Recurrent cystitis and vaginal disorders

What is the link between recurrent cystitis (mainly postcoital) and vaginal disorders?

Why is it so important a “restoration” of the vaginal environment for a more effective fight against recurrent cystitis?

The facts

The vaginal and bladder environment are closely linked for several reasons:

-> they have the same cells embryonic walls origin -> hence the sensitivity of these walls to the hormonal fluctuations that occur throughout life (menstruation, pregnancy, breastfeeding, menopause, etc.). Therefore, it is reasonable to think that what is good for the vaginal mucosa will have a positive impact on the urothelium.

-> the anatomical proximity of these two organs in the female pelvis which facilitates the possible interactions between their walls. It is easy to understand why an irritation of the vaginal mucosa can cause bladder discomfort  and vice versa.

-> this anatomical proximity is accentuated by several factors such as:

– pregnancy = displacement of the organs to give more space to the development of the uterus

– menopause = decreased trophism of the mucous membrane that causes a refinement of the walls (atrophy) and reduces the distance between the two cavities (bladder and vagina)

– organs descent = pathological situation in which bladder and vagina change position in the pelvis

– sexual intercourse = penetration and friction

2) when cystitis becomes recurrent and, in particular, in case of postcoital cystitis, uropathogenic germs present in the bladder are also found in the vaginal mucosa (9 out of 10 cases).

This clinical observation leads to several conclusions:

-> responsible germs for UTIs reach the bladder due to a migration from the vaginal mucosa and/or are found in the vaginal mucosa due to migration from the bladder wall [it is a vicious circle in which germs will gradually colonize the urogenital area and infect alternatively vagina and bladder]

-> presence of uropathogenic germs in the vaginal mucosa can remain asymptomatic if the Döderlein flora has a good balance (not a dysbiosis) or can cause vaginal vaginosis and/or candidiasis

-> presence of uropathogenic germs in the vaginal mucosa can cause a contamination of the male sexual partner that will become a “deposit” for the infection and will facilitate contamination during sexual intercourse

-> antibiotic treatments offered in case of cystitis contribute to the destruction and imbalance of the Döderlein flora which favors and predisposes to the appearance of vaginosis and/or candidiasis

-> treatments that are generally proposed in cases of vaginosis (antibiotic) or candidiasis (antifungal) have the only purpose of destroying the pathogen

3) why a “restoration” of the vaginal environment is then needed?

It is possible to face cystitis in an effective way with a global approach optimazing the natural defensive ecosystem with the following measures:

-> vagina

– maintenance of an efficient Döderlein flora with a local application and oral intake of probiotics (live Lactobacilli)

– eradication of uropathogenic germs present in the vaginal mucosa and their biofilms through the application of D-Mannose and N-acetylcysteine

– eradication of Candida albicans excess by lactoferrin intake

– mucous membrane trophism support, fight against dryness, irritation and microlesions formation by applying (daily or when necessary) moisturizing and lubricating vaginal cream

– maintenance of physiological vaginal pH (quite acidic)

-> bladder

– maintenance of a constant presence of prophylactic D-Mannose in the urine with a dose of 1 g per day

– maintenance of an unfavorable urinary pH to microbial proliferation (alkaline)

D-Mannose (1 g) intake after the intercourse + postcoital urination, intimate hygiene, etc.

– in case of chronic irritation, hematuria or severe pain symptomatology, we need to support the epithelization of the mucous membrane and fight tissue inflammation with an intake of Cistiquer, for example)

-> perineal level

we should maintain an adequate intimate hygiene without being too aggressive:

– after defecation

– before and after the intercourse

– before a gynecological or urological medical examination

4) obviously, in case of postcoital cystitis, the partner should participate in the therapeutic approach as follows:

– optimal intimate hygiene (hands and genitals) without being excessive before/after each intercourse

– urine test, urethral swab and sperm culture are strongly indicated to rule out any suspicion of bladder, urethral or prostatic contamination

– prophylactic intake of D-Mannose (1 g per day) in the absence of certainty about a possible infection

5) antibiotic therapy is also a practice that must be carefully evaluated due to its side effects and, if necessary, completely eliminated to achieve a correct balance of the urogenital ecosystem

6) in practice, these advices imply an interruption or reduction of antibiotic therapy in favour of an intervention with specific food supplements and medical devices which constitute a certain personal and financial investment (people often have difficulty implementing this type of intervention then).

In fact, in this way it is possible to get the entire uro-genital area to recover its physiological competence to fight autonomously against germs thanks to:

-> balanced Döderlein flora

-> adapted physiological pH

-> intact mucous membranes ensuring their barrier role

-> good immune response (production of leukocytes, etc.)

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