Cystitis after sex is also called postcoital cystitis – it is a bacterial infection of the lower urinary tract 24-48 hours after sexual intercourse. In my practice, such cases are frequent and, as experience shows, manual masturbation and solo sex can also activate this type of cystitis. Let me remind you that cystitis is an inflammation of the bladder wall.
Characteristic symptoms of cystitis after sexual intercourse:
- Burning pain during urination;
- Urination with blood impurities;
- Pain in the area above the pubis and a feeling of pressure;
- Sluggish urination, sometimes with an unpleasant odor;
- Frequent urination (more than seven times during the day) and more than twice at night. If you drink 3 liters of water, then during the day you may have frequent urination, but the stream is of normal filling, and it is not a condition of “peeing by the drop”;
- Accelerated urge to urinate, feeling of not completely emptied bladder. Patients often say the following phrase, “I constantly feel my bladder”.
Sexual debut and subsequent active sexual life in a certain percentage of women triggers inflammation of the urethra and bladder. However, post-coital cystitis can also appear after childbirth and with the menopause.
And sometimes it is a symptom of hormonal disorders in women!!! Decrease in estrogen due to prolonged use of birth control pills or due to hypothyroidism.
In 70-80% of cystitis, development is associated with anatomical features of the urethra.
- If the external opening of the urethra is located closer to the entrance of the vagina or on its anterior wall, then during sexual intercourse more microflora enters the urethra;
- If there is a fusion between the remnants of the hymen and the external opening of the urethra, then during sexual intercourse there is a tension of the remnants of the hymen, the urethra shifts and gapes.
Factors that contribute to cystitis after sex:
The thickness of the inner layer of the bladder is very hormone-dependent. The stronger the imbalance of female hormones, the weaker the protective functions of this layer, and as a result, bacteria begin to settle and infect the bladder.
The urethra releases the urine. The mucosal, submucosal and muscular layers of the urethra should provide a good “sealing effect” of the urethral lumen, thus preventing ascending infections during sexual intercourse. This protective mechanism is partly dependent on estrogen and partly on androgen, and can be impaired after menopause or as a result of adrenal or thyroid dysfunction.
Metabolic syndrome, obesity, diabetes mellitus
Glucose is a nutrient medium for bacteria. “Fast” carbohydrates in the diet of a modern woman are a risk factor for her sexual health.
Reduced libido, insufficient central and peripheral arousal with vaginal dryness reduce both vaginal lubrication and blood filling of the cavernous body around the lower third of the urethra, which provokes trauma to this area and the vulva. The probability of urethral damage increases if the muscles around the vaginal entrance are tense and intercourse is painful.
Pelvic floor factor
Pelvic floor muscles can react to tissue inflammation by becoming tense. Due to increased muscle tone during intercourse, microtrauma to the urethra can also occur.
The risk of pelvic floor dysfunction, combined with dyspareunia and symptoms of cystitis, doubles after sexual abuse.
The gaping of the external opening of the urethra is due to a decrease in estrogen levels, which is most often observed in the postmenopausal period. The loss of estrogen (and partially testosterone) deprives the urogenital structures of a key trophic factor.
PH of the vagina and microbiota
Estrogen is necessary to maintain a normal vaginal microbiota, including lactobacilli, which maintain a vaginal pH of 4.0-4.5. Vaginal acidity (pH) levels of 5 or more are associated with bacterial vaginosis, vaginitis and cystitis.
It is also important to exclude thong panties, give preference to underwear made of natural fabrics, use “daily pads” as intended. It is important to refrain from douching and washing out microflora during personal hygiene with inappropriate means.
Altered intestinal flora can lead to an overgrowth of Enterobacteriaceae, the causative agents of most urinary tract infections. Irritable bowel syndrome (IBS) is associated with the presence of cells that cause inflammatory reactions in the intestinal mucosa and easily react to irritants, as well as increased passage of intestinal microbes through the intestinal cells (barrier disruption).
Constipation, which tends to worsen with age and menopause, is another factor contributing to the development of cystitis.
It is important to wash after each act of defecation to prevent bacteria from the rectum from entering the vagina and urethra.
How to treat cystitis after sex:
- compliance with hygiene rules
- reduction of risk factors
- hyaluronic acid
- hormones stabilization
- 1 glass of water after sex
- pee after sex
Be healthy mentally, physically, sexually and reproductively!
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With love, your Natalia Silina,
Director of the LIOR Medical Center