Sexually Transmitted Diseases - I. I. Mavrov 2005

Diseases of the Reproductive Organs of Various Etiologies
Cystalgia

Cystalgia is a condition characterized by frequent, painful urination in the absence of objective signs of bladder damage. It accounts for 10-15% of all urological cases and typically occurs in women aged 30 to 45.

Etiology. Cystalgia arises As a result of circulatory and lymphatic disorders in the region of the trigone of the bladder (Lieutaud's triangle), inflammatory processes in the pelvic Organs and retroperitoneal tissue, pelvic congestion, Diseases of the reproductive organs, hormonal disorders (estrogen deficiency), Pregnancy, abortion, surgical interventions, allergic factors, and neurovegetative dysregulation of the bladder, particularly its neck. The cause of this condition may be a local infection or Inflammatory Diseases of other Urinary System organs (inflammation of Skene's ducts, granulomatous urethritis, prolapse, and urethral polyps).

Cystalgia may occur as a result of endocrine disorders; in particular, ovarian dysfunction plays a leading role in its development (D. K. Balchiy-Ool, 1982). In many women, the disease begins or worsens during menopause, when estrogen production declines. Ovarian dysfunction causes metaplasia of the transitional epithelium of the bladder trigone into stratified squamous epithelium, leading to bladder dysfunction. As a result of constant irritation, Blood AND Lymph Circulation disorders, edema develops in the deep layers of the bladder wall.

The condition is frequently observed in young women with symptoms of Hypogenitalism and severe Menstrual cycle disorders. In such patients, the disease appears or exacerbates during menstruation or pregnancy.

A definite link has been established between cystalgia and diseases of the reproductive organs that cause hemodynamic disorders. These include inflammatory and tumor processes of the internal reproductive organs. Hyperemia, slowed blood flow, or deficient blood supply cause pain and dysuric symptoms.

Not infrequently, the onset of the disease is associated with sexual dysfunctions. This is primarily observed in women who practice coitus interruptus for Contraception, women prone to masochism who perceive sexual intercourse as violence against themselves, aggressive women who experience anger during sex due to submission to a partner, or frigid patients. Sexual dissatisfaction in such patients leads to pelvic congestion and causes a state of mental exhaustion (V. Smith, 1962); consequently, the term "psychosomatic cystitis" was introduced. Therefore, cystalgia should be considered a disorder rooted in neuroendocrine disorders and functional impairments of the neuromuscular apparatus of the bladder, especially its neck.

Clinical manifestations: urinary disorders, pain in the bladder area and Perineum, and discomfort in the Urethra. Pain in the perineum and suprapubic region is usually well-localized, radiating to the iliac or lumbosacral region (sometimes its localization is ill-defined). As a rule, the pain is dull and constant, appearing during and outside of urination, during or after sexual intercourse; it may occur without apparent cause and disappear after urination.

Urinary disorders manifest as pollakiuria, imperative and painful urination (especially at the end of the act), and a feeling of incomplete bladder emptying. The disease is characterized by a protracted course, with alternating periods of remission and exacerbation. Triggering factors may include body cooling, constipation, alcohol consumption, and spicy foods.

Diagnosis is based on medical history and a thorough clinical examination. Cystalgia is diagnosed only after ruling out other bladder and urethral conditions accompanied by dysuria. Special attention is paid to obstetric history, gynecological surgeries, The Nature of sexual relations (presence or absence of orgasm, pain during intercourse), and The Use of contraceptives; data on menstrual function and past illnesses are also collected. Attention should be drawn to signs of inflammation of the reproductive organs and issues related to reproductive function.

Mandatory examination of the reproductive organs is performed. The external urethral meatus is inspected, as polyps and urethral prolapse often complicate the course of the disease. Laboratory urinalysis is conducted (urine in patients with cystalgia shows no pathological changes). Laboratory and radiologic Methods determine the function of the Kidneys, upper and lower urinary tracts. Organic bladder diseases are ruled out using cystoscopy and, when appropriate, other diagnostic methods (Micturition cystoscopy, urethrocystography, ultrasound, etc.). Cystoscopy either reveals no mucosal changes or shows the absence of a clear mucosal pattern in the area of the bladder trigone and lower segment of the neck, as well as polypoid growths on the bladder neck.

Patients with pronounced emotional-neurotic disorders are consulted by a neurologist to rule out neurogenic bladder dysfunction, in particular increased contraction and relaxation processes of the detrusor and sphincters due to impaired innervation. In some cases, the hormonal function of the Ovaries is assessed using the karyopyknotic index.

Treatment for cystalgia must be comprehensive. First and foremost, the causes and etiological factors of the disease should be eliminated. Essential importance is attached to the therapy of inflammatory processes in the reproductive organs, as well as other urogenital disorders accompanied by hemodynamic disturbances and pelvic nerve neuralgia. General strengthening treatment, psychotherapy, and the reduction of pelvic congestion are carried out, along with the administration of sedatives, analgesics, and antispasmodics.

For patients of reproductive age with ovarian hypofunction, cyclic hormone therapy (estrogens, gestagens) is recommended according to standard protocols. Cystalgia in elderly individuals responds successfully to estriol treatment.

To normalize Blood Circulation in the pelvic organs, therapeutic gymnastics and thermal Procedures are recommended. Acupuncture is indicated, as it provides an analgesic effect and relieves dysuric symptoms, alongside sinusoidal modulated currents (using the "Amplipulse-3T" apparatus) with a specially designed vaginal electrode. It is also important to normalize work and rest regimens, as well as the rhythm of sexual life.