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Oganes E. Dilanyan
Urologist, MD, PhD

Cystitis after sex

Reading time: 4 min.
In this article

Cystitis after intercourse (also known as post-coital cystitis) is an acute inflammation of the bladder that occurs after about a day following intercourse. Antibiotics help to combat the flare ups but do not affect the cause of this condition. In this article I would like to describe the causes, diagnosis and treatment of this condition

Post-coital cystitis

Cystitis after intercourse is one of the strangest conditions. A young and generally healthy woman presents with acute cystitis symptoms 1-2 days following intercourse. Pain during urination, frequent urges to empty the bladder not allowing her to ever be far from the bathroom. A course of antibiotics only relieves the symptoms until the next intercourse and various other treatments and intravenous injections and even hospital admissions have the same effect. The peculiar nature of this condition is that it is subject to an anatomically incorrect positioning of the urethra or its gaping, which can be corrected.

Urethral transposition


Reconstructive plastic surgery is aimed at positioning the urethra out of the zone where it is constantly subjected to inbound infection.
- It is the only radical treatment method for post-coital cystitis.
- Constant attempts to treat acute cystitis occurring after intercourse with the help of antibiotics, infusions or attempts to strengthen the immune system are doomed to failure until the cause of the condition has been eliminated.
- Extensive experience in carrying out these types of operations allows me to guarantee the result and, by eliminating the cause, to eradicate the flare ups of acute cystitis.

Before me is a young good looking woman with a very sad and even hopeless expression in her eyes. Judging by the thickness of her medical records she must have a serious condition or maybe even several. The medical records usually only get to this thickness by the age of around 80, or after numerous consultations with a vast number of specialists.

The recommended treatment is always the same: antibiotics. Short course, long course, intravenous injections, physiotherapy. And always with the same outcome: Short-lived clinical effect. Let me “translate” this: Antibiotics help, but not for long. Cystitis after intercourse is still ruining her life.

"A small leak will sink a great ship"
English proverb

Causes of cystitis after intercourse

The main reason of cystitis starting after intercourse is the deep positioning of the urethra or its gaping. In this position the penis acts as a pump helping to push bacteria inside the bladder, 24 to 48 hours later they multiply causing acute cystitis. 

Normal positioning of the urethra: no lower than 1-1,5 cm from the clitoris and always closed.
Under normal condition the clamping of the urethra during intercourse prevents the bacteria from getting into the bladder.
Urethral dystopia: Urethral opening is positioned lower and gaping.
During intercourse the opening widens further and bacteria can easily get into the bladder.
24-48 hours later bacteria multiply causing acute cystitis.

"...So low positioned gaping of the urethra is the reason of cystitis after intercourse"

Common situation I often come across

— “Practice good intimate hygiene”, “Sort out your sex life”, “Try taking antibiotics after every intercourse”, “Do try some sort of physiotherapy treatment”, “Drink tons of cranberry juice”, “Urinate before and after intercourse”, — the patient angrily spits out– “I have a feeling that I am some woman of loose morals with an iron liver and a money printing machine”. I cannot urinate before and after intercourse as I do not have sex for 3-4 hours straight and after intercourse I simply do not feel the need to urinate! I can’t swim in the sea as it results in hypothermia, I can’t get pregnant because it is not recommended while on antibiotics, I can’t have intimate relations with my husband and he has long been cheating on me. Is it not possible to kill this bacterium once and for all? What shall I do?
— “Deep breaths. Pop onto the examination chair” – I tell her, putting on my gloves, and already knowing what I am about to see. It is so easy to actually look at the organ that is causing discomfort. It’s is very straightforward – if we kill the bacteria but it comes back again it means it comes from somewhere. Just a simple examination, palpating the urethra and diagnosis is nearly ready. Now we just need to rule out other possible causes and ultrasound with help us with that, and to sort out the consequences of the bacteria being present for a long time somewhere it should not have been in the first place – the bladder.
— What? Antibiotics again?
— Not at all.
— Physiotherapy?
— No.
— Laser, infusions of some other nasty stuff into the bladder? 
I could bombard her with an array of hard to pronounce words. Such as “Glycosaminoglycan depletion”, “Collagen pathology” and “localised hypo estrogenic condition” etc. But to know these I had to read numerous specialised medical books and she has not read them. And so I say….
— Your urethra is positioned deeper than it should be and also has increased mobility. Because of this it gapes during intercourse and the penis sort of pumps the bacteria from surrounding areas straight into the bladder. The bacteria then multiply and voila, you have cystitis. And surrounding areas include the rectum where E.coli and Enterobacter are found. . 
— Erm... Does this mean it cannot be cured? Are these bacteria going to keep getting into the bladder constantly? 
— Not at all. You can be cured and forget about cystitis forever.
I can see that to her it sounds like sacrilege. I can’t just announce it like this – I will cure you. It needs to be done slowly and reasonably.

