Cystitis after sex in women: symptoms and treatment. Postcoital cystitis.

Urethritis is an inflammation of the urethra. Women are more susceptible to developing this inflammation than men, which is due to the peculiarities in the structure of the genitourinary system. Considering the anatomical factor, untreated urethritis in girls, when periodic “pains to pee,” can lead to a large number of complications.

Moreover, almost 100% of patients complain of frequent pain and pain in the urethra at the end of urination. With urethritis, the pain is strongest at the beginning of the process or the same throughout its entire duration. In addition, as already mentioned, the female urethra can hurt constantly, without any connection with trips to the toilet “in a small way.”

Women often experience urethritis and cystitis, which often accompanies it, at the same time. At the same time, their symptoms may be equally expressed, or the signs of one of the diseases may sharply predominate.

Cystitis and sex

If you had prolonged or too intense sexual contact, then after it you may experience a frequent urge to urinate and pain during it; these symptoms do not always indicate an infection. They often arise due to the fact that the bladder, and in particular the neck and urethra, become “irritated” due to mechanical stress.

If these symptoms do not subside within 24 hours, then you should collect a urine test, an average sample, and contact a specialized doctor for cystitis (urogynecologist, gynecologist, urologist) as a matter of urgency.

Causes of pain during urination

Pain when urinating, as in the beginning, often indicates urolithiasis. The symptom occurs when a stone passes through the urethra. The pain spreads to the lower abdomen and lumbar region. Another symptom may develop against the background of candidiasis (thrush).

A common cause of pain in men is phimosis, a narrowing of the foreskin of the head of the penis. This is due to the fact that before leaving the urethra, urine accumulates, which causes pain in the process of releasing urine in small portions.

Cystitis at any age

An acute attack of cystitis after sexual intercourse can occur at any age. Decades ago, when women maintained their virginity until marriage, cystitis that occurred after sexual intercourse was called the “honeymoon disease.”

At the present time, the fact is that no matter what your age, if the contact took place after a long break, the meeting was too active or sex happened with a new partner, you are not immune from the development of acute cystitis.

Why does the urethra become inflamed in women?

Urethritis, depending on the etiological factor, can be non-infectious (chemical, allergic) and infectious.
But in the vast majority of cases, urethritis is sexually transmitted, and the incubation period of infection can last up to several months.33, 62 Inflammation can be caused by uropathogens such as chlamydia, ureaplasma, trichomonas, gonococci, streptococci, E. coli, and Candida fungi. Inflammation can develop primarily directly in the mucous membrane of the urinary canal or penetrate into it from nearby foci of infection. The general condition of the organism plays a significant role in pathogenesis.33, 62

Causes of cystitis after sex

The main cause of inflammation of the bladder after sexual intercourse is a bacterial infection - the entry of pathogenic microorganisms into the female bladder.

Inflammation of the urinary tract after sexual intercourse can occur for several reasons, mainly anomalies of physiological development. In some women, the external opening of the urethra is located close to the opening of the vagina and bacteria easily enter the bladder.

Another cause of cystitis may be poor personal hygiene, both by women and men. Dirt and bacteria from the hands or genitals can enter the urinary system and cause inflammation.

In addition, the cause of the disease may be a combination of anal and vaginal sex in one sexual act. Among the bacteria that cause cystitis is E. coli, which, when it enters the urinary system, causes extremely unpleasant consequences. Up to 90% of cystitis is caused by the bacterium Escherichia coli, and movement during sex helps move this bacterium into the urethra and bladder.

Cystitis after sex can also develop due to sexually transmitted diseases, microflora disturbances in the vagina, and as a result, with inflammatory phenomena in the pelvic organs.

Any damage to the mucous membrane of the urethra during sexual activity gives rise to excessive proliferation of pathogenic microflora and the development of inflammatory processes. This is especially true if a woman has not had sex for a long time, sexual intercourse was prolonged and/or the woman’s vagina is poorly moisturized (dry, due to the lack of a sufficient amount of “natural” mucus).

Some women also find that certain sexual positions cause irritation and cystitis. Sex from behind, for example, is especially harmful for women who are prone to cystitis.

Treatment

Conservative therapy

The treatment plan is drawn up taking into account the nature of the disease, accompanied by pain when urinating. In case of inflammatory pathologies, it is recommended to avoid hypothermia. Women suffering from urolithiasis are prescribed a special diet. The following medicinal and non-medicinal methods are used:

• Antimicrobial therapy.
  Plays a leading role in urethritis and cystitis of infectious etiology. For nonspecific processes, phosphonic acid derivatives, nitrofurans, and fluoroquinolones are effective. The regimen is adjusted after receiving culture results with determination of antibiotic sensitivity. For specific infections and candidiasis, antibacterial, antitrichomonas and antifungal agents are used.
• Other medications.
  Uroseptics and NSAIDs are used. Women with renal colic are given intramuscular antispasmodics and painkillers. For prolonged attacks, it is recommended to irrigate the lower back with chlorethyl and inject local anesthetics into the area of ​​the round uterine ligament. Herbal medicines are useful for both cystitis and urolithiasis and help improve the condition of the urinary system.
• Local therapy.
  For cystitis, intravesical instillations and physiotherapy are prescribed. For renal colic, thermal procedures, electropuncture and acupuncture are performed. For small stones, vibration therapy, ultrasound and diadynamic therapy are effective. For incontinence, special exercise therapy complexes, electrical stimulation, and urogynecological pessaries are recommended.

Surgery

Surgical interventions are required for women with urolithiasis. In most cases, minimally invasive techniques are used: contact nephrolithotripsy or ureterolithotripsy, percutaneous nephrolitholapaxy. Indications for laparoscopic and open operations are infectious diseases of the urinary system and pathologies of the musculoskeletal system, which do not allow the patient to be given the desired position. Nephrolithotomy, pyelolithotomy or ureterolithotomy is performed.

The simplest and most effective method for treating incontinence in women is the installation of slings. In case of severe genital prolapse, more complex interventions are required to restore the pelvic floor: laparotomic and laparoscopic sacrovaginopexy, Manchester operation, etc. In case of total hypospadias, plastic surgery of the vagina, urethra and detrusor neck is performed.

The first signs of cystitis after sex

Cystitis after sex has several differences from acute cystitis. First of all, symptoms of the disease occur either in the first few hours or 1-2 days after intimacy.

The first symptoms are a frequent urge to urinate, which is accompanied by pain, burning, stinging, a feeling of incomplete emptying of the bladder, urine changes color and smell, and becomes cloudy. Body temperature may rise to subfebrile levels, pain or discomfort may appear in the lower abdomen and lumbar region. Some symptoms may be less severe or not appear at all.

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Why does the urethra hurt, burn and itch?

It’s rare that any girl can say that she has never had pain when urinating in her life. Of course, the more predisposing factors, the greater the chance of developing urethritis, the treatment of which will require some effort. Among these, gynecologists distinguish:

* Hypothermia. * Beginning of sexual activity. * Violent sexual intercourse. * Sexual infections and venereal diseases. * Errors in diet (spicy, sour, etc.). * Gynecological diseases. * Vaginal flora disorders. * Urolithiasis disease. * Medical procedures on the urethra. * Decreased immunity. * Toxic and radiation damage.

Symptoms of urethritis in women

Common complaints are white or mucous discharge from the urethra in the morning, itching, pain and stinging when urinating, “it hurts to pee.” Urethritis in women can occur without discharge from the canal, only with unpleasant sensations. With this disease, as a rule, there are no general inflammatory symptoms - there is no increase in body temperature or general weakness. However, this does not mean that the disease does not need to be treated and that “everything will go away on its own.”

How the disease develops.

Infection of a woman most often occurs during sexual contact with a sick person. Urethritis can occur without pronounced manifestations, unnoticeably, and the patient himself may not know that he is sick. So, we got a pathogen in the vagina. It constantly enters the urethra and causes chronic inflammation. As long as the immunity of the urethral wall copes with the situation, no symptoms of the disease arise. With regular intimacy, a more intense reflux of microflora into the urethra occurs and, in addition, sexual intercourse itself is a considerable burden for it. Therefore, exacerbations of urethritis are almost always associated with sexual activity, its activity and intensity. Symptoms of the disease may not appear immediately after intercourse, but after some time (for nonspecific bacterial urethritis - from several hours to several days or weeks), which is called the incubation period.

