Postcoital cystalgia

Specialty: Nephrology and urology.

• postcoital bladder pain
• bladder burning after sexual intercourse

Why it occurs

• Honeymoon syndrome or postcoital traumatic cystitis (repetitive microtrauma of the urethra and bladder neck during intercourse that facilitate the rise of bacteria from the vaginal vestibule)
• Interstitial cystitis (mechanical friction and direct vaginal compression during sexual intercourse intensely irritate nociceptive nerve endings in a previously inflamed bladder)
• Hypotonia or weakness of the pelvic floor muscles with urethral instability
• Menopausal vulvovaginal atrophy (the lack of lubrication and thinning of the periurethral tissues favors vesicourethral mechanical irritation during intercourse)

Initial workup

Urine sediment and urine culture taken preferably from urination performed immediately after the episode of cystalgia; renal and bladder ultrasound with post-void residue; voiding diary and cystoscopy if the symptoms are persistent and independent of confirmed urinary infections to rule out interstitial cystitis.

Standard management

• Nitrofurantoin — 100 mg orally administered postcoitally prophylactically in a single dose, useful in reducing the recurrence rate in patients with confirmed bacterial honeymoon cystitis
• Phenazopyridine — 100-200 mg PO single dose after intercourse to relieve mechanical vesicourethral burning
• Hyaluronic-based vaginal lubricants prior to sexual intercourse.