Cystitis Research Center

- Causative Factors In Cystitis -

Paul Fugazzotto, Ph.D. MSPH
June, 2004

Considering the marked difference in incidence of Cystitis between males and females, it has been postulated that hormonal differences between the genders might possibly have a bearing on the matter. Hormones are intrinsic hereditary physiological body components related to temperament and social human behavior and are in no way related to microbial behavior and quality.

I. Anatomic Considerations in Cystitis

Studies of urinary bladder function date back to Hippocrates - 400 B.C. (considered in medical circles today as the father of medicine). This ancient scientist focused on the appearance of urine for its diagnostic and prognostic value in relation to the patient's condition. While he was not aware of the microbial world, he pointed out that in all cases abnormalities of body foci are reflected in the urine. This is accomplished by the natural transmigration of materials by way of the circulation system to the kidneys, which sift out harmful substances (organisms, toxins, other waste products of fermentation), and to the urine as the repository of waste from body metabolism: "The yardstick of body function"; whereby one must look to the urine for the natural transmigration of the offending component.

Considering the overall predominance of Cystitis in women whose anatomy places the urethra (and bladder) in close proximity to the anal opening, it is logical to expect easy access of intestinal contaminants by way of the unobstructed horizonal perineal skin between the legs (a moist area conducive to lateral movement) into the urethral opening. This includes the often-occurring Enterococcus pathogens, along with coliforms, to the bladder by way of skin contaminants left on the perineal skin after bowel movements.

It is certainly logical that Cystitis is due to offending organisms derived from the bowel as the natural reservoir, including the Gram-positive pathogens present. In the female it is only the intimate anatomic feature of the pelvic area that is conducive to microbial transmigration from the peritoneal area to the bladder by way of the exposed shorter urethra in the female. Sexual differences would have no bearing on transmigrations of pathogens from upper body foci: dental and extrinsic sources - strep infections, etc.

II. Cross contamination (infection) between partners.

In the female, the initial build-up of offending organisms in the bladder results from offending organisms contained in the bowel transmigrating to the perineum via fecal contamination, and from there to the bladder via the urethral opening. Usually, the first urinary episode in the female happens as a result of the first sexual contact after marriage. This could be triggered by the trauma of advances by the male partner in repeated succession, and has been called "honeymoon Cystitis" which happens on repeated different occasions. This involves the trigger mechanism of semi-traumatic activity of intercourse agitating the offending organisms previously implanted in the bladder. This is not an infection transmitted by the male partner. It is an excitation of organisms already acquired in the female organ.

III. Failure of Fecal Contaminants (in males) to Migrate to the Bladder

After a bowel movement, in both males and females, the perianal skin and peritoneum are contaminated with fecal material. However, due to the anatomic feature of the genitalia obstructing the transmittal to the urethra, the male is less inclined to attain bladder contamination than the female. He, therefore, is seldom inclined to have Cystitis and to infect the female partner. On the other hand, he may be infected by the female partner; or, still more rarely, acquire an infection on his own. In other words, there is a rare occasion when there can be interchange of infection from the male to the female. When such cross-infection occurs, it is possible by the laboratory to detect it. The antibiotic pattern of both partner infections will reflect the situation when the same or different sensitivity patterns occur. Cross-infections are more likely from the female to the male than vice versa.

IV. Other Pelvic Disorders

While specific efforts are required in antibiotic treatment for the three distinct components to Cystitis: Gram-positive cocci, Gram-negative bacilli and yeasts, there are other offending microbial sources of discomfort essentially nowhere between the two genders. Hormones are physiologic components intrinsic to each person. These are hereditary body chemicals related to the temperament, mental attitudes, social behavior, and intrinsic physiological functions. They, therefore, have no effect on special movements of Cystitis components and cannot be considered a feature of Cystitis.