Urogenital Pain Disorders Are Associated with Childhood Trauma

Objectives: To investigate the relationship between urogenital (GU) pain diagnoses and adverse childhood experiences (ACEs).

Methods: All female members of a large integrated healthcare organization between October 2021 and November 2023 who completed the ACE questionnaire were included in this retrospective cohort study. The ACE questionnaire is a 10-item survey (Figure 1) about childhood exposure to household challenges, abuse, and neglect, with a score range of 0 to 10. Previous studies have equated high ACE scores (≥4) with significant childhood trauma which, in turn, is strongly associated with adverse health outcomes and mortality (Felitti et al.). Within this cohort, international classification of disease codes were used to identify patients with GU pain disorders (bladder pain syndrome, overactive bladder, urinary frequency, urinary urgency, chronic pelvic pain, dyspareunia, dysmenorrhea, endometriosis, and somatic dysfunction of the pelvic region). The prevalence of high ACE score was compared among patients with and without GU pain diagnoses. Additionally, demographics, medical history, neighborhood deprivation index, non-genitourinary chronic pain diagnoses, and annual healthcare utilization (inpatient and outpatient) were compared among those with and without GU pain disorders.

1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8

Results: Of the 7111 subjects included in the study, 717 (10.1%) had a GU pain diagnosis (Table 1). Patients with GU pain were more likely to have a high ACE score (27.3% vs 19.1%, p < .001) and had higher mean±SD ACE scores (2.4±3.1 vs 1.7±2.6, p < .001) than patients without GU pain. In this cohort, black patients had the highest prevalence of both GU pain (19.2%) and high ACE score (28.4%), while Asian patients had the lowest prevalence of both GU pain (6.7%) and high ACE score (10.7%). Patients with GU pain were more likely to reside in more deprived neighborhoods (38.1% vs 32.8%). GU pain syndromes associated with the highest prevalence of high ACE score were endometriosis (36.1%), dyspareunia (31.3%), and chronic pelvic pain (27%). Healthcare utilization among patients with GU pain was double that of patients without GU pain, with a three-fold higher rate of ED visits and hospitalizations (Table 1).

Conclusions: Our study demonstrates that GU pain is associated with childhood trauma, with 1 in 7 patients with GU pain reporting a high ACE score. These findings underscore the importance of a comprehensive treatment approach of GU pain that goes beyond pharmacologic and procedural therapies to address past trauma and its somatic manifestations. Future research should focus on the role of enabling integration of trauma in the treatment approach to chronic GU pain disorders.