OVERVIEW
Interstitial cystitis, restrictive vulvovaginitis, and desquamative vaginitis are rare syndromes in which the patient has urinary symptoms such as frequent urination, lower abdominal pain, and nocturia, with bladder tenderness on duplex examination and a urine culture that is free of bacteria; and in which the patient has pain with sexual intercourse and/or vulvar discomfort with vestibular lesions that can be painful or uncomfortable when the lesion is squeezed with a cotton swab or an examining finger, which is limited Vulvovaginitis, also known as minor vestibular adenitis or vulvar vestibulitis; if the symptoms include a purulent vaginal discharge or pain with intercourse, and the vaginal saline douche contains a large number of leukocytes and basophils, the diagnosis of desquamative vaginitis is made; and the syndrome of the three diseases above is a noninfectious inflammatory syndrome. The above diagnosis cannot be made if there is a definite cause of infection. If a few patients have concomitant infections, the diagnosis of the three-disease syndrome can be made only after elimination of these coexisting infections.
Etiology
The syndromes of interstitial cystitis, restrictive vulvovaginitis, and desquamative vaginitis are associated with multiple sexual partners, Candida infections, Mycoplasma hyopneumoniae infections, or post-infectious sequelae. The tissues involved in restrictive vulvovaginitis and interstitial cystitis, including the bladder, urethra, and vestibular tissues, all of which originate in the embryonic genital sinuses, may be associated with autoimmune causes of this noninfectious inflammatory syndrome.
Symptoms.
Patients with the syndromes of interstitial cystitis, restrictive vulvovaginitis, and desquamative vaginitis have urinary frequency, pyuria, and bladder pain, nocturia, vulvar itching, vulvar discomfort, dyspareunia, pain with sexual intercourse, abnormal vaginal discharge, abnormal genital tract odor, and lesions of the vestibule that may be present with urethral pressure and bladder tenderness.
There are small erythematous lesions on the outer hymen at the vestibule, all other examinations are normal, and pressure on these lesions with a cotton swab or examining finger may produce tenderness or discomfort.
There was discomfort, burning or pain in the vulva. There was purulent vaginal discharge in all cases, with a vaginal pH of 4.5 to 5.5, and a fishy odor was not produced by adding 10% potassium hydroxide solution to the discharge.
Examination
Routine urinalysis and bacterial culture, smear examination of vaginal discharge, vaginal pH examination, pathologic examination of vaginal epithelial cells, and immunologic testing for mycoplasma infection.
Diagnosis
The presence of this syndrome should be considered in conjunction with the clinical features described above, including the prevalence of young women with multiple sexual partners and the predisposition of women who consume alcohol to this syndrome.
Cystoscopy under anesthesia can make the diagnosis of interstitial cystitis, the beginning of the bladder is normal in appearance and volume, but after the bladder is filled and emptied, and then refilled, scattered submucosal hemorrhage can often be seen, biopsy can show the above mentioned subepidermal edema, congestion, dilated capillaries, and interstitial hemorrhage in the perivascular interstitium of the pathological changes, and it can also be used to exclude some in situ carcinoma and tuberculosis lesions. In limited vulvovaginitis, there is a small erythematous lesion on the outer vestibule of the hymen, but the rest is normal. Vaginal pH is measured and 10% potassium hydroxide is added to the vaginal secretions without a fishy odor. Microscopic examination of the secretion suspension reveals no cells suggestive of a diagnosis and the secretions contain only a large number of leukocytes and immature vaginal epithelial cells (stromal-like cells), and cultures of Chlamydia trachomatis, gonococcus, and Trichomonas vaginalis are all negative.
Treatment
There is no safe, convenient and efficient treatment for interstitial cystitis; dilatation under anesthesia and injection of dimethyl sulfoxide (DMSO) are currently available and are two of the more commonly used treatments.
Limited vulvovaginitis can be treated by applying a surface application of lidocaine and a lubricant to give the patient relief from contact pain and painful intercourse. In severe and recalcitrant cases, surgical excision of the hymenal ring and nearby vestibular mucosa may be used. Pathologic examination of the excised tissue is also free of inflammation characteristic of the disease.
Desquamative vaginitis can be treated with metronidazole (methotrexate) to normalize vaginal discharge, and with Candida albicans can be treated with miconazole, mycotoxin, and clotrimazole (Kenitin). Topical hydrocortisone is also effective in the treatment of desquamative vaginitis.