When I think about the aspect of sex that has made me most anxious over the course of my seven years of sexual activity so far, it’s not the risk of pregnancy or STDs, nor is it whether the guy will call back. It’s whether I will wake up feeling like there are razor blades in my bladder. Yes, my friends, I am talking about urinary tract infections (UTIs). The persistent and urgent need to pee that just won’t go away. The burning that lingers infinitely. The small amounts of cloudy or bloody pee. If you’ve ever had a UTI (you probably have, if you’re a sexually active person with a vagina), you know what I’m talking about. I want to start by expressing how shocking it is to me that UTIs aren’t one of the first things you hear about when you learn about sex, and especially heterosexual intercourse. When I got a UTI promptly after losing my virginity at age 18, I had literally no idea what was going on. I remember waiting around in debilitating pain, not knowing what was up — until I saw drops of blood appear in the toilet. I then sprinted to University Health Services, where I was prescribed the antibiotic nitrofurantoin. According to recent survey data, 1 in 3 women will have had a diagnosed and treated UTI by age 24 — and more than 50% of women get at least one UTI during their lifetimes. According to The New York Times’ comprehensive report on UTIs, “Frequent or recent sexual activity is the most important risk factor for urinary tract infection in young women.” As well, “Nearly 80% of all urinary tract infections in premenopausal women occur within 24 hours of intercourse.” UTIs are apparently very, very rare in celibate women. Why do UTIs happen? Needless to say, there’s a lot of jostling around that occurs during sex. According to the American Congress of Obstetricians and Gynecologists, microbes from the anus or vagina (where naturally occurring bacteria live) are able to travel and eventually enter the urinary tract and bladder, where they are not meant to be found.
According to recent survey data, 1 in 3 women will have had a diagnosed and treated UTI by age 24.
Women are far more prone than men to getting UTIs, says the Mayo Clinic (which my gyno also reminds me, reassuringly, during our annual visit), as the female urethra is shorter. This allows “easy access” for bacteria to enter the bladder. That’s why you’ve probably heard your Ob/Gyn or mom tell you to pee immediately after having sex. Peeing after sex ensures that any potential bacteria that has entered the urinary tract during sex is flushed out. Or, as my gyno instructs often, “Think of the difference between a flowing river and a stagnant pond.” After my first time having sex and getting over my first UTI, I was all clear — until the second time I slept with someone, a few months later. Five more days of nitrofurantoin. I then had sex a few more times my freshman year, and almost always got a UTI. Looking back, I am able to recognize that many of the times I had sex that year occurred when I had alcohol in my system and was very dehydrated. They also tended to be with people with whom I wasn’t super comfortable, meaning that I often didn’t feel readily inclined to say that I had a history of UTIs, and that I needed to make sure to drink water and pee immediately after sex so as to avoid getting sick. I hate to say it, but I suspect that many women can relate to my experience of just not wanting to talk about it — thinking it would be gross, embarrassing, not the guy’s problem. Luckily, all was okay for a year following the freshman frenzy (celibacy helps with UTI prevention — how fun), until I began dating my then-boyfriend in the middle of my junior year. From the first time we had sex, I got recurrent UTIs. Taking nitrofurantoin became almost as regular a thing as taking my daily antidepressant — because it basically was. In fact, when I went to see a urologist, he prescribed me an ongoing dose of prophylactic nitrofurantoin, to take every time I had sex in order to avoid infection. Note: This is a fairly common practice for people prone to UTIs, though I don’t think it’s a great plan. According to the Human Microbiome Project, an initiative of the NIH Roadmap for Biomedical Research, antibiotic use may harm the balance of the body’s naturally occurring “good” bacteria (also known as the microbiome). Studies also show that antibiotic overuse can cause bacteria to become resistant down the line — definitely not a good thing for our immune systems in the long run. For these reasons, I refrained from using the drug daily, and only took it when I got a positive culture back from a urine test. My then-boyfriend and I were instructed not to have sex during treatment for these diagnosed infections, but he would often complain or make passive-aggressive remarks, making me feel guilty every time I was sick. Clearly, he had never learned about how common (or awful) UTIs were, and neither of us were equipped with the communication skills to deal with it. Long story short, we broke up after about a year in October of 2012, and I was UTI-free until March of 2015. During those years, I had actually begun dating my second serious boyfriend — a relationship that ultimately lasted two years — and I didn’t get a single UTI the entire time, believe it or not. I had realized the actual importance of drinking tons of water every day, of peeing regularly and not “holding it in,” and taking explicit precautions to avoid bacteria getting into my bladder. The fact that I was able to communicate with a loving partner about all this certainly helped. While there isn’t much research detailing the correlation between dehydration and UTIs, it’s certainly logical that staying hydrated — and also emptying your bladder regularly — would be beneficial for prevention. And experts agree: "Fluid helps move things through the urinary tract, but it also dilutes the urine so bacteria can't grow," Kimberly Cooper, MD, a urologist at New York-Presbyterian Hospital/Columbia University Medical Center, recently told Prevention magazine. Bacteria-avoidance is also simple, though it similarly requires vigilance. In my case, I finally learned the real importance of wiping front-to-back (studies prove that doing the opposite is a frequent cause of UTIs), and made the commitment to always showering before sex.
This is about way more than just UTIs. It’s about the importance of accepting when you need to speak up to protect yourself.
After an almost-three-year-long hiatus (the result of sticking to my prevention regimen), I wrote a celebratory article for Cosmopolitan’s September 2014 issue entitled “I Finally Got Rid of My UTIs.” The crux of the article was that healthy communication is one of the most effective tools when it comes to UTI-prevention. Well, apologies to any Cosmo readers who shared in my celebration back then, but the repeated infections came back this past spring. They appeared after a year-plus of being single, something my body had clearly gotten used to. When I began dating someone new in February, I realized I had lost a bit of discipline with hydrating and peeing. And after all, sex is the main culprit of UTIs. I also wasn’t yet comfortable enough with the guy (my now-boyfriend) to tell him that I had a history of UTIs, and what that meant for my self-care. But since I’ve been in this now-committed relationship for six months, my communication skills have improved. I have returned to my regular and rigorous prevention regime. It is simple and perhaps even obvious — but I am rigorously committed to it, because above all, I am committed to myself. It involves drinking about 3 liters of water a day, and always making sure to pee before and after sex (which I have to do anyway now, given how much water I drink). I also started regularly taking a supplement called D-Mannose, which is the active ingredient in cranberries, long known as a go-to holistic treatment for UTIs and overall kidney health. D-Mannose is scientifically proven to help prevent UTIs, as it prevents the bacteria from sticking to the wall of the bladder. Cool, huh? The person you (or I) deserve to be with should not only be cool with you getting up to pee right after sex, but also comfortable with — and perhaps even fascinated by — learning about what you need to do to feel healthy and happy, in and out of the bedroom. Whether your Achilles' heel is UTIs or something entirely different, accepting it is a helpful first step. When you know what you need, you can put yourself first with authenticity and self-awareness, without shame or regret. Because the bottom line is that taking care of yourself is not selfish. When it comes down to it, all of this is about way more than just UTIs. It’s about the importance of accepting when you need to speak up to protect yourself. No relationship can be healthy — emotionally or physically — if we forget the simple but radical necessity of taking care of ourselves first.