Fifty percent of women will have a Urinary Tract Infection (UTI) in their lifetime. A portion of those women will identify sexual intercourse as a precursor to their symptoms. Typical UTI symptoms include painful urination, lower abdominal pain, urinary frequency, urinary urgency, foul-smelling urine, and blood in their urine (hematuria). A woman may only have one of these symptoms that prompts her to present for a clinical evaluation. Women are naturally at risk for developing a UTI due to a shorter urethra adjacent to the vagina and rectum, which harbors microorganisms that may contribute to a UTI. The gastrointestinal organism Escherichia coli (E.coli) is the most common organism and accounts for about 80 percent of UTIs confirmed with a urine culture.
Estrogen levels play a role in the prevention and development of a UTI. The premenopausal woman has adequate estrogen levels that contribute to healthy genital tissues. However, a postmenopausal woman has decreased estrogen, which contributes to thin, fragile genital tissues. Vaginal tissues that lack estrogen or are hypoestrogenic are easily irritated and prone to infection due to the lack of the genitalia's natural barrier created with estrogen. As vaginal estrogen decreases, the prevalence of painful sex (dyspareunia) and UTIs will increase. Hypoestrogenic tissue is treated by the replacement of hormones at the source of atrophy. Vaginal estrogen cream or an estrogen ring is best for improving vaginal tissue to prevent the occurrence of a UTI.
Women must understand that, although their symptoms may present after intercourse, a UTI is not a sexually transmitted infection. Regarding the onset of symptoms after sex, it is helpful to inform women that the frequency of sex, new sex partner, type of lubricants and spermicides, are additional risk factors for a UTI. Overall health status is essential when considering the cause for UTIs as women with underlying health issues such as diabetes, renal failure, kidney stones, neurologic disease, sickle cell, and sickle cell trait.
Intake of concentrated cranberry juice, low dose antibiotic after sex, vaginal estrogen, boric acid vaginal suppositories, D-Mannose supplement, and applying antiseptics to the urethra before sex are proven beneficial in the prevention of UTIs related to sexual intercourse. Studies lack sufficient evidence that supports the prevention of a UTI when emptying the bladder before and after sex. Despite its lack of supportive evidence, maintaining good hygiene is beneficial and recommended as a prophylactic measure.
At the UCA Women's Center, we create an individualized care plan for each woman. The anticipation of discomfort after or during sex will decrease sexual desire, which can cause a relationship strain for some couples. If a UTI is negatively impacting a woman's life, we want to evaluate, diagnose, and treat it so that she can embrace her sexuality and engage in intimacy without hesitancy. We encourage women to express any concern regarding intimacy and seek help.
Heather Williams, CRNP is a board certified Adult-Gerontology & Women's Health Nurse Practitioner with the UCA Women's Center.