Next time I’m coming back as a man, he doesn’t get cystitis every time we have sex.
This is effective in women who have a very clear temporal relationship of up to 12 hours between an episode of cystitis and sexual intercourse. Retrospective and prospective studies have shown that sexual intercourse has a mechanical effect in introducing uropathogens into the bladder. Sexually active women have a greater risk of infection than non-sexually active women. Some diaphragm users have a higher rate than women using other methods of contraception. There is debate whether this is due to a mechanical effect of the diaphragm in the vagina altering the angle of the bladder neck (from urodynamic studies), or due to the change of vaginal pH from the spermicidal cream or jelly. If the woman gets recurrent postcoital dysuria and uses a diaphragm, it is certainly worth considering either checking the diaphragm for its size and fitting, changing the spermicide, or discussing the use of another form of contraception.
A residual pool of urine in the bladder may act as a reservoir for infection. The woman may be advised to empty the bladder before and after intercourse. Early post-intercourse micturition has a proven protective effect.
In women who do develop postcoital dysuria a single dose of trimethoprim can prevent an attack if taken immediately prior or post-intercourse. The issue of antibiotics interacting with oral contraceptive drugs must be considered in this group. In a recent paper in 135 sexually active premenopausal women were offered either a post-intercourse dose of ciprofloxacin, or daily ciprofloxacin 125 mg. In the study, sexual intercourse rates averaged a mean of 2.52 times per week. During the year, 94% of the post coital group and 95% of the daily group remained symptom free, and had a significant drop in measured introital colonization of enteric organisms. The rate of discontinuation due to adverse drug reactions was 5.3% in the continuous group and 1.3% in the postcoital group. The postcoital group consumed 33% less drug. There was a higher rate of thrush in the continuous group (3.9%), there was none in the postcoital group. It is surprising that no one in the postcoital group had thrush all year. A very important point from this trial, which has been consistently shown in other trials, was a mean relapse time after stopping antibiotics of 6 – 7 months for both groups (they were followed for a year). Recolonization of the vaginal introitus with pathogenic E. coli seems to take time after a year’s treatment with antibiotics.