Chronic urethritis

The inflammatory process of the urethra is an insidious disease that often goes unnoticed and treatment requires considerable effort.
This greatly complicates its timely diagnosis, because Patients sometimes come to the gynecologist late, when the process has already entered the chronic stage and it is painful for a woman to “go to the toilet a little” and has already become habitual. Symptoms and signs of chronic urethritis appear in women more often as follows:

• the frequency of the urge to urinate increases,
• the interval between trips to the toilet decreases,
• a woman feels a burning sensation and pain in the urethra, in the lower abdomen,
• Purulent and bloody discharge may come from the urethra.

Relapse is caused by hypothermia or excessive consumption of alcoholic beverages. Under the influence of harmful effects, all the symptoms of primary acute infection gradually resume. Possible and frequent complications of chronic urethritis are the same urogenital diseases that are among its possible causes, namely cystitis, salpingitis, prostatitis and balanoposthitis (in men), pyelonephritis, etc. With a long course against the background of fibrous scarring of the walls of the inflamed In the urethra, a stricture (pathological narrowing of the lumen of the urethra), chronic pelvic pain syndrome, and ectopic pregnancy in women can form. We should not forget that urethritis, or rather its causes, often begins with both female and male infertility...

Frequent urge to run to the toilet “little by little”?

Why do women often start running to the toilet due to the unbearable urge to “pee”?
Which can cause a strong desire to be near a bathroom. Find out more about bladder inflammation and what to do about it using the links below! assignment_ind

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Tests for urethritis

Diagnostics carried out in women before treatment are aimed at identifying the pathogen. Therefore, to determine the cause of urethritis, tests are of paramount importance. The gynecologist usually prescribes the following for women who have pain in peeing:

1. Gram microscopy of urethral smear;
2. bacterial culture of discharge from the urethra and/or vagina in order to detect the microbe and perform an antibiotic sensitivity test;
3. PCR tests for “hidden infections”,
4. bacteriological culture of urine,
5. general urine analysis.

You can read about these methods of laboratory diagnosis of urethritis, find out the list of tests and the address of the laboratory at the link “Where to get tested” in Moscow.

Diagnosis of urethral inflammation

Examination before treatment

Complications and consequences of postcoital cystitis

Cystitis after sex is dangerous due to its complications, like any other inflammation.

If you ignore the first signs, the disease may develop into a more severe form that is more difficult to treat. Infection from the bladder can spread higher and provoke inflammatory kidney disease - pyelonephritis. In addition, if cystitis after sex occurs every time, a woman will eventually lose the desire to have sexual intercourse due to the fear of getting cystitis again, and this in turn leads to uncertainty, stress, disagreements between partners, etc.

Recently, self-medication has become widespread, and women who already know their problem can take a course of antibiotics immediately after sexual intercourse, but regular use of such drugs can cause other, more serious problems (in particular, uncontrolled use leads to drug resistance, i.e. e. antibiotics become powerless in the fight against pathogenic microorganisms).

In addition, antibiotic treatment is contraindicated during pregnancy, and cystitis in this situation can lead to miscarriage, premature birth, and cessation of fetal development. All experts agree that cystitis requires professional and complete treatment, otherwise not only physical problems are possible, but also psychological ones, both on the part of the woman and the family as a whole.

In response to inflammation, an admixture of blood may appear in the urine - hemorrhagic cystitis, and frequent episodes of inflammation lead to a chronic process with the involvement of deeper layers of the bladder wall in the inflammatory process, partial or complete destruction of the GAG ​​layer (glycosaminoglycan layer) - a protective or barrier layer , which prevents the adhesion of bacteria to the bladder mucosa.

Risk factors

Urologists are aware of certain signs and primary diseases associated with dysuria. These forms of predisposition should be taken into account when conducting diagnostics.

Key risk factors:

1. Female. The narrower and shorter urethra in women is more likely to be invaded by pathogenic microorganisms.
2. Treatment of oncology with chemotherapy. Painful urination can be a side effect of cytotoxic and cytostatic drugs.
3. Age from 45 years for men. In middle-aged and elderly patients, prostatitis or prostate adenoma is more often diagnosed.
4. Using unsafe intimate hygiene products, getting soap or shower gel into the urethra.
5. Allergic reactions to various substances and tissues that come into contact with the external genitalia.
6. Impaired immune function, facilitating the invasion of pathogenic microorganisms into the organs of the genitourinary system.
7. Long-term catheterization of the bladder.
8. Recent diagnostic procedures, such as a urethral smear.
9. Surgical interventions in the area of ​​the external genitalia and bladder.
10. Eating too spicy foods and coffee.

Discomfort when urinating, not accompanied by other symptoms, is often due to allergies and hygiene products.

Tests for diagnosing cystitis

If a urogynecologist diagnoses “postcoital cystitis” (or cystitis after sex), to confirm it, not only anamnesis and examination of the patient is required, but also additional examination.

First of all, analyzes are carried out:

• general blood test (the basis for diagnosing most diseases),
• general urinalysis (study of the chemical and physical properties of urine, which may indicate pathological processes in the body),
• urine culture - bacteriological examination (detects infection in the urinary tract and its sensitivity to antibiotics),
• vaginal smear (allows you to identify pathogenic bacteria and identify the inflammatory process).

Other reasons

Not in all cases, discomfort during urine output is associated with infection. Structural diseases can also cause dysuria.

Additional reasons:

1. Urolithiasis is the formation of stones in the urinary tract. Stones not only make it difficult to pass urine, but also damage the mucous membranes, resulting in pain.
2. Oncology. The growth of a malignant or benign tumor in the urinary tract can cause severe pain. This can be a relatively harmless disease, such as urethral polyps, or an aggressive variant of oncology with a poor prognosis.
3. Abnormal narrowing of the lumen of the urethra (urethral stricture). In the presence of such a disease, urination becomes not only painful, but also very difficult.
4. Formation of stones in the kidney tissue (renal stones). Small stones spread with urine into the underlying parts of the excretory system.

It is advisable to conclude that dysuria can occur in a large number of urological disorders, so it is impossible to clarify the cause of the symptom without further examination of the patient.

Instrumental diagnosis of cystitis

Instrumental diagnostics, as the name suggests, is carried out using instruments. Cystitis after sex can be confirmed in the following ways:

• Kidney ultrasound
• Ultrasound of the bladder
• Ultrasound of the pelvic organs
• Cystoscopy of the bladder in women

Ultrasound examination to detect signs of inflammation in the bladder and kidneys, uterus and its appendages.

Cystoscopy is an examination of the urinary tract using a special optical system to determine the volume and depth of damage to the bladder mucosa. (more details...)

Diagnostics

Urologists deal with any disorders of the excretory system. During the appointment, the doctor will question the patient in detail about symptoms and study medical history to look for risk factors for diseases. The initial examination sometimes reveals additional symptoms. An accurate diagnosis can be made only after receiving the results of instrumental and laboratory studies.

Diagnostic procedures performed:

1. A blood test is the first test that needs to be done for dysuria. Detection of white blood cells in the urine suggests the presence of infection. In addition, the doctor evaluates the chemical composition of the urine.
2. Blood test to detect additional pathologies. For example, detection of prostate specific antigen (PSA) in the blood serum of men may indicate prostate disease.
3. Ultrasound imaging of the bladder, prostate and internal genital organs in women. Ultrasound is a completely safe non-invasive method of examining the genitourinary system.
4. Endoscopic examination of the inner surface of the urethra and bladder.
5. Urethral smear followed by cytological and microbiological examination of the material.
6. High-precision imaging methods: radiography with contrast, computed tomography. Obtaining volumetric images may be preferable if cancer is suspected.

The doctor may prescribe a limited number of tests after examining the patient and studying the medical history.

Differential diagnosis of cystitis

Differential diagnosis consists of excluding diseases that are characterized by similar symptoms.

