Urinary tract infections occur 25 times more often in women than in men. Between the ages of 20 and 50, women have UTIs 50 times more often than men. Each year, UTIs are the reason for more than 9 million visits to the doctor in the United States. By the first few years after menopause, 1 out of 10 women can expect to have had a bladder infection or worse. Why is this so?
One reason women are so suseptible can be found in the physical makeup of the human body. Infections in the urinary tract generally start when bacteria enter from outside. The bacteria that cause about 9 out of 10 urinary tract infections, Escherichia coli (abbreviated E. coli), are normally found in the lower intestine, their natural home. The trouble starts when they move into the urethra and up into the bladder.
In both men and women, E. coli leaving the body through the rectum can sometimes reenter through the urethra. If they succeed in reaching the bladder, they then find a warm, moist environment in which to settle and multiply rapidly. However, because a woman's urethra, at 1 inch long, is far shorter than a man's (which runs the full length of the penis) bacteria invading a woman's urinary tract have a much shorter trip and a far better chance of getting established.
After urination or a bowel movement, bacteria can enter the urethra through the vagina in two ways. First, wiping from back to front with toilet tissue can bring bacteria directly into the entrance of the urinary tract. Second, even if you keep your rectal area very clean, E. coli can reside in your underwear and work their way around to the vaginal area during exercise.
The thrusting of sexual intercourse, especially with both anal and vaginal entry, can spread bacteria throughout your genital area while temporarily traumatizing the urethra. The more prolonged or vigorous the thrusting, the more it is likely to open the door to infection. In fact, many women who suffer from repeated bouts of urinary tract infection start to realize that the pain begins within 12 to 24 hours after sex.
Sexual activity doesn't have to be unusually forceful to induce an infection. Women who have recently embarked on an active sex life, either for the first time or more intensively than usualas newlyweds, for example, or on vacationfrequently find themselves with UTIs, specifically, with bladder infections. That's where the term honeymoon cystitis comes from.
Barrier methods of contraception can irritate sensitive vaginal and urinary tissue as well, and irritated tissue helps create an environment where bacteria can thrive. In addition, the active ingredient in most spermicidal foams and jellies, nonoxynol 9, kills some of the vagina's beneficial bacteria, allowing the bacteria that cause cystitis to colonize. Furthermore, a diaphragm can also press against the urethra, and cause irritation. Some women are allergic to the latex in condoms or to the spermicides contained in some condoms. (Oral contraceptives have also been found to predispose women to UTIs. Fortunately, today's low-dose pill is less likely to do this than the higher-dose pills of the past.)
| Why UTIs Hit Women Hardest It's simply a matter of distance: Bacteria travel no more than a few inches to reach the friendly environment of a woman's bladder, while they must navigate a urethral canal four times as long in a man. |
What's a woman to do? Two very easy steps are ensuring cleanliness and minimizing irritation. Be sure you and your sex partner keep your genital and anal areas clean at all times and wash your hands (and under your fingernails) before foreplay and sex. If your partner is uncircumcised, he should always clean under the foreskin before sex. A circumcision would eliminate that problem, and men do have them. If you include anal penetration in your lovemaking, be sure your partner uses a condom, discards it, and washes his penis before vaginal entry.
Vary your sexual positions, too, to avoid bruising the urethra. Keep a tube of sterile lubricant, such as K-Y Lubricating Jelly, handy. If recurring UTIs are a serious problem for you, and you think your contraception is the cause, consider changing your method.
You may also want to consider sterilization if your family is complete and you can't get rid of your UTIs after taking other preventive measures. Alternatively, your partner might consider having a vasectomy.
The hormonal changes of pregnancy cause the muscles in the urinary system to relax. This allows urine to be retained in the ureters and bladder. Fifteen percent of pregnant women have bladder infections without even knowing it. If you get a UTI during pregnancy, it's important to treat it right away because kidney infections, dangerous enough to you, can also lead to premature ruptures of the membranes and thus premature delivery of your baby. Your doctor will know which antibiotics are safe to take during pregnancy. This is one of the reasons your doctor will ask for a urine sample during your pregnancy checkups.
Many body fluids can mix outside the body and reenter it during the intense activity of childbirth. This, too, can lead to a UTI. In addition, the hemorrhoids that frequently disturb women after delivery provide sites for potential infection.
As your body ages, your bladder becomes less elastic and may not empty completely. That allows urine to collect, and create a hospitable environment for bacteria, thereby encouraging infection. Older people tend to be less active, which adds to the problem, restricting the movement of bladder muscles and thus impeding emptying. A clean, flushed bladder also requires a nutritious diet, which the elderly don't always maintain. And diabetes, which affects many parts of the body, including the urinary system, becomes more common as people age.