The knowledge of anything, since all things have causes, is not acquired or complete unless it is known by its causes

Cystitis after intercourse: Treatment

The treatment of cystitis after intercourse consists of the elimination of the cause. Because if we can normalise the positioning of the urethra then we will remove the possibility of the bacteria entering into the bladder. The flare ups of cystitis after intercourse will stop. The unpleasant symptoms surrounding it, such as urinary incontinence, irritation of the urethral opening and inability to have normal intercourse will go away. 
The treatment method has been developed. It involves a surgical procedure titled “Urethral transposition”. The aim of the procedure is to isolate the urethra from the surrounding tissue, lifting it into its intended normal position and fixing it there. During the operation the minimal remains of the hymen which could pull the urethra down are also removed.
This treatment method is highly effective in combatting recurrent cystitis after intercourse. Hospital stay does not normally exceed 2 or 3 days and recovery time following urethral transposition procedure takes no longer than one week.

Urethral transposition: two small incisions are made.
Urethra is isolated from the surrounding tissue for 2,5-3 cm.
Isolated urethra is positioned into the submucosal tunnel onto its anatomically intended place.
Urethra is then fixed and followed by elytrorrhaphy.
Here you can see surgically corrected urethra 3 months after the operation.
Usual situation...

— How? How is this even possible? 
— Surgically. It is necessary to re-position the urethra to its intended normal location so it gets clamped by the penis during intercourse and does not gape allowing the bacteria to get in. 
— Is there a surgical procedure for this? 
— There is and it is called Urethral Transposition. Basically lengthening of the urethra takes place. 
— Will I have to wee like a boy? — says the patient with sheer horror on her face.
— Well, not quite that much. We will just re-position the urethra back from deep in the vagina to its normal site under the clitoris. Here, look – I draw a diagram of the surgical procedure, here is the end result. 
— I don’t believe it! So you will simply take the urethra out of the zone where the bacteria live and that’s it? Cystitis after intercourse will end.
— Most definitely. But first - cystoscopy.
— What for? As you have just explained, the problem is in the urethra. 
— Correct. But urethra acts as a conducting track for the bacteria. You have had recurrent cystitis for so many years that we need to make sure that bladder mucosa is ok. 
— And if it isn’t? — The patient’s face falls. Things are probably really bad in there. 
—    Well, they could be. There might be leukokeratosis or polyps or anything else. But also treatable. When we remove the problem in the bladder and sort out the urethra we can say goodbye to cystitis. Please bring me a little souvenir when you go on your next beach holiday.

Urethral transposition: What you need to know.

1. There are two ways of performing urethral transposition: O’Donnell’s technique and Komyakov’s technique. Most clinics offer surgical procedures carried out following O’Donnell’s technique, which leads to a relapse in 30-40% of cases. This is why I offer the procedure carried out according to Komyakov’s technique, which very rarely leads to any relapses.
2. Attempts to inject hyaluronic acid into the urethral wall lead to relapses in 40% of all cases. I do not use this technique and consider it flawed and unfounded. More importantly the injection of gel into the urethra complicates further surgical procedure of urethral transposition. 
3. Urethral transposition is the only radical way to cure cystitis after intercourse. 

Преимущества операции Комякова


Urethral transposition when carried out correctly carries minimal risk of surgical trauma. Urinary catheter is installed only for 24 hours, contrary to a popular but erroneous belief that it should be left in place for 7 to 10 days. Usually patients are discharged 2-3 days after the operation.

Superior effectiveness

Urethral transposition is the most effective treatment method for cystitis after intercourse. Hyaluronic acid injections and O’Donnell’s technique do not compare with this surgical procedure in terms of side effects, relapses and results achieved.


The safety of the Urethral transposition procedure is ensured by the extensive experience in carrying out similar operations, the use of best equipment and constant monitoring of the patient’s condition. The correct preparation which every single patient undergoes before the operation is also very important for ensuring safety during the surgical procedure.

No blood loss

Use of latest technology and extensive experience allow me to carry out the transposition procedure without blood loss which in turn no doubt speeds up the patient’s recovery. General blood loss volume is no more than would be expected during a routine blood test.

Fast recovery

Patient recovery following urethral transposition usually takes around 2 days. Normal sex life can be resumed 3 months after the operation and pregnancy can be attempted after 6 months. Vaginal birth following the operation is possible and there are NO contraindications.

Cosmetic effect

Many patients are worried about scarring and unsightly appearance following the operation. Nothing like this occurs after Urethral transposition. Urethra simply assumes its normal appearance. The surgery leaves no scars.

"If something can be misunderstood it will be."
One of Murphy’s laws
Unexpected conclusion of the story.

…I can explain a lot of things. I can talk about the complicated using only simple words. But I cannot understand why I need a barometer from Greece in the shape of Hippocrates’ head. It rather scares me in the dark. It gets better because inside the Hippocrates’ plaster head are the ashes of the patient’s burnt medical records. As if to say “Remember me, doctor dear”.

Information for foreign patients:

If you require treatment for recurrent cystitis after intercourse in Moscow please contact us. We will arrange admission to hospital on the same day you arrive and will carry out the surgical procedure as soon as possible. Taking into account all preliminary investigations and examinations you will be able to return home after 5-6 days.