Bladder Parasites and other Causes of Symptoms: Dr. Michael Hsieh on Chronic UTI, Part 1

Dr. Michael Hsieh explains that lichen sclerosus is a condition presenting as vaginal atrophy and chronic inflammation, and can lead to UTI symptoms like frequency and urgency. It occurs during or after menopause as estrogen levels deplete. Lower estrogen levels means fewer lacto bacteria, which are natural defenders against UTI, as well as a weaker regional immune system. It also means less vaginal lubrication and thus potential discomfort. Lichen sclerosus can be diagnosed by a urologist or gynecologist often via a pelvic exam and can be treated with estrogen and steroid creams.
Meanwhile, vestibular vulvodynia can also result in urinary symptoms. Vulvodynia refers to pain or discomfort and chronic inflammation in the vulvar and vaginal region. The vestibule is the area between the labia minora that includes the urethral and vaginal openings. Vestibular vulvodynia is a diagnosis of exclusion and is believed to be caused by nerve or mast cell overactivation. People with vulvodynia often experience pain during intercourse or as a response to light touch. Some feel pain or discomfort even without external stimulation.
According to Dr. Hsieh, some parasites can likewise trigger urogenital symptoms. For example, Schistosoma haematobium is responsible for urogenital schistosomiasis in the urinary tract and the vagina. Symptoms include blood in the urine as well as urinary frequency and urgency. S. haematobium lives on waterborne snails. When the parasite detects human products in water, it follows the gradient and enters the body through the skin. From there, it lays eggs in the bladder that develop into worms, each of which can live for several years. It is endemic to sub-Saharan Africa, the Middle East, and Corsica. Treatment for schistosomiasis includes the antiparasitic Praziquantel.
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