The burning sensation. The lower belly pain. The cloudy, odorous, or blood-tinged urine. And, lest we forget, the sprinting to the bathroom every few minutes, feeling like you’re going to pee your pants, only to eke out the littlest bit of urine. All of these things can creep up a day or two after having sex and are the telltale signs of a urinary tract infection. UTIs are familiar to many people — about 150 million people worldwide every year, in fact, making them one of the most common bacterial infections. However, some of the common advice we hear about them, including making sure to pee after sex, isn't all it's cracked up to be.
If you’ve ever wondered why you seem to contract UTIs not long after sex, there’s a pretty simple explanation: Intercourse can essentially jostle around that infection-causing bacteria upwards into the urinary tract, Howard Goldman, a urologist at Cleveland Clinic, tells Allure. “Sometimes during sexual activity, the bacteria can get moved around and some [bacteria] from the vagina could end up getting into the urethra and ultimately into the bladder.”
While UTIs affect people of all sexes and ages, Kathleen Kobashi, a urologist at Virginia Mason Medical Center in Seattle, tells Allure that women are much more likely to be afflicted thanks to their anatomy. Basically, the urethras of people with vaginas are rather short, making it pretty easy for bacteria — often E. coli, according to the Mayo Clinic — to get from the outside world to the inside of the body. Once it gets in there, the bacteria can colonize at any point along the urinary tract, most commonly in the urethra or bladder. Rarely, it can migrate up to the kidneys, resulting in a much more serious kidney infection (known as pyelonephritis).
Though UTI infections tend to first crop up around the time when a person with a vagina starts having sex, Goldman says, there's another time they tend to occur, as well. “There's an initial peak [in infections] when women become sexually active,” but the second peak comes decades later when menopause begins, during which changes in hormone levels and the vagina make it a more hospitable environment to the kind of bacteria that cause UTIs.
While the particular combination of discomfort and inconvenience caused by UTIs is miserable, the treatment is fortunately easy and effective. A few days of antibiotics clears things up for the vast majority of simple UTIs. But if you’d like to do what you can to minimize your chances of this post-sex nuisance in the first place, then you’ll be glad to know the following steps.
There are plenty of myths out there about UTIs — including the need to pee after sex.
Unfortunately, many of the UTI prevention tips you’ve probably heard before are also among the least evidence-based. “There are a lot of old wives’ tales about [UTI prevention], none of which has ever been really proven to impact anything,” Goldman says. For example, there is a surprising lack of hard science showing a correlation between recurring UTIs and frequency of urination, hot tub or bubble bath use, or wearing tight clothing, according to Ja-Hong Kim, an associate professor of urology at UCLA School of Medicine.
Even the most sensible-sounding post-intercourse UTI prevention tip of all should be met with some skepticism: peeing after sex. “Voiding [urine] after sex can theoretically flush bacteria out,” Kobashi says. But the efficacy of this common habit just doesn’t hold up under scrutiny. “I hate to say it, but I’m not sure there’s any data that supports that,” Goldman tells Allure. Kim adds, “Review of scientific literature has failed to show any association between recurrent UTIs and voiding patterns before [or] after intercourse." Of course, however, there’s certainly no harm in the post-sex pee, as Goldman points out. So by all means, go for it — just know you’re not necessarily nixing your chance of getting an infection.
While we’re on the subject of myths: It’s the same deal with wiping front to back when you pee, whether it’s after sex or not. The practice, which every person learns in Owning a Vagina 101, certainly doesn’t hurt and is a good idea for general hygiene purposes. But when it comes to preventing UTIs, “there's been very little evidence that in general, in most healthy normal people, [the direction you wipe] makes a big difference,” says Goldman. Thankfully, the anatomy of the vagina is actually pretty good at preventing lingering poop particles from working their way up into the urinary tract, he explains. “The urethra is all the way in the front of the vagina, so you’d have to be wiping like all the way around the front for it to really make a difference.” (If you are suffering from recurring UTIs and suspect things are less than spotless down there, Kim recommends using baby wipes to keep things tidy post-number two.)
So, how do you prevent UTIs after sex?
Change up your birth control
If you are using spermicide-coated condoms or diaphragms during intercourse and keep getting UTIs after sex, you might want to rethink your method of contraception, because it could be making your vagina more friendly to the bad kind of bacteria. “Spermicide kills the sperm, but it also may kill some of the healthy bacteria that are normal in the vagina,” Goldman tells Allure. “Then, when those healthy bacteria are killed or gone, some of the bacteria that you don't want then take up residence in the vagina.” Once they travel up the urethra, you’ve got a UTI on your hands. (For the same reason, you’ll also want to avoid douching, which you shouldn’t be doing anyway.)
Stay hydrated and pee frequently
Peeing right after sex might not necessarily be as crucial as you thought, but peeing regularly, in general, is definitely a good idea. “One of the ways that women can prevent infections is that when bacteria gets in the bladder, hopefully, it kind of washes out when they go to the bathroom,” Goldman says. The idea is to regularly flush out any bad bacteria that may be hanging around in your system before it gets a chance to build up.
