Small fiber neuropathy (SFN) is an emerging and debilitating condition impacting small, myelinated A-Delta and unmyelinated C fibers, which affect pain and autonomic function. Patients with SFN present with multiple co-morbidities and symptoms throughout the body (pain, urinary and bowel symptoms, migraine, IBS, anxiety), which seem unexplained until the diagnosis is considered. Urologists see people with SFN frequently due to the impact of the autonomic nerves on bladder function. In our single-center retrospective cohort, we hypothesize that patients with SFN will have a high prevalence of sexual, urinary, bowel, pelvic, psychological, neurological and autonomic dysfunction.

259 patients completed the electronic intake for our subspecialized adult Urogynecology and Reconstructive Pelvic Surgery (URPS) clinic. 38 (14.7%) were male, 215 (83%) female, and 6 (2.3%) identified as transgender. Of these patients, 17 females, 1 male, and 1 transgender person had SFN. Statistical analysis included unpaired t-tests. Validated measures were: POPDI-6, autonomic symptom score, PHQ4 (anxiety and depression), UDI-6 (urinary symptoms), neuro-urological symptoms, PISQIR (sexual health and function), CRAD-8 (lower urinary tract symptoms, GUPI pain subscales/total and quality of life scores (genitourinary pain), IPSS QOL (urinary symptoms) and SHIM (sexual health inventory).

Please see Table 1 for results.

Female patients positive for SFN had significantly more urinary symptoms (UDI-6 mean 61.2 ± 20.0 vs. 43.3 ± 25.3, respectively, p value = 0.007, T value = -3.09), pelvic organ prolapse symptoms (POPDI-6 mean 40.9 ± 23.4 vs. 30 ± 21.3, respectively, p value = 0.036, T value = -2.27), anxiety and depression (PHQ-4 mean 5.0 ± 3.14, vs. 2.27 ± 3.65, respectively, p value = 0.006, t value = -3.07), neurological symptoms (mean 5.63. ± 2.97 vs. 1.97 ± 2.34, respectively, p value < 0.001, t value = -5.23), and autonomic symptoms (mean 12.36 ± 5.77 vs. 4.04, ± 4.32, p value <0.001, t value -5.26) compared to those without SFN. These patients also experienced less intense orgasm (mean 2.0 ± 0.996 vs. 2.728 ± 0.775, p value 0.013, t value 2.85), more pain with intercourse (mean 3.44 ± 0.88 vs. 2.6 ± 1.19, p value 0.024, t value -2.262), higher presence of any urinary, bowel, or sexual symptoms (p value = 0.016, chi square = 5.097), and significantly more pelvic pain (chi square = 14.064, p value <0.001).

Our findings demonstrate that SFN is strongly associated with urinary, bowel, pelvic, sexual, psychological, neurological and autonomic symptoms. Clinicians should have a high index of suspicion for SFN in patients presenting with multisystem genitourinary dysfunction in the setting of multiple pelvic, pain, and autonomic symptoms, engaging multidisciplinary collaboration in diagnosis and management of this complex but treatable condition.