Q: I seem to get bladder infections every time I have sex. What would you suggest? (I hope it’s not abstinence!)
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A: It sounds as though you may have a condition that doctors have euphemistically termed “honeymoon cystitis.” Cystitis means inflammation of the bladder. The “honeymoon” part implies frequent intercourse with a new partner, though today the term refers more to the “honeymoon period” of a relationship than to a post-wedding trip to the tropics.
Most of us are familiar with the symptoms of a bladder infection: Frequency of urination, an urgent need to empty the bladder and dysuria (a burning sensation during urination). There may even be visible blood in the urine.
One of the most frequent causes of a bladder infection is coital activity. This doesn’t mean your partner is giving you a unique bacteria causing the infection but rather that the act of intercourse is “pushing” bacteria that normally reside in your vagina up into the urethra (the short conduit that leads from the vaginal opening to the bladder). In fact, considering our anatomy “down there,” it’s amazing that bacteria don’t get into the bladder and cause infection more frequently.
It turns out some women are more likely than others to get a bladder infection after sex. In the past, we hypothesized that perhaps these women’s urethras were congenitally short or that they had poor sphincter activity, but we now think it has more to do with components in the bladder lining which increase the ability of bacteria to adhere and multiply. There may be a genetic propensity for this condition.
With the onset of a new relationship (and new bacterial “importing”), the bladder may initially be unable to clear these bacteria, but with time and perhaps the body’s acceptance of this microbial invasion, the situation improves. I often find that if a patient doesn’t regularly have sex with her partner — for example, if they are in a long-distance relationship — when they do get together and have more frequent sex, infections occur. Diaphragms that may press on the urethra also seem to increase bladder infections subsequent to coitus.
So, what do you do if you suffer from frequent bladder infections?
1. Make sure you empty your bladder before and after intercourse. Urinating after sex is the most effective mode of prevention because the voiding actually rinses bacteria from the urethra and clears it from the bladder.
2. Make sure you hydrate sufficiently. I would recommend at least six glasses of water a day.
3. Cranberry juice and/or tablets have been found to decrease adherence of bacteria to the urethral and bladder walls (a glass or a couple of tablets a day is a good habit to get into if you get frequent infections).
If you continue to get infections, talk to your doctor about the use of prophylactic antibiotics. I usually prescribe one pill or capsule after intercourse on a regular basis. The most common antibiotics are Macrodantin, Bactrim, Levoquin, Cipro (in low doses), though there are others as well.
Prior to any course of treatment, it is important that your doctor perform a urinalysis and culture to confirm what you have is indeed a bladder infection. Some patients have a condition known as interstitial cystitis, a chronic inflammation of the bladder which results in pain and symptoms that may mimic those of a bladder infection. It is thought to be caused by an alteration in a component of the bladder’s protective coating so that the urine itself irritates the bladder wall.
Dr. Reichman’s Bottom Line: If you get recurrent bladder infections after sex, you don’t have to stop having sex but you should consider ways to flush out bacteria to prevent its adherence and, if necessary, take antibiotics.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.