That’s why it’s important to drink enough fluids so that you’re peeing every few hours. And this is the case all the time, not just after sex. “If some bacteria does get in there, and you're totally dehydrated and you only go once a day, then what can happen is that bacteria is sitting there all day and has a chance to start dividing and causing problems,” Goldman explains.
Use vaginal hormonal cream
Menopause triggers a drop-off in estrogen, along with a change in the pH in the vagina and a thinning of vaginal tissues, according to Goldman. This change in the vaginal environment just compounds the issue for somebody already prone to getting UTIs after sex. The good news is that vaginal estrogen cream has been clinically proven to significantly reduce the risk of UTIs in postmenopausal folks (whether or not their UTI is the result of intercourse). “If you use very low dose vaginal hormonal cream in the vagina, that actually can sort of rejuvenate the vaginal tissues and change the pH back to what it's supposed to be, and help [cultivate] the good bacteria in the vagina,” he explains.
Preventative measures that may help you avoid UTIs
1. Take probiotics
“There is some very mild evidence that probiotics may help prevent bladder infections,” says Goldman. The idea is that probiotics can help restore the healthy bacterial flora or good bacteria in your vagina and along your urinary tract. You can get these probiotics either naturally in your diet from foods like yogurt and kimchi, or in the form of supplements. Probiotics are also available in the form of vaginal suppositories. “Some people do well with the vaginal insertion of special probiotics formulated for [the] vagina,” says Kim.
2. Drink cranberry juice
While the notion that cranberry juice can cure a UTI is pretty flimsy, there are some studies suggesting it can aid in preventing them. “There is some very, very weak evidence that cranberry juice or cranberries — or other things in that family, like blueberries — may help lower one's risk for infection,” says Goldman.
“Cranberries contain tannins (aka proanthocyanidins) that are thought to minimize adherence of bacteria to the urinary tract,” Kobashi explains, “but the thinking is that there is not enough of them to be effective.” However, both doctors reason that given it’s totally harmless, upping your cranberry intake in the name of a UTI-free existence can’t hurt.
3. Take D-Mannose
There have been some studies suggesting that this simple sugar, found in fruits like cranberries but in much greater concentrations in supplements, may be worth looking into. “The data is on the weak side,” says Goldman, “but there is some evidence that [they] may help prevent bladder infections.” Similar to cranberries, D-Mannose may block some of the receptors on the bladder wall that UTI-causing bacteria adhere to, he explains.
4. Try out pericoital antibiotics
If you keep getting UTIs after sex and your doctor has ruled out any underlying issues, a semi-regular low dose of antibiotics may be the answer. Your doctor may opt to put you on a regimen of pericoital antibiotics, for instance, “which means whenever they have sex they just take a low-dose antibiotic,” Goldman explains, “particularly in the young women [who] come to us and say, ‘You know, I noticed that whenever I get a UTI it's the day after I had sex.’” He continues, “The idea is that if any bacteria get up into the bladder, that one antibiotic kills it and prevents the infection from taking hold.”
Another possibility is “self-start treatment,” where your doctor will give you a standing prescription for antibiotics to take the second you feel the symptoms of a UTI coming on, Goldman explains, knocking it out within 24 hours or so. (If it doesn’t go away, give your doctor a call.) The last resort is daily suppression, Kobashi says, which involves a very low dose of certain antibiotics taken every day as a preventative measure, so that if and when bad bacteria weasels its way into your urinary tract during sex, your body can evict it ASAP.
If you’re following your doctor’s advice and have tried all the tricks and are still getting UTIs after intercourse, there could be something else going on.
“A lot of people have one infection and it goes away,” says Goldman. “But when people start having recurrent UTIs, where they get two or three or four or five a year, that's when it really becomes a problem.” If that’s your experience (whether or not it correlates with sex), talk to your primary care physician or see a urologist who can look at your medical history, do an exam, and potentially order further testing to rule out any underlying issues. For example, Goldman says, you could have an immune disorder making you more prone to infection; a neurological disease or anatomical issue preventing you from fully emptying the bladder every time you pee, allowing urine (and any nasty bacteria) to hang stagnate in the bladder; or diabetes, where extra sugar in the urine can help breed bacteria.
However, some people are just more prone to UTIs than others — both after sex or in general — and there’s nothing you can do about it. “There are some genetic subtypes who are just more prone to it,” Goldman says. Some people have a larger number of the receptors in the bladder lining that bacteria can “stick to.” On the other hand, other people are lucky and just don’t ever get UTIs.
“For some people, even if they get bacteria in the bladder, the next time they go to the bathroom it just washes right out,” he explains. A genetic predisposition to UTIs can even run in families, so that if a parent is prone to getting them you may be, too. The point is, as with any health condition, while there are some things you can try out on your own to prevent UTIs after sex, it's important to talk to your doctor about any concerns you may have.
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