Honeymoon cystitis is often a recurrent inflammation of the bladder that occurs within a day and a half after intimate relationships or vaginal manipulations. It is manifested by frequent painful urination, abdominal pain, polakiuria. It is diagnosed by examination of the genitals, urine analysis, smear examination for flora, cystoscopy, ultrasound of the urinary organs. Drug therapy is aimed at preventing postcoital relapses, involves taking herbal uroantiseptics, immunostimulants, less often antibiotics. A radical method of treatment is surgery for the transposition of the urethra and dissection of urethro-hymenal adhesions.
ICD 10
N30.0 N30.2
General information
Honeymoon cystitis (recurrent sex-induced dysuria) it is detected in 11.5-12.5% of patients with frequently aggravated inflammation of the bladder. The main distinguishing feature of the disease is the occurrence of characteristic dysuric symptoms within 12-36 hours after coitus, less often — other vaginal manipulations. According to the observations of specialists in the fields of clinical urology and gynecology, up to 80% of cases of postcoital dysuria have an anatomical basis.
Since the disorder is often detected in young women almost after the first sexual intercourse, it has been called “honeymoon cystitis”, “sexual”, “defloration” cystitis. In some patients, the problem occurs 1-3 years after the beginning of intimate life or childbirth, complicated by ruptures of the vagina and perineum. The relevance of the correct diagnosis of the disease is due to the low awareness of specialists about its existence and prolonged unsuccessful treatment as a common inflammatory process in the bladder.
Causes
Honeymoon cystitis is provoked by pathogenic microflora penetrating into the urogenital tract of a woman. The causative agents of the disease can be conditionally pathogenic microorganisms (E. coli, Klebsiella, proteus, enterobacteria, staphylococci, gardnerella, etc.), yeast-like fungi, viruses, trichomonas, chlamydia, ureaplasma, etc. Unlike other forms of cystitis, in 70-80% of patients, postcoital inflammation and its relapses are provoked by such congenital and acquired anatomical abnormalities of the urethra as:
- Female hypospadias. With the displacement (ectopia) of the external opening of the urethra to the entrance of the vagina or to its anterior wall, the penetration of the vaginal flora into the urethra is facilitated. Due to embryonic underdevelopment, the urethral canal is often shortened, which simplifies ascending infection. Urogymenal adhesions are usually absent or poorly developed.
- Hypermobility of the distal urethra. The mobility of the urethra is caused by the formation of hymenourethral adhesions — adhesions between the remains of the hymen and the external urethral opening. Due to their tension during frictions, the entrance to the urethra shifts to the vagina, which contributes to damage to the mucous membrane and the discharge of secretions into the urethra.
20-30% of patients with postcoital cystitis have no anatomical defects. In such cases, the main prerequisites for the rapid spread of infection after sexual intercourse are bacterial vaginosis, colpitis, cervicitis, high sexual activity with frequent changes of partners, abuse of contraceptive spermicides, mechanical injury of the mucous membrane with increased vaginal dryness.
Postcoital recurrent dysuria occurs more often in women with metabolic syndrome, obesity, decompensated diabetes mellitus, reduced immunity. The risk of infection increases with violation of the rules of intimate hygiene, the use of tampons and abuse of daily pads, regular wearing of uncomfortable underwear made of synthetic fabrics.
Pathogenesis
Honeymoon cystitis develops as a result of ascending infection. With female hypospadias and the presence of urogymenal cords, the external urethral opening during sexual intercourse shifts into the vagina and opens. Under the pressure arising from the movements of the penis, the vaginal flora is thrown into the urethra.
Since the female urethra is normally wide and short, and with congenital hypospadias it shortens even more, microorganisms enter the bladder quickly and unhindered, causing inflammation of its mucosa. With the anatomically normal structure of the urogenital region, inflammation is caused by massive microbial contamination during rough sexual contacts.
Symptoms
The clinical picture of the disease develops within 1-1.5 days after the sexual intercourse that provoked it. In some patients, the time interval before the appearance of the first symptoms is no more than 2-3 hours. A woman with postcoital dysuria often urinates, complains of discomfort, pain, burning, and pains that occur during urination and increase towards its completion. There may be false urge to urinate, a feeling of overcrowding of the bladder, soreness in the suprapubic region.
The general symptoms in the form of a slight increase in temperature, weakness, fatigue, headaches are expressed slightly or absent. Sometimes the urine becomes cloudy, a small admixture of blood appears in it. An acute attack is stopped on its own or after taking antibacterial drugs. Relapse occurs almost at every sexual contact, can be provoked by hypothermia, diet errors (consumption of alcoholic beverages, fried, spicy, smoked), gynecological examination using vaginal mirrors and bimanual palpation.
