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Help! Painful cystitis is destroying my sex life

My partner of a year is the sexiest man I’ve ever dated and I thank my lucky stars I’ve met him after 18 years in an emotionally abusive relationship. 
We have an amazing love life, but there’s one big problem: I keep getting cystitis. My doctor says you can be vulnerable to it when you’re menopausal (I’m 51) and has given me antibiotics, but I don’t want to keep downing drugs. 
I know it has something to do with the vigorous sex life I enjoy, but my partner doesn’t seem to get the message to be more gentle. What should I do?
Downside of passionate sex: A reader is struggling with repeat bouts of cystitis (posed by model)
Downside of passionate sex: A reader is struggling with repeat bouts of cystitis (posed by model)
Ouch! It makes me cross my legs with sympathy just to read your letter.
It doesn’t help that there are so many triggers for the condition and a raft of differing advice. I have never found, for example, that cranberry juice (or capsules) help me, whereas drinking lots of water with a little sodium bicarbonate does seem to improve things.
 
Apart from that, there are certain times in life when you’re more likely to develop cystitis, as you now know. Pregnancy and menopause both heighten the risk of urinary tract infections (UTIs) because of fluctuating hormone levels.
You can also be more susceptible close to your period. Then there’s what the medics call ‘honeymoon cystitis’, which you contract simply as a result of lots of passionate sex at the start of a relationship. You currently have two top risk factors, plus an over-zealous lover, hence the frequent recurrence.
The first thing you need to do is to minimise all the triggers that raise your risk of a repeat infection. Get plenty of sleep, avoid alcohol and coffee, drink plenty of water, be extra vigilant about personal hygiene and try to pass urine after every sexual encounter. 
Remember that any form of contraception that involves spermicides heightens your chances of cystitis, as do certain lubricants (try to use organic ones). Antibiotics are effective, but you can become resistant to them with repeated use and they also often wipe out your ‘good bacteria’ leading to yeast infections.
However, it seems your main risk factor here is your partner’s energetic approach to sex. You say he’s not getting the message to be more gentle, but I wonder how you’re delivering it. The fact you were in an 18-year, emotionally abusive relationship suggests you are accustomed to relegating your own needs to second best.
It also raises the question of whether you would rather cling to the man you love — whatever his flaws — than risk rocking the boat.
As anyone who’s had cystitis knows, it’s a delicate issue asking your partner to moderate the way he makes love to you. You don’t want to restrict his enthusiasm or make him so paranoid he treats you like a glass ornament. And you, in particular, are so happy to have found a man who is properly passionate about you that you don’t dare tell him the scale of the problem.
The truth is you’re going to have to stop acting like a dumbstruck teenager; it’s time to be more forceful. Tell him a bad UTI makes you feel like you’re passing razor blades, because that’s the truth of it — that’ll make him sit up!
You need to act as a team, identifying what is most likely to trigger the condition and avoiding those things when you feel vulnerable.
Swap the obvious causes for something else that pushes his buttons.
The thing to bear in mind is that your situation isn’t unusual, so don’t be a martyr — all healthy sexual partnerships hinge on the pleasure of both participants.
And if your man really cares for you, he won’t value his erotic pleasure above yours


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