complexity of addressing sexual function in patients with BPS/IC and vulvodynia. This case report underscores the need for a holistic approach to managing these conditions, addressing both the physical and psychological aspects of the disease.
本病例报告强调了心理评估在膀胱疼痛综合征/间质性膀胱炎（BPS/IC）和外阴痛患者管理中的关键作用。一名48岁女性，有5年难治性BPS/IC和外阴痛病史，表现为尿频、盆腔疼痛和严重性交困难，导致性厌恶并与伴侣离婚。先前的治疗，包括生活方式改变、镇痛药、抗胆碱能药、膀胱水扩张、膀胱内注入二甲亚砜和心理干预，均无效。使用患者健康问卷-9、广泛性焦虑障碍-7和多伦多述情障碍量表-20进行的心理评估显示出严重的抑郁、焦虑和述情障碍症状。由于患者的性厌恶以及没有伴侣，无法进行完整的女性性功能指数（FSFI）评估。取而代之的是，使用部分FSFI和女性性困扰量表修订版的人工智能翻译参考值来评估与患者病情相关的方面。患者每隔一个月接受三次 Fotona 激光治疗、铒激光和钕激光治疗。使用数字评分量表-11、外阴痛总分、间质性膀胱炎症状指数和心理评估工具评估治疗结果。在六个月的随访中，所有身体和心理症状均有显著改善，12个月时实现了完全缓解。尽管治疗结果总体呈阳性，但患者的性厌恶仍然存在，且无法进行准确测量，这突出了处理BPS/IC和外阴痛患者性功能问题的复杂性。本病例报告强调了对这些病症进行整体管理的必要性，要同时解决疾病的身体和心理方面问题。