Complications
In the absence of adequate treatment, honeymoon cystitis often takes a chronic course, the risk of developing pyelonephritis increases. The appearance of symptoms after each sexual intercourse makes it impossible for the patient to have a normal intimate life, over time, due to the fear of a recurrence of cystitis, the woman’s sexual desire decreases, anorgasmia occurs, less often vaginismus. Since patients suffering from postcoital inflammation often self-medicate and take antibiotics uncontrollably for preventive purposes, they may develop therapeutic resistance, develop vaginal dysbiosis and intestinal dysbiosis.
Diagnostics
Usually the patient is led by a urogynecologist or an obstetrician-gynecologist with a urologist. The presence of honeymoon cystitis in the patient can be suspected when establishing a reliable connection between clinical manifestations and sexual intercourse or vaginal manipulation. To confirm the diagnosis, physical, laboratory, instrumental studies are used to identify anatomical prerequisites for infection and signs of honeymoon cystitis:
- Gynecological examination. Visual examination of the external genitalia determines the atypical location of the external opening of the urethra. Often it is displaced in the vestibule of the vagina or is found in the vaginal cavity. Hymenourethral adhesions have the appearance of thin, rigid folds stretched from the urethra to the vestibule. It is recommended to supplement the examination on the chair with an O’Donnell-Hirshhorn finger test, confirming the displacement and gaping of the urethra.
- Urine examination. In the general analysis of urine, the content of leukocytes and protein is increased (up to 1.0 g / l), mucus, squamous epithelium is present, erythrocytes, bacteria can be detected, the reaction becomes more alkaline. For differential diagnostic purposes, the examination is supplemented with a urine analysis according to Nechiporenko, a three-cup sample. Bacterioscopic examination of the urethral smear and urine culture for sterility plays an important role in establishing the pathogen.
To clarify the diagnosis and exclude other causes of inflammation, the patient may additionally be prescribed a transabdominal ultrasound of the bladder, cystoscopy, sowing a vaginal smear on the microflora with an antibioticogram, PCR diagnosis of genital infections. The disease is differentiated with cystalgia, acute and chronic cystitis of other origin, urethritis, tumors and bladder stones, colpitis.
Treatment of honeymoon cystitis
At the initial stages of therapy, patients with bladder inflammations that recur after sex are given nonspecific and specific prevention of exacerbations. The recommended algorithm of pre- and post-coital behavior includes careful hygiene of the genitals before intimacy, the use of certified lubricants and non-irritating contraceptives, emptying the bladder and toilet of the vulva after coitus, the use of up to 2 liters of fluid over the next day.
Methods of specific prevention of recurrence of cystitis are selected individually. To suppress possible pathogens of the disease, plant uroantiseptics with cranberry extract, urological immunostimulants are used. Antibiotic prophylaxis of postcoital forms of cystitis, despite a sufficiently high efficiency, reaching 70% or more, is carried out limited due to side effects of pharmaceuticals, the formation of antibiotic-resistant strains, dysbacterial complications.
In case of ineffectiveness of anti-relapse prevention, severe, complicated course of the disease, surgical correction is recommended for patients with identified anatomical defects (ectopia of the urethral orifice, urethro-hymenal adhesions). The most effective types of surgical interventions for postcoital inflammation of the bladder are:
- Dissection of hymenourethral adhesions. The operation eliminates hypermobility of the urethra. The resulting splices are transversely dissected, after which the incisions are sutured in the longitudinal direction. The effectiveness of the intervention can be checked intraoperatively using the Hirshhorn test. While maintaining tension after a transverse incision of the anterior vaginal wall, its longitudinal suturing is performed.
- Transposition of the urethra. The distal urethra is moved from the vagina or its vestibule closer to the clitoris. Thus, the prerequisites for the discharge of vaginal secretions into the urinary organs are eliminated. Previously, urethral transposition was performed with circular mobilization of the distal part of the urethra. Currently, less traumatic immobilization-free modifications are proposed.
Surgical treatment of recurrent postcoital dysuria is highly effective, since it is aimed at eliminating the prerequisites of the disease. Women who have refused surgical correction are prescribed prophylaxis with antibiotics, the drugs of choice are phosphonic acid derivatives and nitrofurans in low dosages.
Prognosis and prevention
The most reliable method of treating honeymoon cystitis that has arisen against the background of anatomical anomalies is surgical removal of an existing defect. The effectiveness of surgical treatment reaches 70-85%. Prophylactic use of uroantiseptics can prevent postcoital relapse in 35% of patients, immunoprophylaxis reduces the frequency of exacerbations by 73% and reduces the severity of pathological manifestations in 48-67% of patients.
Measures for the primary prevention of cystitis caused by the peculiarities of the structure of the urethra have not been proposed. In the absence of anatomical defects, women with recurrent sex-induced dysuria are recommended to treat inflammatory gynecological diseases, replace tampons with menstrual sanitary pads, exclude hypothermia, refuse douching, contraception with spermicidal agents, use daily pads and condoms without lubricants, and wear synthetic underwear.