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Cystitis related to Sexual Intimacy

Relationships affected by cystitis and UTI

Cystitis related to Sexual Intimacy Cystitis is a major health concern for women in particular and it is estimated that approximately 40% of women have had a UTI at some time in their lives. Many women associate these problems with sexual activity and tell us that their intimate lives are overshadowed and badly affected by a fear of further infection.

Development of Cystitis

Women develop cystitis within a day or so after having sex for several reasons. Vigorous movement during sex can push bacteria from the peritoneum up into the bladder and may cause some damage to the urethra, which is thought in turn to enable bacteria to take hold and thrive. All of these circumstances will be exacerbated if the vagina is dry during sex, so it may be wise to use lubricant.

The most prevalent bacterium that causes bladder infections associated with intimacy is Escherichia coli or E. coli, (statistics suggest approximately 90% of the time) though any coliform can potentially cause problems and kissing can introduce another bacterium from the mouth, Streptococcus (Strep). When these attacks of cystitis keep occurring they are usually referred to as complicated UTIs (the dangers of recurrent UTIs range from painful cystitis to serious kidney infections and life threatening sepsis) and longer courses of antibiotics are then prescribed. We have become used to these episodes being dealt with effectively by antibiotic therapy and have perhaps become complacent but the truth is that bacteria are survivors and have mutated in response to repeated courses of antibiotics: they have got stronger and acquired resistance and burrowed deeper in to the bladder wall where they lay dormant, protected from further attack by biofilms. These biofilms are currently estimated to be responsible for over 65% of nosocomial infections (hospital acquired) and 80% of all microbial infections.

It is more accepted now that sex related cystitis is not always about reintroduction of bacteria but also about embedded bacteria coming to the surface where they attach to mannose in bladder cells and proliferate, causing the same infection to reappear and grow stronger.

There is currently a plethora of research available that proves that bacteria can colonise layers of the bladder epithelium and bury themselves deep within the bladder wall, especially after an antibiotic attack, waiting to reappear when conditions are favourable.

As a result doctors are increasingly, and quite rightly, reluctant to over-prescribe antibiotics unless a kidney infection is a factor as the understanding increases that although antibiotics destroy unwanted bacteria, they also destroy "friendly" bacteria living in the gastrointestinal (GI) tract, and antibiotics can cause unwanted side effects. If enough friendly bacteria are destroyed, an overgrowth of the "not-so-friendly" yeasts, moulds, and bacteria - all of which produce unwanted toxins can occur. Most women who have problems with cystitis will report a cycle of infection, antibiotics, candida, being well, then reinfection later. But perhaps our reliance on antibiotics must stop for an even more important reason and that is that antibiotic-resistant bacteria "superbugs" are emerging that are resistant to all known antibiotic drugs.

So how can we manage sex related cystitis in women?

  • Take 1 level to heaped teaspoonful or 3 x 1gm tablets of D-Mannose one hour before sexual activity.
  • Immediately after sex, urinate and take another dose of D-Mannose.
  • The following day, take another dose when you wake up and then every 4-6 hours.
  • Keep the urine pH above 7.2 to inhibit most bacterial growth
  • Meanwhile, go on to a heaped teaspoonful or 3 x 1gm tablets every three hours, then reduce to half that dose for the next day or two.
  • Keep up the normal hygiene standards.
  • After following this regime for a few months, you may occasionally risk sex without taking D-Mannose beforehand, however, continue taking D-Mannose after sex.
  • Gradually you should be able to return to a normal sex life.

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