The aberrant urethral meatus as a possible aetiological factor of recurrent post-coital urinary infections in young women

Recurrent urinary tract infections (rUTI) in women is a common cause of morbidity worldwide. In young women recurrent cystitis associated with sexual intercourse is quite common; however not all sexually active women will suffer a post-coital UTI episode. A variety of possible predisposing factors has been described, including behavioral risk patterns, genetic factors and increased virulence of certain subtypes of uropathogens. It has long been regarded that anatomical anomalies are rare in this setting of rUTIs. The shorter distance of the urethra to the anus has been the only anatomical risk factor described that is marginally significant in predisposing women for rUTIs. We hereby present a hypothesis that focuses on the shorter distance of the urethral meatus to the vaginal opening as the mainstay of sexually-induced rUTIs. In this theory of "functional hypospadias", the low misplacement of the urethral opening allows for easier advancement of pathogen-laden mucous by penile thrust and increased friction during intercourse. Our hypothesis suggests that a shorter distance of the urethral meatus to the vaginal opening (and not the anus itself) is an anatomical risk factor for recurrent post-coital cystitis. Verification of this hypothesis might lead to a more patient-oriented approach by alerting clinicians in looking for an aberrant meatus and save the patient from unnecessary imaging and endoscopic examinations often used in these cases. Moreover it may also aid the patient in understanding her anatomy and modify behavioral risk practices.