Getting a urinary tract infection (UTI) once in your life is bad enough. It comes with a constant urge to pee, yet when you go to the bathroom, you can only squeeze out a little urine — and it burns like crazy. So having recurring UTIs? Just the thought might make you shudder.
Yet that's the reality for some people, primarily those with vaginas. About half of adults assigned female at birth experience at least one UTI in their lifetime, per July 2016 research in Translational Andrology and Urology. And, according to a separate August 2013 study in the Sultan Qaboos University Medical Journal, for every one person with a penis who gets a UTI, eight people with vaginas get a UTI.
And then there are the unlucky folks who get recurrent UTIs, which means three or more in a year or two or more in six months, per the National Institutes of Health (NIH). Just as with UTIs in general, recurrent UTIs are more common in people with vaginas. And for anyone, it may be a sign of a bigger problem.
Why Are UTIs More Common in People With Vaginas?
When it comes to UTIs, urethra size matters.
"A shorter urethra is an easier path for bacteria [that cause UTIs] to climb into the bladder," says Amin Herati, MD, director of men's health and male infertility and assistant professor of urology at Johns Hopkins Medicine.
In adults with vaginas, the urethra is much shorter, measuring about 1 to 1.5 inches long, while the urethra in people with penises is about 7 to 8 inches long, per an October 2018 paper in Biology of Sex Differences.
Plus, in people with vaginas, the opening of the urethra is in close proximity to the opening of the vagina.
"From birth, the vagina is filled with different bacteria and yeast. But occasionally that microbiome can be altered, and there might become less of a certain type of good bacteria," says R. Mark Ellerkmann, MD, director of the Urogynecology Center at Mercy Medical Center in Baltimore. And if that bacteria gets into the urethra, which can happen during sex or with improper wiping after going to the bathroom, it can lead to a UTI.
To make matters more complicated, the vaginal opening is also close to the anus.
"All you need is for some E. coli from the anal area to move across the perineum, and it's a hop, skip and jump to the vagina and urethra," Dr. Ellerkmann says.
That said, although it's less common, people with penises can also get recurrent UTIs.
Whatever your anatomy, if you're experiencing a urinary tract infection every few months, below are some reasons that may help explain what's going on.
4 Reasons You Keep Getting UTIs
1. You're Having a Lot of Sex
Whether you and your partner can't keep your hands off each other or you're having fun with multiple people, more sex can lead to more UTIs.
In premenopausal people assigned female at birth, having sex at least three times a week and having new or multiple partners can increase the risk of UTIs and recurrent UTIs, per the NIH.
"Being sexually active can push bacteria into the urethra opening and into the bladder," Dr. Ellerkman says.
Using spermicide (alone or on condoms or diaphragms) also increases the risk, according to an older, May 2008 study in General Internal Medicine. It's believed that the spermicide damages the vaginal flora, encouraging the growth of bacteria that causes UTIs, according to American Family Physician.
The fix: None of this means you have to give up sex. First, if spermicide seems to be the issue, talk to your doctor to find another form of birth control and other ways to protect yourself against sexually transmitted infections (STIs).
If you frequently get UTIs, you should pee after intercourse, Dr. Ellerkman says. Although it has not been proven effective in randomized controlled studies to reduce the risk of UTI, Dr. Ellerkman says it doesn't hurt to try if you're prone to infections. "You don't need to spring out of bed as soon as your orgasm is complete," he says, but try to hit the bathroom within about a half hour.
Another option is taking a prescribed low-dose antibiotic after sex, per American Family Physician. Talk to your doctor, who can discuss these options and which may be best for you.
Then there's the infamous cranberry juice, which some swear can help keep UTIs at bay. The belief is that D-mannose, a type of sugar found in some fruit or in cranberry extract tablets, can help prevent bacterial infection.
"Cranberry has proanthocyanins, compounds similar to D-mannose that seem to help to cover certain bacteria like E. coli and make the bacteria less able to stick to the lower urinary tract and the walls of the bladder and urethra," Dr. Ellerkman says.
Although scientific evidence around cranberry juice and tablets is conflicting, Dr. Ellerkman says that taking the latter can do no harm. He does not recommend cranberry juice, however, since it's high in sugar, and most of us don't need any more sugar in our diets as it is.
2. You're Postmenopausal
About 11 percent of people with vaginas get UTIs, but the risk doubles for those 65 and older, per May 2019 research in Therapeutic Advances in Urology. Frequent infections are also more common in those who are postmenopausal.
