Dear Doctor,
I seem to be getting UTIs way more often. In college I learned to pee after sex to prevent them, but that doesn’t seem to be doing the trick anymore. Why is this happening, and what should I do to make them stop?
Dr. LaFollette says:
The shortest answer as to why this is happening is that the vagina changes during menopause. It gets narrower and doesn’t have the same elasticity and blood supply as it did before, which makes its lining thin. As the vagina becomes smaller, the bladder, which sits atop the vagina, collapses downward a bit. Changes in hormone levels and the thinning of the vaginal lining can lead to changes of the vaginal pH, which can make bladder infections more common. The change in pH can also give you yeast infections or bacterial vaginosis.
And as the vagina gets narrower, the urethra takes up a much larger section of the area near the vaginal opening than it used to. If we look at the vaginal opening and urethra of younger women, the urethra is sort of up at the top, and out of harm’s way for many people. But in time, as the vagina changes, the urethra becomes more prominent in the area near the vaginal opening, taking up about a third of the space. It’s smack dab in the middle, so if you’re having penetrative sex, you’re hitting the bladder every time — so it’s no coincidence, then, that you would get bladder infections more frequently as you age.
What can you do to prevent UTIs?
If you’re experiencing UTIs, there are a few steps you can take for future prevention.
- Lube up. Using a water-based lubricant can make a difference, as friction can irritate the urethra.
- Drink fluids, before and after. Many people are careful to do this before sex, but it’s important to do this after sex and throughout daily life as well. Drinking lots of water can help dilute the concentration of bacteria in the bladder that leads to UTIs. Try drinking 50 ounces a day.
- Try cranberry. Some people find consuming cranberry supplements and juice to be helpful, although there are no formal medical studies showing that cranberry helps prevent UTIs.
- Switch up your positions. If you’re having penetrative sex, there are certain positions that are less likely to lead to a UTI — positions where the penetration is directed to the back wall of the vagina, more toward the pelvic floor rather than to the top of the vagina, where the bladder sits. For some women, this might involve lying on your back or being on top. Experiment to see which positions work best for you.
- Pee before and after. Urinating before and after sex flushes bacteria out of the urethra. It’s also important to pay attention to how it feels when you urinate in the hours after sex. If you feel a sting while urinating, say, half a day after you’ve had sex, that’s a sign that a UTI might be coming on.
What can you do if you feel a UTI coming on?
- Fluids and NSAIDs. Provided you don’t get bladder infections often, some recent studies have shown that taking nonsteroidal anti-inflammatories like Aleve or Motrin and consuming lots of fluids may be enough to prevent it from turning into a full-blown bladder infection without using any antibiotics.
- Preventative antibiotics. If you’re experiencing frequent UTIs, your doctor can prescribe you a prophylactic dose of antibiotics, which contains a quarter the strength of a full dose. If you are prescribed prophylactic antibiotics for UTIs, the time to use them is usually when, 12 or so hours after sex, you feel some stinging toward the end of your urination stream. Doing this will usually nip the UTI in the bud.
