Sex and Urinary Tract Infection (UTI)

It’s known variously as urinary tract infection, UTI, bladder infection, and cystitis (“cyst” is Greek for bladder). It occurs mostly in women, and causes urinary urgency–I have to go NOW–burning pain on urination, and possibly lower abdominal pain, sometimes even fever. It tends to recur, with many women suffering several UTIs a year. And it’s closely related to sex.

Women often develop UTIs shortly after intercourse, and sometimes blame their infections on the men in their lives, possibly with good reason. This, in turn, can drive a wedge between lovers, with women avoiding sex to evade this infection, and men wondering what they’ve done wrong. Fortunately, UTIs can be prevented, usually pretty easily.

UTIs are caused by intestinal bacteria, typically Escherichia coli (E. coli). These bugs aid in digestion, but if they get into a woman’s bladder, they cause UTI.

During digestion, E. coli become incorporated into stool. Even with careful wiping, some remain around the anus. Vigorous or careless sex can move them the few inches to a woman’s urethra, and then they work their way to her bladder.

Compared with men, women are more susceptible to UTI because their anuses and urethral openings are much closer, and their urethras are considerably shorter. Meanwhile moisture promotes bacterial transit from the anal area to the urethra. Sex leads to increased vaginal lubrication (natural or a commercial), which moistens the area and increases UTI risk.

Prevention: What Women Can Do

  • When you feel the urge, go. Urination flushes out bacteria before they can cause infection. Holding urine is associated with increased UTI risk. Even if you don’t feel the urge, go every hour or two. And be sure to go before and after sex.
  • Wipe from front to back, away from your urethra. Never wipe from back to front, which moves E. coli toward the urethra.
  • Avoid external irritants. Use a mild unscented soap, e.g. Ivory. Avoid perfumed and deodorant soaps, and bubble baths, which may irritate the urethra. Wear cotton underwear, which is less irritating than synthetics. Stay away from tight-fitting clothing, for example, leotards. Their rubbing may move bacteria toward the urethra.
  • Avoid internal irritants. Some evidence suggests that cigarettes, alcohol, and caffeine (coffee, tea, many soft drinks, and some over-the-counter drugs) may increase UTI risk. Experiment with reducing your intake or eliminating them.
  • Go with your flow. During menstruation, change tampons or pads often, Blood is an excellent bacterial growth medium.
  • The contraception connection. Compared with women who use other forms of birth control, diaphragm users are at increased risk for UTI. Not too long ago, doctors believed that diaphragm rims were to blame. When the rim presses against the urethra, it may cause irritation and increase risk.  Now it appears that the spermicide used with diaphragms also plays a role in UTI risk. Don’t stop using birth control. But if you use a diaphragm and suffer recurrent bladder infections, consider a different contraceptive.
  • The aging connection. As women become menopausal, the chemical environment of the genitals changes, which may allow E. coli to pass more easily into the urethra. Soy foods and an estrogen cream may help.
  • Drink cranberry juice and eat cranberries. During the 1840s, German researchers discovered that people who eat cranberries pass a bacteria-fighting chemical, hippuric acid, in their urine. Sixty years later, American researchers speculated that urine acidified by a steady diet of cranberries might prevent UTIs. Women began drinking cranberry juice, and several studies endorsed the practice. But by the late 1960s, nay-sayers claimed that the tart berries did not significantly acidify urine and therefore could not prevent UTIs. However, many studies have shown that cranberries do, in fact, reduce risk of UTIs, among them, reports in the New England Journal of Medicine (1991), the Journal of the American Medical Association (1994 and 1998), the Journal of Family Practice (1997), and the Journal of Urology (2008). It turns out that the reason has nothing to do with acidifying urine. Actually, cranberries add compounds to urine that deter E. coli from adhering to the bladder lining, thus reducing their ability to clause infection. There are several ways to eat cranberries. You can drink cranberry juice cocktail, a glass or two a day. You can snack on dried cranberries. You can cook with the berries (cranberry bread). Or you can take a concentrated extract in pill form, available where supplements are sold. No matter which form of cranberry you use, take some before and after lovemaking.
  • Try probiotics. One possible reason E. coli can invade the bladder is  that women’s vaginas may lack healthful (“probiotic”) bacteria.  One way to support these friendly bacteria is to eat yogurt containing a live-culture of Lactobacillus acidophilus. Probiotic bacteria supplements are also available.

Prevention: What Men Can Do

  • Make love gently. Back when premarital sex was less common than it is today, newlyweds spent their honeymoons engaged in very vigorous sex, and so many brides developed UTIs that the condition was called “honeymoon cystitis.” Vigorous sex can irritate a woman’s urethra, and move anal area bacteria toward her urethra. Make love gently.     
  • Make love hygienically. Another reason honeymoon cystitis was so common was that many newlyweds were uninformed about sexual hygiene. Shower before sex, then during lovemaking, nothing that touches a woman’s anal area should come in contact with her vulva. Keep track of where your fingers and any sex toys have been.
  • Go oral. Some women have sex gently, with lots of lubricant and excellent hygiene, and still get UTI’s. They’re just prone to these infections. One alternative worth trying, is oral sex instead of intercourse.
  • The condom connection. Diaphragms are not the only contraceptive to employ spermicide. Condoms often come coated with the spermicide, nonoxynol-9. A study of 1,200 Seattle women showed that UTI risk increased for women whose lovers wore spermicide-coated condoms. If you use condoms and she suffers recurrent UTIs, consider another method.

Treatment

  • At the first twinge of infection, immediately start drinking lots of water–10 cups a day.  You may be able to flush the bacteria out of your bladder before they become established firmly enough to cause a full-blown infection.
  • Increase your cranberry consumption. It might help.
  • See your doctor for antibiotics, and take the entire course even if you feel better before you finish all the pills.
  • Talk about it. While recurrent sex-related UTIs can drive a wedge between lovers, working together to prevent the infection can increase intimacy and enhance the relationship.

There’s a lot you can do about urinary tract infection UTI.

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