"The pH of the vagina changes with age," Dr. Ellerkman says. "Post-menopause, the vaginal wall thins out and concentrations of good lactobacilli drop. This causes the pH to rise, and we believe a more alkaline environment is a more hospitable environment for opportunistic bacteria like E. coli to hang out in."
Once E-coli reaches the vagina, it can easily enter the bladder.
The fix: The good news is that estrogen can help when applied to the vagina. When compared to a placebo cream, vaginal estrogen delivered via a cream or ring reduced the number of UTIs in those who had recurrent infections, found a small 2019 study of 35 women published in Female Pelvic Medicine & Reconstructive Surgery.
Rather than oral estrogen, estrogen cream or suppositories, which are applied directly to the vagina, are found to be effective. You can talk to your health care provider to find the best option for you.
3. You Have a Structural Problem
In people assigned male at birth, recurrent UTIs may suggest you have an enlarged prostate, Dr. Herati says.
In those assigned female at birth, it may be a sign of pelvic prolapse, Dr. Ellerkman says. This is when the muscles supporting the pelvic organs weaken, causing them to drop in the pelvis and making the vagina bulge out.
Both of these conditions can hinder your ability to fully empty your bladder, which turns the bladder into a warm swimming pool of urine where E. coli loves to breed, Dr. Ellerkman says.
The fix: If you have recurrent UTIs caused by an enlarged prostate, surgery may be necessary, Dr. Herati says. Talk to your physician about your options.
If your UTIs are due to pelvic organ prolapse, doing kegels can often help the condition from worsening, Dr. Ellerkman says. It can also help to work with a pelvic floor physical therapist to be sure you're performing kegels properly.
4. You Have Kidney or Bladder Stones
For anyone, frequent UTIs could also be a sign of kidney or bladder stones.
"Bacteria love to attach to foreign objects," Dr. Herati says. "So if you have a structural abnormality like a stone, the body can't fight those bacteria as effectively."
The fix: Drinking more fluids, especially water, may help you pass the stones, according to the Mayo Clinic.
Even more reason to drink? A November 2018 study in JAMA Internal Medicine found that people assigned female at birth who drank an extra six cups of water a day experienced half as many UTIs as those who didn't add the extra H2O. "Dilution helps," Dr. Herati says.
If this advice doesn't remedy your problems, it's important to see your doctor, who can perform tests to check for stones and recommend other treatments, such as surgery.
5. It's Not Actually a UTI
"People often perceive a UTI that's not a UTI," Dr. Herati says.
Some may experience burning when they urinate and other symptoms of UTI, and those problems can improve with antibiotics. However, if what you think is a UTI keeps coming back — and particularly if you also experience discomfort during intercourse — it may be pelvic floor dysfunction.
In this condition, you're unable to properly control the muscles of your pelvic floor, per the Cleveland Clinic. It has a wide variety of causes, including stress and anxiety, an enlarged prostate and pelvic pain conditions, Dr. Herati says.
The fix: See your doctor for a urine culture, which is more specific than urinalysis and can help reveal an accurate diagnosis, Dr. Herati says.
If you indeed have a dysfunction, pelvic floor physical therapy (with a professional trained in this practice) or biofeedback (where you're hooked to devices that give you information about your body so you can learn to control its processes) to retrain your muscles can help. So can medications such as muscle relaxants or Cialis, Dr. Herati says.
Everyday relaxation practices like yoga or meditation can also provide relief by helping you learn to relax the pelvic floor muscles, and because "stress and anxiety are drivers of the dysfunction," Dr. Herati explains. "Stress reduction with yoga, meditation and psychotherapy play a big role in symptom reduction and resolution."
Is This an Emergency?
- Translational Andrology and Urology: "Non-surgical management of recurrent urinary tract infections in women"
- Sultan Qaboos University Medical Journal:"Recurrent Urinary Tract Infections Management in Women"
- National Institutes of Health: "Common Questions About Recurrent Urinary Tract Infections in Women"
- Biology of Sex Differences: "Sex differences in lower urinary tract biology and physiology"
- General Internal Medicine: "Sexual Intercourse and Risk of Symptomatic Urinary Tract Infection in Post-Menopausal Women"
- American Family Physician: "Spermicide-Coated Condoms and Urinary Tract Infections"
- American Family Physician:"Common Questions About Recurrent Urinary Tract Infections in Women"
- Therapeutic Advances in Urology: "An introduction to the epidemiology and burden of urinary tract infections"
- Cochrane: "Oestrogens for preventing recurrent urinary tract infection in postmenopausal women"
- Mayo Clinic: "Bladder stones"
- JAMA Internal Medicine: "Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections"