Help! UTIs Are Destroying My Sex Life

Some women experience tension in their pelvic muscles, which can spasm during sex and cause issues with urination such as pain, urgency and frequency. Kandadai says a gynecologist or urogynecologist can examine you to see if you have a UTI, or if pelvic floor spasms and/or dryness are the culprit. The fix? Kandadai suggests a muscle relaxant or a few sessions with a physical therapist specializing in pelvic floor issues.

To be on the safe side, licensed clinical social worker Allison Kent, a sex and relationship counselor, also recommends getting tested for sexually transmitted infections. They, too, can produce the same symptoms as a UTI. 

“It’s important to be honest with your doctor about your sexual activity,” Kent says, adding that many medical providers avoid talking about sexual health with older adults. “Just because you are older does not make you immune to sexually transmitted infections — and certainly does not make you immune from having sex.”

The connection between aging and UTIs. It’s true that many women get UTIs more often when they’re older. Why?

After menopause, when you lose estrogen in the vulva and vagina, tissues become dry, and it changes the pH level and the microbiome, explains Evelin Dacker, a family physician specializing in sexual health in Salem, Oregon.

“The thinning between the vagina and urethra can be an invitation to bacteria,” she says. “So there’s more bacteria and more UTIs.”

Certified sex therapist Sari Cooper, founder of the Center for Love and Sex in New York City, wants to remind you that UTIs are not your fault.

“So often, women tend to blame themselves when their bodies begin to change and negatively impact their sexual lives,” she says. “We need to be proactive about getting accurate, research-based information and treatment.”

Treatment and prevention. If you do suffer from recurrent UTIs after sex, don’t lose heart. There are plenty of remedies. Among them:

• Vaginal estrogen. Kandadai calls it the “best preventative” because it restores estrogen, plumping up the vaginal walls and serving as a bacteria fighter. She says it can be continued indefinitely and will also help with dryness, which often makes sex uncomfortable.

Vaginal estrogen, which requires a prescription, can be applied as a cream, a vaginal insert, a tablet or a ring. Dacker says all are covered by insurance, adding, “It’s a really easy fix.”

• Antibiotics. If you get UTIs after sex, Kandadai says you could take a small dose of an antibiotic either before or after sex. There are a variety that she prescribes, including cephalexin and nitrofurantoin.

If you are getting UTIs that are not related to sex and just seem to happen randomly, Kandadai sometimes recommends taking a low-dose antibiotic for six months or so. The antibiotic she prescribes depends on the type of bacteria that show up on the culture. “It can calm things down,” she says.

• Lube. Without proper lubrication, increased friction from the penis can tear delicate tissues. Sexuality educator Stella Harris says those tears, uncomfortable on their own, can also create openings for bacteria to enter the body.
• What to stay away from. Kent says to avoid douching or using scented products on your genitals. “Do not just start ordering products on Amazon and inserting them into your vagina,” she cautions.

And here’s a news flash: The popular practice of peeing and washing before and after sex, along with drinking lots of water to ward off nasty bacteria, is not recommended by the American Urological Association, according to Kandadai. Technically, there isn’t sufficient data to suggest that hygienic practices help. “They probably don’t actually decrease the risk, but if it makes you feel better, go ahead and do it,” she says.

Communicate with your partner. Needle says to let your partner know what you are going through, as rebuilding intimacy following a medical concern also requires emotional closeness. In the meantime, she suggests considering other forms of sexual expression that don’t involve penetrative intercourse while you’re figuring out what works best for your body.