For example, if there are signs of cystitis (painful and frequent urination, changes in urine composition, etc.) and high fever, then this condition may be caused by inflammation of the renal pelvis, not the bladder, and the presence of blood or pus in the urine may be caused by the presence of stones in the urinary tract.

If cystitis after sex bothers you for a long time and is difficult to treat, you should undergo a full examination; perhaps the reasons lie in the presence of other diseases - for example, an active viral infection, sexually transmitted diseases, etc.

Signs of cystitis that are not confirmed by the presence of bacteria in the urine may be associated with a fairly common female disease - cystalgia. The disease occurs exclusively among the female population, characterized by frequent and painful urination and pain in the lower abdomen. Cystalgia has not been fully studied, but, according to some data, it is associated with hormonal disorders and circulatory disorders due to pathological processes in the pelvic organs.

When making a diagnosis, the urogynecologist relies on the patient’s complaints and the results of the examination.

Why does a burning sensation occur after urination in men?

In men, the length of the urethra is much longer than in women, so bacterial inflammation occurs less frequently in them, and among the main causes, in addition to sexually transmitted infections, the following can be identified:

• The consequences of inflammation of the urethra are urethritis.
• Urolithiasis, when sediments of urine, consisting of insoluble salts, irritate the mucous membrane, passing through the urethra.
• Most often, burning sensation after urination in men occurs in the presence of various diseases of the prostate gland (for example, prostatitis), which provoke a violation of the outflow of urine.

Treatment of cystitis after sex

Treatment is both symptomatic and etiotropic in nature (i.e., eliminating the cause of the disease).

For example, the presence of inflammation in the vagina is eliminated with the help of local antifungal and antibacterial drugs. If a sexually transmitted disease is detected, a specialist requires treatment of both partners. If there are anatomical features of the urinary system, the urogynecologist may recommend surgical treatment - urethral transfer, i.e. transposition of the urethra (higher above the vagina), if necessary, the surgeon excises the remains of the hymen, which “stretch” the urethra.

After surgery, recovery takes 7-15 days; in 85% of cases, the operation allows you to forget forever what cystitis after sex is.

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Medications

The main treatment for postcoital cystitis is primarily aimed at blocking the spread of infection. Antibacterial therapy helps with this.

The main treatment of cystitis is supplemented with medications that help reduce the unpleasant manifestations of the disease and normalize the functioning of the urinary system - painkillers, herbal medicines, immunostimulants, vitamin complexes.

In the treatment of inflammatory processes in the bladder, the administration of anti-inflammatory drugs through the urethra into the bladder (instillation) is often used.

Cystitis after sex with proper treatment and following all the doctor’s recommendations goes away within a week, but immunostimulating drugs, herbal medicines and vitamins should be taken longer (2-3 weeks).

With this disease, it is extremely important to complete the full course of therapy, otherwise cystitis will become chronic, and treatment of chronic pathology will be much more difficult.

Causes of pain during urination associated with other body systems

• Tumors – benign and malignant, in the organs of the urinary system or nearby organs. Pain occurs due to mechanical compression of the ureter and bladder. Relief of the condition in this case depends on the method of treating the tumor.
• Gout is a rheumatological disease in which uric acid salts are deposited in the joints. The kidneys and urinary system are often affected. In this case, not only pain is observed, but also a burning sensation when urinating.
• Complications after diseases not related to the urinary system. These include sinusitis, all types of sore throats, flu, intestinal diseases, pathological changes in teeth and other inflammatory diseases of organs and systems.

Traditional treatment

Traditional medicine is used to remove inflammatory processes in the bladder, and this is only possible after prior consultation with a specialist. One of the most common methods in folk medicine is to use a heating pad or hot bottle. Yes, there really is relief, but! only for a while, because the cause has not been eliminated, and the bacteria in the bladder has not disappeared.

It is worth remembering that cystitis after sex requires an integrated approach and should include the use of antibiotics, antispasmodics, uroseptics and other medications.

It is important to follow a home regime, diet and drink plenty of fluids. So cold, the use of cold drinks, caffeine, and spicy foods aggravate the symptoms of the disease.

