Pathophysiology - SEXUALLY ACTIVE WOMEN !!!

• During sexual intercourse, the bacteria in the vaginal area may be pushed into the urethra and eventually end up in the bladder
o urine provides a good environment for the bacteria to grow.
• Cystitis commonly occurs in women as a result of sexual intercourse
o Cystitis refers to inflammation of the lining of the bladder.
o It usually occurs when the normally sterile urethra and bladder (lower urinary tract) are infected by bacteria
 become irritated and inflamed.
• anus, a constant source of bacteria, is so close to the female urethra.
• More than 90 percent of cystitis cases are caused by Escherichia coli (E. coli) , a species of bacteria commonly found in the rectal area

E-coli :• inhabit the periurethral vaginal introitus and ascend into the bladder via the urethra
• bladder mucosal invasion
• type 1 fimbriae with adhesion known as FimH.
• Beacterial adhesins are necessary for attachment of bacteria to the mucous membranes of the perineum and urothelium
• Multiply and the bladder becomes inflamed.

Frequent and/or vigorous sex increases the chances of physical damage or bruising, which in turn makes the likelihood of cystitis developing higher

Urine is generally a good culture medium; factors unfavorable to bacterial growth include a low pH (5.5 or less), a high concentration of urea, and the presence of organic acids derived from a diet that includes fruits and protein. Organic acids enhance acidification of the urine.

Normally, a thin film of urine remains in the bladder after emptying, and any bacteria present are removed by the mucosal cell production of organic acids.

Use of a diaphragm increases the risk of developing cystitis, possibly because spermicide used with the diaphragm suppresses the normal vaginal bacteria and allows bacteria that cause cystitis to flourish in the vagina

Sexually transmitted diseases (STDs) may cause UTI-like symptoms, such as pain with urination. This is due to the inflammation and irritation of the urethra or vagina that's sometimes associated with chlamydia and other STDs.