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Obstetrics and Gynegology2026№8

The use of D-mannose drugs for sexual function and recurrent postcoital cystitis prevention in women of reproductive age

DOI
https://dx.doi.org/10.18565/aig.2026.285

Teterina T.A., Apolikhina I.A., Nashivochnikova N.A., Al-Shukri A.S.

1) Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia; 3) Privolzhsky Research Medical University, Ministry of Health of Russia, Nizhny Novgorod, Russia; 4) Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia

Rationale. Recurrent postcoital cystitis substantially impairs quality of life and may be associated with female sexual dysfunction. Given the risk of antimicrobial resistance, non-antibiotic prevention strategies are of clinical interest.
Objective. To compare four postcoital prevention strategies in women of reproductive age with recurrent postcoital cystitis for two primary outcomes: the number of cystitis recurrences over 6 months and the change in the total Female Sexual Function Index (FSFI) score
Materials and methods. This multicenter study (2024–2025) enrolled 195 women aged 19–50 years with recurrent postcoital cystitis. Group 1 (n=53) received an oral complex containing D-mannose, proanthocyanidins, arbutin and vitamin C together with Cystalis gel; group 2 (n=62) used Cystalis gel only; group 3 (n=40) was prescribed a control water-based lubricant; group 4 (n=40) received postcoital furazidin 50 mg as an active comparator. Follow-up lasted 6 months. The analysis followed the intention-to-treat principle. The total FSFI score was the sum of six domains (range 0-36). Quantitative data were reported as Me (Q1; Q3) and M (SD); non-parametric tests with Holm adjustment were used.
Results. The number of recurrences decreased significantly in all groups (p<0.001). In the combined-prevention group it changed from 4.8 (1.9) to 0.3 (0.6) episodes over 6 months. Between-group differences at 6 months were significant (p<0.001): group 1 had fewer recurrences than the control-lubricant group (p<0.001), whereas no statistical significance was reached within the difference versus furazidin (p=0.064). Pain on the VAS and leukocyturia decreased in all groups, with no between-group differences in the magnitude of change.  Total baseline FSFI scores did not differ between the groups (p=0.113). At 6 months the mean scores were 24.11 (2.61), 22.63 (2.20), 16.90 (2.89) and 18.37 (2.65) in groups 1-4; mean increases over 6 months reached 9.30 (2.97), 9.70 (3.42), 2.97 (3.26) and 5.67 (3.15). Increases in the D-mannose gel groups (alone or combined) exceeded those with the lubricant and furazidin; the difference between combination therapy and gel monotherapy was not statistically significant.
Conclusion. All evaluated strategies were associated with fewer recurrences and higher total FSFI scores. The most favourable numerical results were observed with local and combined D-mannose prevention. No superiority of the combination over postcoital furazidin for recurrences, and over gel monotherapy for total FSFI, was demonstrated.

Authors’ contributions. Teterina T.A. – publications collection, materials processing and analysis, article writing, articles translation; Apolikhina I.A. – materials processing and analysis, article editing; Nashivochnikova N.A., Al-Shukri A.S. – patient recruitment and material collection.
Conflicts of interest. The authors declare no conflicts of interest.
Funding. The study was conducted under the support of SH PHARMA Company, which provided the study products and financial support. The sponsor did not participate in the development of the protocol, recruitment of patients, data collection, statistical analysis, interpretation of the results, preparation of the manuscript, or decision on publication.
Ethical Aproval. The study was conducted in accordance with the principles of the Helsinki Declaration of the World Medical Association. All participants signed a written informed consent before inclusion. The oral medication “Cystalis D Plus” is registered as a dietary supplement, and the “Cystalis” gel is registered as a cosmetic product; both were used within the framework of their registered indications. Furazidin 50 mg is a registered medicinal product and was used in the post coital prophylaxis regimen provided for in the clinical guidelines “Cystitis in women”. The study was not a clinical trial of a new medicinal product under the Federal Law No. 61 FZ dated April 12, 2010, and was not submitted for approval by the Ministry of Health of Russia / the ethics committee for clinical trials of medicinal products. The protocol was not registered in the publicly accessible register of clinical trials before recruitment began.
Generative Artificial Intelligence. Artificial intelligence systems were not used for statistical analysis, interpretation of results, or formulation of conclusions. The authors are responsible for the content of the manuscript.
Patients’ Consent for Publication. Written informed consent to participate in the study and to the processing of personal data was obtained from all 195 included participants.
Authors' Data Sharing Statement. The anonymized aggregate data is available on a justified request from the corresponding author. The individual data of the participants is not made publicly available.
For citation: Teterina T.A., Apolikhina I.A., Nashivochnikova N.A., Al-Shukri A.S.  
The use of D-mannose drugs for sexual function and recurrent postcoital cystitis prevention in women of reproductive agе.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (8): 185-198 (in Russian)
https://dx.doi.org/10.18565/aig.2026.285

Keywords

postcoital cystitis
recurrent cystitis
D-mannose
sexual function
FSFI
non-antibiotic prophylaxis
Full text (in Russian)

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Received 26.08.2026

Accepted 31.08.2026

About the Authors

Tatiana A. Teterina, PhD, Obstetrician-gynecologist, USD, Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4; Expert of the Association of Aesthetic Gynecology Specialists, +7(963)961-67-44, palpebra@inbox.ru, https://orcid.org/0000-0003-0990-2302
Inna A. Apolikhina, Honored Doctor of the Russian Federation, Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, Professor at the Department of Obstetrics and Gynecology, Department of Vocational Education, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University),
i_apolikhina@oparina4.ru, https://orcid.org/0000-0002-4581-6295
Natalia A. Nashivochnikova, PhD, Associate Professor at the Department of Urology named after E.V. Shakhov, Privolzhsky Research Medical University,
Ministry of Health of Russia, 603950, Russia, Nizhny Novgorod, Minin and Pozharsky sqr., 10/1, dom17.doctor@mail.ru, Author ID: 980736,
https://orcid.org/0000-0002-1138-1174
Adel S. Al-Shukri, Dr. Med. Sci., Professor, Head of the Urological Division No. 1 (General and Urgent Urology) of the Research Center of Urology, Research Institute of Surgery and Emergency Medicine, Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, ad330@mail.ru, https://orcid.org/0000-0001-6543-8589
Corresponding author: Tatiana A. Teterina, palpebra@inbox.ru

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