UTI: The Sexually Transmitted Infection Few Mention

It goes by different names: bladder or urinary tract infection, UTI, and cystitis (“cyst” from the Greek for bladder). It occurs mostly in women, and causes urinary urgency—I have to go now—usually with burning pain on urination, possibly lower abdominal pain, and sometimes fever. It may recur, with many women suffering several a year. And it’s closely related to lovemaking. 

Women often develop UTIs shortly after intercourse, and may blame their partners—often with good reason. This can drive a wedge between lovers, with women avoiding sex to evade infection, and men wondering what they did wrong. Fortunately, with minor sexual adjustments, most UTIs can be prevented.

The cause of most UTIs is intestinal bacteria, typically Escherichia coli (E. coli). These bugs aid in digestion, but if they attach to women’s bladders, they cause UTI.  

During digestion, E. coli become incorporated into stool. Even with careful wiping, some remain around the anus. Vigorous or careless lovemaking can move them the few inches to women’s urethras, where they may work their way into the bladder.          

Bladder infections can strike men as well as women, but women are more susceptible. Their anuses and urethral openings are much closer than men’s, and without penises, their urethras are considerably shorter. In addition, moisture promotes bacterial transit from the anal area to the urethra. Women who self-lubricate copiously are at increased risk. 

Prevention: What Women Can Do—Especially If Prone to Recurrent UTIs 

• When you feel the urge to urinate, go. Urination flushes out bacteria before they can climb into the bladder. Holding urine raises UTI risk. Even if you don’t feel the urge, if you’re prone to UTI, go every hour or two. And be sure to go shortly 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 traps less moisture than synthetics. Stay away from tight-fitting clothing, for example, leotards. Their rubbing can move bacteria toward the urethra.

• Avoid internal irritants. Some evidence suggests that cigarettes, alcohol, and caffeine (in coffee, tea, many soft drinks, and some over-the-counter drugs) may increase UTI risk. If you suffer recurrent UTIs, 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.

• Reconsider birth control. Compared with women who use other contraceptives, diaphragm users are at increased risk for UTI. It’s not entirely clear why, but if you use a diaphragm and suffer recurrent bladder infections, consider switching methods.

• As women become menopausal, the chemical environment of the genitals changes. This may allow E. coli to enter the urethra more easily. To reduce this risk, try an estrogen cream. And eat more soy foods: tofu and textured vegetable protein, used in many meat substitutes.

• Drink cranberry juice and eat dried 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 cranberries might prevent UTIs. But by the late 1960s, nay-sayers showed that the tart berries don’t acidify urine sufficiently to prevent UTIs. 

Meanwhile, two dozen studies have investigated cranberry for UTI prevention, and the substantial majority show significant preventive action. Cranberries may not acidify urine, but they add compounds to it that deter E. coli from adhering to the bladder wall, reducing their ability to cause infection. 

Drink cranberry juice cocktail, a glass or two daily. Snack on dried cranberries (Craisins). Cook with the berries. Recipes abound. (I love cranberry-nut bread.) Or take a concentrated extract in pill form, available where supplements are sold. Whichever form you use, have some cranberries 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 that keep the nasty ones in check.  One way to support friendly bacteria is to eat yogurt containing a live-culture of Lactobacillus acidophilus. Probiotic bacteria supplements are also available.

Prevention: What Men Can Do—Especially If Lovers Are Prone to UTI

• Be gentle during intercourse. Back when premarital sex was less common, newlyweds spent their honeymoons doing the horizontal tango, often so frequently and vigorously that many brides developed UTIs. The condition was called “honeymoon cystitis.” Vigorous intercourse can irritate the urethra, increasing risk of UTI. Do the deed gently. 

• Make love hygienically. Honeymoon cystitis was rampant for another reason. Many newlyweds were uninformed about sexual hygiene. Anal play—sphincter massage, shallow fingering, and intercourse—is more popular than many believe. While anal intercourse is rare (about 2 percent of couples) and regular anal play in other ways isn’t very common, still, around 40 percent of couples have experimented with backdoor sex at least once. If you play that way: Shower before sex. Wash both of your anal areas with soap. During lovemaking, nothing that touches either lover’s anal area should come in contact with the woman’s vulva. Keep close track of where your fingers and sex toys have been. 

• Sex with less intercourse. Some women have sex gently with perfect hygiene, but have the misfortune to be prone to UTIs. Try de-emphasizing vaginal intercourse, and moving more toward sex based on hand jobs, oral, toys, and perhaps a bit of kink.

• The condom connection.  A study of 1,200 Seattle women showed that UTI risk increased for those whose lovers wore spermicide-coated condoms. If you use condoms and she suffers recurrent UTIs, consider no-spermicide brands or another method.

Treatment

• At the first twinge of infection, immediately start drinking lots of water or cranberry juice—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.  

• Immediately increase consumption of dried cranberries or extract. 

• See your doctor for antibiotics, and take the entire course—even if you feel better before you finish the pills.       

• Talk about it. Recurrent, sex-related UTIs can drive a wedge between lovers. But working together to prevent them can increase intimacy and enhance your relationship. 

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In lists of sexual infections—chlamydia, gonorrhea, etc.—UTI is often forgotten.
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In discussions of sexualy transmitted infections—chlamydia, gonorrhea, syphilis, etc.—urinary tract infection is often forgotten.
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Reference: 

Fihn, S.D. et al. “Association Between Use of Spermicide=Coated Condoms and Escherichia Coli Urinary Tract Infection in Young Women,” American Journal of Epidemiology (1996) 144:512.

Foxman, B. et al. “Cranberry Juice Capsules and Urinary Tract Infection After Surgery: Results of a Randomized Trial,” American Journal of Obstetrics and Gynecology (2015) 213:194.

Herbenick, D. et  al. “Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94,” Journal of Sexual Medicine (2010) 7(Suppl 5):255.

Maki, K.C. et al. “Consumption of a Cranberry Juice Beverage Lowered the Number of Clinical Urinary Tract Infection Episodes in Women with a Recent History of Urinary Tract Infection,” American Journal of Clinical Nutrition (2016) 103:1434.

Moore, E.E. et al. “Sexual Intercourse and Risk of Symptomatic Urinary Tract Infection in Post-Menopausal Women,” Journal of General Internal Medicine (2008) 23:595.

Vincent, C.R. et al. “Symptoms and Risk Factors Associated with First Urinary Tract Infection in College Age Women: A Prospective Cohort Study,” Journal of Urology (2013) 189:904.

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