⏱ 2 Min Read

The truth about UTIs: what a seasoned urologist wants you to know

Words
Dr Ashley Winter (as told to Eleni Stefanou)

Updated on
3 Apr 2024

About the expert

Dr Ashley Winter is a urologist and sexual medicine specialist based in Los Angeles, California.

We asked her which UTI essentials she wishes every woman knew.

The hygiene myth

If you get frequent UTIs it doesn’t mean you’re dirty or have a lack of hygiene. In rare cases, if someone has faecal incontinence and faeces get into the area of their urethra, that’s a hygiene issue. But as a woman with normal continence it doesn’t make a difference.

Some women go their entire lives wiping back to front and don’t ever have a UTI and some women never do this and have many UTIs. Unfortunately, this myth is perpetuated even in the medical sphere, so women have to be prepared; it’s very stigmatising.

Hydration and bathroom breaks

Keeping hydrated and listening to your body when you need the toilet can help prevent UTIs. There are certain professions where women don’t have any time to go to the bathroom and those individuals have more of a propensity to get UTIs. I’ve treated teachers who don’t have a break all day so they can’t empty their bladder when they feel they need to.

The oestrogen link

You have lactobacilli bacteria in your vagina, which act as your security system, preventing bad bacteria from getting into your bladder and causing an infection.

When your vaginal microbiome is not in its optimal shape, that's a tremendous risk factor for UTIs. That's so important to understand because people often silo urinary and vaginal health, not realising they're linked.

The lactobacilli bacteria feed on glycogen, which the vagina produces with the aid of oestrogen. As oestrogen levels drop in perimenopause and menopause, it can lower your lactobacilli because it doesn’t have as much to feed on. This means that when oestrogen levels go down, you're more susceptible to UTIs because you have less lactobacilli to defend against the bad bacteria.

Depending on the dose you’re taking, the combined oral contraceptive pill can also increase your chance of UTIs because it suppresses oestrogen. (1)

Pay attention to timing

Notice how symptoms are timed with your period. If right before your period you experience symptoms like bladder urgency and/or frequency, or irritation when you pee, this could indicate a decline in oestrogen levels (oestrogen is lowest about a week before your period).

UTI tip

If you only get UTIs after sex and this tends to happen right before or during your period, you could avoid vaginal penetration during this specific time-period.

Vaginal oestrogen: a game-changer

A study found that using a low dose of topical vaginal oestrogen can lower your risk of UTIs by 50%. (2)

I have had women in their late 30s and early 40s log their symptoms and realise that their UTIs were timed with their period. We had them try a very low dose of vaginal oestrogen and it revolutionised their symptoms.

It's tough because it's a struggle to get vaginal oestrogen for UTI prevention in the menopausal population, even though it’s incredibly well-established from a scientific standpoint. Advocating for women to use it at younger ages is an even bigger battle.

Do vaginal probiotics work?

When it comes to vaginal probiotics there is variability in quality and data behind each product, so options need to be individually and rigorously vetted. You could also try D-mannose supplements, but they don’t work for everyone. (3)

You can follow Dr Ashley Winter's work on Instagram and Twitter.

References

(1). Oral Contraceptives Suppress Ovarian Hormone Production (Published: 2010 Authors: Diana S. Fleischman, C. David Navarrete and Daniel M.T. Fessler)

(2). Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women (Published: 2023 Authors: Jasmine Tan-Kim, Nemi M Shah, Duy Do, Shawn A Menefee)

(3). D-mannose: a promising support for acute urinary tract infections in women. A pilot study (Published: 2016 Authors: L Domenici , M Monti, C Bracchi, M Giorgini, V Colagiovanni, L Muzii, P Benedetti Panici)