What can I do to stop recurring cystitis infections?

I have recurrent cystitis and it makes it difficult to have a steady sex life with my boyfriend, who I live with. At least once a month, I have a seriously painful few days. 

I then feel quite awkward and unsexy when it eventually passes. What would you suggest? Are there ways of avoiding it in the first place?

Cystitis may not be sexy, but it is very common. It affects about half of all women at least once, and a quarter are plagued by recurrent bouts. It is caused by bacteria from the bowel getting into the bladder via the urethra.

Transmission can happen when going to the toilet, inserting a tampon, a contraceptive diaphragm, or during sexual intercourse.

Fortunately, cystitis responds well to antibiotics, and a three-day course is the usual treatment for a single bout.

Women who suffer from recurrent cystitis may be prescribed different treatments.

You may be advised to take a low dose of antibiotics for six to 12 months, or if the cystitis is triggered by sex, you may be advised to take an antibiotic tablet within two hours of sex.

Recurrent cystitis is defined as two proven infections within six months or more than three infections in a year.

The fact that you are suffering for several days a month suggests that you may be suffering from a nonbacterial form of cystitis, which would explain why antibiotics did not do the trick.

Interstitial cystitis is a chronic inflammation of the bladder wall.

Like regular cystitis, it can cause an urgent and frequent need to urinate, but it can also cause intense pain and discomfort in the bladder and pelvic area.

Sexual intercourse can trigger pain lasting several days, and symptoms may worsen with menstruation.

It is thought that the condition may be related to a defective bladder lining or an autoimmune disorder.

Unfortunately, because the symptoms can be so similar to bacterial cystitis, or an overactive bladder, interstitial cystitis can take time to diagnose.

Although it can’t be cured, it can be treated, so get a referral to a urologist soon.

Taking an over-the-counter antihistamine and anti-inflammatory painkiller could provide some relief in the meantime.

Penetrative sex can aggravate symptoms of any form of cystitis.

There are many ways to manage cystitis within a sexual relationship, but once sex becomes associated with pain, it sets up a cycle of avoidance.

This will cause tension because your partner will feel rejected.

There are creative ways of having sex without penetration, but you need your partner’s support.

Explain how painful it is and suggest reserving certain nonpenetrative sexual practices for days when you are suffering.

You also need to be vigilant about taking care of your body to prevent flare-ups and to minimise discomfort during sex.

Aim to drink at least six to eight large glasses of water every day, because dehydration makes urine more concentrated and this can irritate the urethra and cause inflammation.

Potassium citrate or sodium citrate powder (both of which you can buy in pharmacies) can be added to water to make urine less acidic and reduce the burning feeling when you pass urine; however, it won’t kill the bacteria causing your infection.

Also, try to drink one glass before you have sex because urinating straight afterwards will help to expel any rogue bacteria from the urethra.

Cystitis is not related to poor personal hygiene. Bathe in warm water, without soap.

Sugary drinks, caffeine, alcohol, acidic and spicy foods can be triggers. Avoid tight-fitting trousers or nylon tights, which make the genital area hot and damp, conditions in which bacteria thrive.

Avoid tampons. During sex, use additional lubrication. Natural brands such as Yes or Replens Silky Smooth are long lasting and won’t irritate.

Consider using ReplensMD as a regular vaginal moisturiser; it helps to maintain the pH level in the vagina and prevent infection.

Some women are irritated by latex, so switch to a hypoallergenic polyisoprene alternative if condoms are your contraceptive of choice.

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