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post coital increase in frequency of urination-help!

I am a 58 year old monogamous married woman (25 years),in excellent general health.
I exercise 4x a week (2x pilates, 2x personal trainer) and eat balanced diet. Weight 58 kilograms, height 1.65 meters

Past medical history:
1992-anterior and posterior spinal fusion with bilateral titanium rods from C5 to L1.
There is also an area of parasthesia on my back, approximately related to the surgical site.
I am on the hormone Activelle(Estradiol 1mg, Norethisterone acetate 0.5mg).
Periods of post coital ecoli infections with resultant periods of vaginal irritability and increased urination frequency.
To combat this I take a single dose of Macrodantin (Nitrofuratoin) pre intercourse. This regimen has drasticaly reduced the ecoli problem.

Chief complaint:
Over the past 1.5 years, despite the Macrodantin, the frequency of urination post intercourse persists at a rate of 1x hourly during the night, tapering off during the day.  These symptoms persist for 3-4 days until the next intercourse. There is no accompanying urinary infection- I have had tests fot urinary tract innfections, ultrasounds of bladder and uterus including numerous thorough gynecological
exams and a cystocopy. All negative apart from a small amount of rbc's in my urine.
In the past I have taken Nirvaxal-chlordiaxepoxide/clidinium bromide- which after a time did relieve the symptoms. However the side effect of fatigue did not allow me to function properly.

My feeling is that these symptoms (urination frequency and vaginal irritability) might be due to mechanical trauma.

Do you have any ideas re the cause and treatment?

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233190 tn?1278553401
Mechanical trauma is a good possibility.  You have mentioned that you have had many tests for infection and they are all negative.  You also want to ensure that any bacteria that does grow out is not resistant to the Macrodantin you are taking.

If infection is not an issue, you can evaluate for any anatomical abnormality with a cystoscopy.  Treatment would depend on what was found - but you can discuss the option of this test with a urologist.

Another consideration would be post-menopausal vaginal dryness - which can lead to irritation and discomfort.  Discussion of whether a estrogen cream would be helpful can be also made with your physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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