Out, Out Damn UTI!

Could not cleaning myself a certain way after sex be causing my frequent urinary tract infections? What is the proper way to clean myself after sex (we use condoms and KY)?
Heather Corinna replies:

I feel your pain. Big time.

I have had times in my life where UTIs were something I could count on more than the sun coming up every day, owing the IRS money while people who made 100 times more than I do in a year didn't, and never getting a seat on the subway during rush hour. I know too well how crazymaking getting them all the time can be, and because of both what I do in my work here and all too many doctors visits for UTIs of my own, I have an encyclopedia of UTI prevention forever etched in my brain I'm glad to share with you.

Your UTIs probably are not influenced by how you clean your body after sex, but there are a host of preventative measures you can take if you're not taking them already. Let's start by first filling you and everyone else in on the basics of UTIs.

UTI stands for urinary tract infection. Sometimes you'll hear UTIs referred to as cystitis or bladder infections. A UTI is an infection caused by bacteria (most commonly E. coli or staph saphrophyticus) that occurs and multiplies anywhere along the urinary tract: the urethra, the ureters, the bladder and/or the kidneys.

Some typical symptoms of UTIs are feeling like you have to urinate often, and then sometimes only being able to squeeze out a few drops; burning and/or strong odor with urination; blood in the urine; soreness or a feeling of fullness in your bladder, stomach, lower back or sides. When UTIs spread or get serious, people can also feel nauseated, start vomiting, or get a fever or chills. Should you ever get the more serious symptoms, you'll want to head to an urgent care or emergency room, rather than scheduling an appointment with a doctor or clinic.

UTIs can be anything from mild to severe. Very mild UTIs will often go away without treatment, but if UTI symptoms stick around for more than a day, or aren't mild, you likely need treatment. UTIs are usually treated with a round of antibiotics. If left untreated, UTIs can become kidney infections, which can become very serious, even life-threatening, so it's always important to do what you can to be seen by a healthcare provider when you know or suspect you have a UTI.

When being diagnosed for a UTI, you'll ideally want to get a full pelvic exam that also looks for other infections, since sometimes what we think is a UTI is actually something else. If you've been sexually active, STI screenings should be part of that exam, especially if you or any partners aren't up to date with them (and yes, even if you're using condoms -- they reduce the risks of STIs, but don't mean there have been no risks). Be sure to fill a healthcare provider in on your sexual history and ask for those STI screenings: some providers won't do them unless you ask. There are DIY at-home tests for UTIs, but if access to a healthcare provider isn't a big issue for you, I'd strongly suggest being diagnosed by a professional instead, especially if UTIs are chronic.

Some people will never get them, some will get them only occasionally, and some people will get them often or chronically. They're far more common in people with a vagina than in people with a penis, because for those with a vagina, the urethra is much shorter and is also closer to the anus, which holds bacteria. Diabetics and pregnant people also tend to get UTIs more often than other folks.

UTIs aren't technically STIs, though they can, and often do, develop due to sexual activity, because that's a common way for bacteria to be pushed into the urinary tract. All that rubbing of the vulva from some sexual activities that can feel so nice to you unfortunately is also something bacteria greatly enjoy: they get massaged into the urethra that way. Vaginal intercourse, specifically, is the sexual activity most often associated with UTIs, as is having frequent sexual activity (which is why they're sometimes called "honeymoon cystitis") or a new sexual partner. Some sexual positions are also more associated with UTIs, namely positions where vaginal entry occurs from behind.

So, you know what UTIs are, and know you'd move heaven and earth to try and avoid them. What can help keep those darn UTIs the hell away from your body?

Some or all of these things won't work for everyone, but some ways to prevent UTIs, which may also help you avoid other kinds of genital infections, are:

  • Keep well-hydrated, drinking plenty of water each day. Being dehydrated makes UTIs more likely to happen. Having a glass of water before sex may also help.
  • Eat well: poor diet can also predispose people to UTIs. Eliminate or cut back on some things that may be part of your diet, like refined sugars and simple starches, caffeine, aspartame (an artificial sweetener in a lot of diet foods/drinks) and alcohol.
  • If you smoke, cut back or quit (which is best for you, anyway)
  • When toileting, wipe from the front (your vulva) to the back (your anus), not back to front. That helps keep bacteria from the rectum from spreading to your urinary tract.
  • Don't "hold it" when you need to urinate. When you gotta go, go.
  • Take showers instead of baths, or at least ditch bubble bath if you bathe. You'll also want to avoid other potential irritants like scented tampons, any kind of "deodorant" for the vulva, douches, scented or harsh soaps or detergents.

