Dear Dr. Myrtle,
I keep getting urinary tract infections, especially after sex. Why does this happen, and what can I do about it?
Vaginal penetration is the number one cause of urinary tract infections (UTI's) in women. It might seem that UTIs occur because bacteria are physically pushed inside the urethra (the tube which carries urine from the bladder to the outside of the body). Instead, it appears that vaginal penetration can cause irritation of the urethra itself, and that this irritation leads to bladder infections. Research shows that specific types of E. coli bacteria with specialized hooks allow the bacteria to physically attach and stay attached even during urination. Once attached, they can multiply and cause an infection.
Other causes for premenopausal women are:
- spermacide use (either with condoms, diaphragms or cervical caps),
- high peak blood sugar levels,
- recent antibiotic use (for any reason, including skin or sinus infections).
- urine holding (not voiding regularly during the day, not drinking enough water),
Unfortunately, women who have had a UTI in the past are more likely to have another, either because their anatomy favors UTI formation, or because their natural bacterial defenses are already disrupted. While you can't change past infections or personal anatomy, you can take advantage of strategies which prevent future infections from occuring.
Post-menopausal women have a few additional UTI-promoting issues to consider:
- urine trapping (prolapsed internal organs, overweight which causes organs to slump in pelvis)
- urinary incontinence (involuntary loss, either from stress--coughing/sneezing/laughing, or urge--sudden contraction of the bladder),
- use of prescription estrogen supplementation (see data from the Women's Health Initiative Study for more information).
Anyone can contract a UTI, but it is especially likely when a woman has penetrative sex with lots of pressure against the urethra after not having it for a while, or when she has thin vulvar skin as a result of postmenopausal atrophy.
Suggestions for reducing the likelihood of UTIs related to sexual activity:
1. Consider perineal massage before penetration. The perineum (space between the vaginal and anal opening) needs flexibility to allow for comfortable penetration without putting pressure against the urethra. Some women massage themselves, while others have their partners massage the whole vulva, before penetration. Consider focusing on increasing your overall arousal before any thought of penetration arises. The more aroused you are, the more flexible your vulva will be, and the maximal amount of lubricant will be present prior to penetration.
2. Change your position for sexual penetration such that rubbing against the urethra is less likely. These positions include:
- Penetration from behind.
- Sitting up face-to-face (also called lotus position).
- Spooning (partners lie side by side, with receptive partner in front).
- Partners are positioned at a ninety degree angle. The penetrating partner is on his or her side, while the receptive partner puts her legs over the other person’s hip.
Some women find that lowering the frequency of vaginal penetration (to 2 or less episodes/week) in favor of other activities reduces the recurrentce of UTIs. Pleasure yourself without penetration, and enjoy cuddling, kissing, whispering and other enjoyable play. You'll be enhancing your sexual repetoire at the same time.
3. Change your sexual lubricant:
- Look at the ingredients for sexual lubricants, and avoid those with glycerin, honey, sugar, xylitol, or any other type of sweetener/carbohydrate. These products act as food for bacteria and yeast, and can cause harm to your natural protective vaginal biome.
- Use a lubricant with an acidic (lower) pH, such as Oasis Silk or Pjur Med Repair. Oasis Silk is our first choice, as it seems to have the most ability to offer some preventive protection. Silicone lubes like FeMani Lubricant and Uberlube, may also work, since these have an acidic pH and will form a slippery barrier to reduce friction against the skin.
4. Change your behaviors and diet:
- Drink water, coffee or tea, and urinate evey couple of hours. I know you're busy, but it just isn't good for your bladder to hold it for so long.
- Get your fasting blood sugar checked by your health care provider. When your blood is high in sugar/glucose, your secretions are too, and this sugar is eaten by bacteria that can overgrow and cause infections. This can be an important heads-up warning that your lifestyle and diet are unhealthy for you in many other ways.
- For those women who struggle with chronic UTIs: it is advisable to add live-culture, unsweetened yogurt to the diet on a daily basis, which helps add beneficial bacteria back to your body systems everywhere.
- Take cranberry capsules or drink cranberry juice (though most juices have a lot of sugar themselves, and can cause weight gain). Cranberry and blueberry juices have components which help protect the lining of the bladder and urethra from bacterial invasion. Because this effect can be overwhelmed, juices are less effective options for full blown infections.
- Make it a habit to always urinate after penetrative sex. Women who are the most consistent at post-coital urination have the lowest risk of UTIs.
5. Other things to consider include:
- Post-sex antibiotics. For some women, this is a last-effort solution. Talk to your health care provider about which type of bacteria you seem to be having trouble with, and if there is any type of antibiotic that would be advisable for you to have on hand. It isn't the best choice, but when all else fails, it is a choice.
- Reduce your contact with semen. Because semen has a high chemical pH, semen itself can change the healthy vaginal environment into a less healthy one for some women. Try using non-spermacide male condoms, or even better, using female condoms with a lubricant of your choice. Female condoms completely prevent the semen from contacting your skin/vulva/vagina while giving your partner the warmth, contact and slippery slide they want.
- Some like oils for vaginal penetration, but they are not good for use by women who get UTIs. Even though they seem slippery, oils cause increased friction over what sexual lubricants can prevent, and bacteria and yeast eat them as food. We advise against using oils for vaginal penetration.
- Address pelvic floor dysfunction. Consider making an appointment with a pelvic floor physical therapist for an evaluation.
- Address postmenopausal vaginal atrophy with the Vaginal Renewal Program, rather than using supplemental estrogen. Increasing the tone, health and blood flow of your vulva and vagina is just another way of boosting your defenses against pathogenic bacteria.