I've got bladder pain & sex is painful. What's wrong with me?

Q. My bladder has a lot of pressure and pain. I pee a lot and sex is painful. My doctor is struggling to treat me. What could be the issue?

A. There are common urethritis, cystitis, and general urinary tract disorders which respond to first-line treatment and are short-lived.

It can be challenging to diagnose some medical conditions and the bladder is no different. The impact on your social life, exercise, sleep, your ability to work, and in your case, enjoying sex, is what often prompts general practitioners to consult a specialist.

Interstitial cystitis carries other symptoms such as pressure on the bladder, pain in the vulva, vagina, lower abdomen, back, pelvis or urethral pain. In men, the pain can be located in the scrotum or testicles, with pain during orgasm or after sex. The symptoms can vary weekly or be recurrent for months or years. Urinary urgency and frequency are also common.

The bladder pain can range from a dull ache to piercing pain. Some causes could be a nerve problem, an autoimmune disease or another condition that causes inflammation could also affect the bladder.

Common bedside tests can be done and tests such as urine culture and postvoid residual urine volume will aid diagnosis. In consultation with the urologist, a cystoscopy can be ordered and when necessary, a bladder and urethra biopsy can be obtained.

Treatment is mainly about symptom control. It takes trial and error to find the right combination of treatments. And it usually takes weeks or months to calm the symptoms.

The first stage of treatment is to try to avoid triggers and try lifestyle changes that may help ease symptoms, including trying different sex positions and using cushioning and lubricants to the vulva to avoid excessive friction and dryness. Surgery may be an option, as well as other prescription medication and neurostimulation.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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