When it comes to washing, it's actually more important for partners to wash before sexual intercourse or other activities than after. I know that's not always convenient or doable, but the rationale is that our bodies tend to carry bacteria as a rule. So, when we rub them together with someone else's, we spread that bacteria around. If we and/or a partner clean up first, especially genitally, there's less bacteria to introduce to the urinary tract in the first place. You can certainly also try showering after sexual activity to see if that helps, but you're more likely to see results with cleaning up before, especially if BOTH you and your partner do so, not just you.

You mentioned you're using KY as a lubricant. Have you tried changing your lube? Sometimes, a given brand can irritate us, so making a switch just in case is smart. Some lubes are also more hypoallergenic than others, so I'd suggest seeing if you can't find one of those, like Pink, Emerita, Pjur or other higher-grade brands than KY. You can also ask your OB/GYN for suggestions on lubes that might be less irritating. Too, to avoid genital irritation from sex that can make UTIs more likely, be sure to use lube right from the start, rather than only adding it if and when you're feeling the burn. You might also try switching your brand or style of condom: if you use male condoms, try female condoms and see if that helps. If you use latex condoms, try a nitrile or polyurethane condom (female condoms are also non-latex).

I don't know how you get healthcare, but whoever you see about UTIs, if you're getting them often, make sure they know that. In other words, if you use different clinics or don't always see the same doctor, be sure to tell them that you have a history of UTIs, how often you have them, and how you have been treated for them in the past. Investigating and treating a lone or occasional UTI is a different story than investigating and treating chronic UTIs/interstitial cystitis, so you want to be sure you're getting the right care and treatment. With UTIs that keep coming back for more, your doctor should also be testing you after a treatment to be sure it did actually get rid of the UTI: sometimes they keep coming back because they never fully went away in the first place.

If you have been seeing the same provider for your UTIs who just keeps giving you the same treatment and the same tests, it might also be worth your while to see someone else for a second opinion. Not only can UTIs sometimes not be UTIs at all, but sometimes they can be caused by conditions like diabetes or urinary tract abnormalities that need management of their own. Lastly, sometimes a doctor will treat sexual partners for UTIs when another partner keeps getting them, especially if they keep happening in the same relationship despite a person taking many preventative measures to avoid them.

You might also want to look at a couple of the resources I double-checked when writing this piece, namely Our Bodies, Ourselves (The Boston Women's Health Book Collective), the Mayo Clinic's page on UTIs and some UTI info from the Office on Women's Health in the Department of Health and Human Services. Your healthcare provider is also someone you can talk to and who should take the time to sit down with you and give you the skinny on all of this: providing you information is just as much a part of their job as giving you medical treatment.

  • Ditch thongs or only wear them very infrequently. They can drag bacteria from the anus to the vulva. Avoiding very tight pants or leggings may also help. (And no, people who advise these things aren't just being killjoys about the way folks want to dress.)
    • If you masturbate with your hands, be sure to wash them first. If you use any sex toys or objects when masturbating, either cover them with a condom or boil them before and after use.
    • Use condoms with genital sexual activity, especially with vaginal and/or anal sex. While bacteria can live on parts of the body not covered by a condom, they can help reduce at least some of the possible bacteria you'll be exposed to with sex.
    • Urinate both before and after sexual activity: that helps flush bacteria from the urinary tract.
    • For those who use a diaphragm or oral contraceptives (the pill) as contraception, switching to another method may help. These methods have been associated with UTIs. If you use condoms with a spermicide, switch to those without, as spermicides have also been associated with UTIs.
    • When you have and/or are being treated for a UTI, take a pass on sexual activity.
    • If you're getting UTIs a lot, ask your healthcare provider about medications or supplements you can take preventatively, like a low-dose antibiotic. Even just a daily cranberry supplement (more advised for preventative use than when you already have a UTI) or a Vitamin C supplement may do the trick, because they can help acidify urine, which helps stave off bacteria.
    • If you're being treated for a UTI, be sure to take your medication properly, including finishing the whole course of treatment, not stopping when symptoms seem to subside. Just because symptoms of an infection get better or go away doesn't mean an infection is gone.

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