title: Changes in sexual function of women with refractory interstitial cystitis/bladder pain syndrome after intravesical therapy with a hyaluronic acid solution.
abstract: BACKGROUND
  Intravesical instillation with a hyaluronic acid (HA) solution is an effective treatment for interstitial cystitis/bladder pain syndrome (IC/BPS), but its impact on sexual functioning of patients is not known.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the changes in sexual function of women with refractory IC/BPS who underwent a second-line intravesical HA therapy.
  
  
  METHODS
  A total of 103 women diagnosed with refractory IC/BPS were enrolled in this prospective, multicenter study. Sexual function was evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-9). Bladder-related symptoms and bother were assessed by the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), and a pain visual analog scale (VAS), respectively. Data were analyzed with univariate methods or multivariate logistic regression analysis accordingly.
  
  
  METHODS
  Changes in PISQ-9, ICSI, ICPI, and pain VAS scores after treatment were assessed.
  
  
  RESULTS
  Mean age and duration of symptoms was 43.6 ± 11.8 and 5.1 ± 5.0 years, respectively. ICSI, ICPI, and pain VAS scores were significantly (P < 0.001) improved after 1 month and 6 months of treatment. Of the 87 (84.5%) sexually active women evaluated, PISQ-9 total scores improved significantly (P < 0.001) from the baseline (mean 18.9 ± 6.4), after 1 month (20.4 ± 5.8), and 6-months (21.5 ± 5.6) of treatment. Significantly improved PISQ-9 items included "dyspareunia" (P < 0.001) and "negative reactions" (P = 0.015) during sexual intercourse, and "intensity" (P < 0.001) of sexual orgasms. After a logistic regression analysis, we found that a baseline PISQ-9 score was negatively correlated with the duration of IC/BPS symptoms (P = 0.022). Meanwhile, the changes in PISQ-9 scores were positively correlated with the reduction in ICSI scores after treatment (P = 0.045).
  
  
  CONCLUSIONS
  Intravesical HA is an effective treatment for refractory IC/BPS. A longer duration of IC/BPS symptoms may be a predictor of poor sexual function. However, intravesical HA may improve sexual function along with the reduction of IC/BPS symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University School of Medicine, Taichung, Taiwan.
authors.forename: Man-Jung
authors.initials: MJ
authors.lastname: Hung
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Su
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Lin
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Huang
authors.forename: Tzu-Yin
authors.initials: TY
authors.lastname: Lin
authors.forename: Chun-Shuo
authors.initials: CS
authors.lastname: Hsu
authors.forename: Fei-Chi
authors.initials: FC
authors.lastname: Chuang
authors.forename: Ching-Pei
authors.initials: CP
authors.lastname: Tsai
authors.forename: Pao-Sheng
authors.initials: PS
authors.lastname: Shen
authors.forename: Gin-Den
authors.initials: GD
authors.lastname: Chen
mesh_terms: D000328:Adult; D018856:Cystitis, Interstitial / Q000188:drug therapy* / Q000503:physiopathology; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D006820:Hyaluronic Acid
keywords: Bladder Pain Syndrome; Dyspareunia; Hyaluronic Acid; Interstitial Cystitis; Intravesical Therapy; Sexual Dysfunction