Other symptoms

Burning during urination is rarely the only symptom of a disease of the genitourinary system. As a rule, patients complain of other unpleasant sensations associated with the functions of the kidneys, bladder and genitals. Isolated dysuria may indicate the absence of infection.

Additional signs:

• discomfort in the pubic area, perineum and lower back;
• bleeding in the urine (hematuria);
• increased body temperature;
• nausea and vomiting;
• discharge of cloudy fluid from the urethra;
• decreased libido;
• weak stream when urinating;
• soreness of the skin in the area of ​​the external genitalia;
• unpleasant odor in urine;
• false urge to defecate;
• fatigue and weakness.

Prolonged fever, accompanied by difficulty urinating, indicates the development of a dangerous infection.

Surgical treatment of cystitis

Cystitis after sex is treated mainly with therapeutic agents; surgical treatment may be required to change physiological developmental abnormalities, for example, when the urethra is located close to the vagina, which leads to trauma to the canal and the rapid spread of infection into the bladder. During the operation, the surgeon moves the opening of the urethra to the desired location. After surgical treatment there are almost no complications and the problem of cystitis after sexual intercourse for women in 85% of cases remains a thing of the past.

Complications

Bacteria, viruses and fungi can cause an acute infection that quickly spreads to nearby organs. So, in the case of urethritis and cystitis, an ascending infection affecting the kidney tissue is possible. The negative consequences of such a disease can threaten the patient's life.

Dangerous complications of diseases that cause dysuria:

• Purulent lesion of renal tissue.
• Severe renal failure due to chronic infection.
• Pregnancy disorders in women.
• Penetration of pathogenic microorganisms into the bloodstream with the development of sepsis.

Thus, burning when urinating is not a harmless symptom. Diseases of the genitourinary system that cause dysuria can lead to serious complications. Urological examination allows for timely therapeutic or surgical treatment.

Prevention

• As a preventative measure, both partners should be sure to maintain good hygiene.
• Partners should avoid sexual positions that create pressure or friction on the urethra, as well as intense tempos.
• It is necessary to use special lubricants (lubricants) in case of natural deficiency of vaginal mucus.
• Provide timely treatment for gynecological diseases.
• Do not use spermicides or vaginal diaphragms for contraception.
• It is recommended to empty the bladder immediately after sexual intercourse, this allows you to “evacuate” most of the bacteria that have entered the bladder.
• Immediately after contact, drink at least 300 ml of liquid.

Physiology of urine output

Urination is necessary to remove unnecessary metabolic products and harmful chemical compounds from the body.
Urine itself is formed in the kidney tissue as a result of blood filtration: nephrons successively remove ballast substances from the blood vessels and return necessary components, such as proteins and salts, to the bloodstream. More than one hundred liters of primary urine can be formed per day, but as a result of final filtration, 800-1500 milliliters of liquid per day are removed from the body. The excretory fluid formed in the kidneys penetrates into other parts of the excretory system for accumulation and gradual removal from the body. Approximately 500 ml of urine can be deposited in the bladder, and a person begins to feel the need to urinate when a quarter of the organ’s volume is filled. The signal received from the brain relaxes the sphincter and promotes the removal of fluid from the body through the urethra. In men, part of the urethra passes through the prostate gland, so prostate pathologies can cause dysuria.

Urethritis in women: symptoms and treatment with medications

To treat infectious inflammation of the urethra, antibacterial therapy is used, which is based on the sensitivity of the identified uropathogens to the drugs used. As part of therapy, antibiotics of different groups can be used, and their choice depends on the severity and form of the disease.33

When treating nonspecific urethritis (caused by Escherichia coli, gardnerella, enterobacteria, streptococci), it is recommended to take antibacterial drugs in combination with agents that potentiate their effect. These can be multivitamins, immunomodulators, biostimulants, as well as anti-inflammatory drugs. In case of acute inflammation, urethral instillations are indicated.33

During active therapy, it is necessary to follow a diet (exclude spicy foods, alcohol and other irritating foods), and sexual abstinence. You should also follow the drinking regime.

With timely detection and adequate treatment, the prognosis is usually favorable. But in advanced cases, especially with chronic urethritis, complications may occur (narrowing of the urethra, infertility).33