What positions are less likely to cause a UTI?
November 30, 2010 1:26 PM   Subscribe

I'm prone to UTIs after intercourse. What sex positions are less likely to cause UTIs? (NSFW)

I am susceptible to urinary tract infections after intercourse. No other sexual activity causes this problem for me. I am female.

My boyfriend and I take a variety of precautions, including cranberry pills (which I take), showering before sex (for both of us), showering after sex (for me), peeing before and after sex, and only having intercourse for 10 minutes at a time (yes, we use a timer; no, it's not particularly sexy). I also take an antibiotic three times a week (I used to also take one after intercourse, but I got a UTI that was resistant to that particular antibiotic, and my doctor told me to stop taking it). We only have intercourse every four days, a new tactic -- we used to wait seven days; after doing that for three months, we decided it was safe to bump it up to every four days. We've been doing this for a month with no ill effects so far.

We also only have sex with him on top, and pretty much stick to the missionary position. There is no research that I can find on sex positions and their affect on UTIs. Do you know of any scientific research on this? I've searched Google Scholar and medical journals pretty extensively with no real leads.

Alternatively, anecdata would be welcome. If you are extremely prone to UTIs, what positions do you use?

Finally, we suspect that the duration of intercourse is more dangerous than the freqency; this is why we decided to go to every 4 days rather than prolonging the length of each session. Is there research on duration and frequency as it relates to UTIs? I couldn't find any, but that doesn't mean it is not out there. Anecdata on this subject would also be helpful.

I have other complicating medical factors that make UTIs very dangerous for me, so trying stuff and seeing if it gives me a UTI is not really an option.

I have talked to a variety of doctors about this and have been told nothing useful. Their remarks were mostly jokes, and ranged from "stop having intercourse" to "kill your boyfriend for giving you a UTI." Both of those things are obviously not options.
posted by anonymous to Health & Fitness (24 answers total) 5 users marked this as a favorite

 
Have you been checked for interstitial cystitis?
posted by emilyd22222 at 1:32 PM on November 30, 2010


There are other antibiotics you can take if the one you're on isn't working. Did your doctor prescribe that? And did you take that one pill after intercourse based on a prescription? (I see that it's recommended for some women with recurrent UTIs, but there are various options there.)

Have you noticed a difference between fingers/hands and PIV?

Are you using a condom or on the pill? I've heard of both increasing UTIs for some people.

Do you have diagnosed Recurrent UTI?

You need to find a new OB-GYN. Not just a GP, an actual OB-GYN.

I've heard that the cranberry pills aren't' as effective as REAL (undiluted, strong, not Cran-Apple) Cranberry juice.

And yeah, have you been checked recently for cystitis?
posted by barnone at 1:42 PM on November 30, 2010


Ugh. This sounds terrible and I'd say way outside the norm for UTIs. Can you find a doctor who specializes in reproductive health - someone recommended? You should also take this whole list to your appointment. FWIW, I have never heard of a position affecting UTI development either positively or negatively.

Do not let a doctor get off the hook with dismissive remarks. This is your health and just because it is tangentially related to sex doesn't make it not a serious issue.
posted by amanda at 1:43 PM on November 30, 2010 [1 favorite]


Although you've talked to a variety of doctors, I still want to say to keep trying to find someone that can help you. Those remarks are so unprofessional! There must be SOMEONE out there that can act like a doctor instead of a comedian and give you good advice. You may get some good tips and tricks from this thread but since you say you have other complicating medical factors that make UTIs dangerous for you, I think it would be in your best interest to locate a doctor that is on board.
posted by coupdefoudre at 1:43 PM on November 30, 2010


It might be difficult for others to suggest particular positions, as a lot is going to depend on the size and angle of his penis and your vagina.

Any position that stimulates your g-spot is also likely irritating your urethra, so you might want to avoid the ones you know of. (G-spot stimulation often makes you feel like you have to pee, that's one way to tell if you're not familiar with it.) For me, girl-on-top leaning way forward doesn't provide much g-spot stimulation, but then again, neither does missionary.
posted by Serene Empress Dork at 1:44 PM on November 30, 2010


Have you been checked for bacterial vaginosis? It's basically just an imbalance of the good and bad bacteria that naturally occur in your vagina. If you have it and the bacteria get into your urethra during sex, you can get a UTI, which you're then treated for, but then the imbalance comes back and you get another UTI. This can be helped by using something like RepHresh to restore vaginal pH to normal, which keeps the "bad" bacteria in check.

I used to get chronic UTIs when I was younger, and I didn't notice any difference with different positions or timing. Religiously peeing before and after sex seemed to be the only thing that made any sort of difference, aside from antibiotics when I did get a UTI (not after sex as my doc had once suggested, because of antibiotic resistance concerns). I honestly don't know why I stopped getting them, but I used to get them a few times a year and now I can't remember the last time I had one.
posted by bedhead at 1:44 PM on November 30, 2010


From a MeFite who would prefer to remain anonymous:
Dear Anonymous,
My wife is susceptible to UTIs. We take similar, though less extreme, precautions as you. The thing that has seemed to work best is for me to use a hand sanitizer on my hands and junk prior to getting busy. It dries quickly, and there are some with moisturizers and nice scent, so it's not like I'm slathering up with raw alcohol. And it doesn't kill the mood, because both of us are usually in and out of the bathroom prior to sexy time, anyway.
posted by jessamyn at 1:54 PM on November 30, 2010 [2 favorites]


I too am in your boat, and I think that duration plus low lubrication is a key issue.
posted by RedEmma at 2:36 PM on November 30, 2010


Among other things, you need to see a urologist with an academic interest in female urinary problems. The bulk of them, who are male, seem to be more attuned to, interested in and sensitive to male problems. Unfortunately, all too many of them view female UTIs as minor irritations at best and 'all-in-her-head' nonsense at worst. I can recommend someone in New York City; memail me and I'll be happy to forward his contact information. If he isn't conveniently located or accessible to you, he might be able to refer you to someone who is.

Now, IANAD, but if the antibiotic you were using was macrodantin (commonly prescribed for UTIs for a variety of reasons), ask the doctor to try macrobid: the latter is a related compound but is often effective when the more commonly prescribed macrodantin loses its effectiveness. Another thing: nonspecialists have a tendency when prescribing antibiotics for UTIs to fail to prescribe the antibiotic for a long enough period of time. If you are experiencing frequently recurrences, this may be part of the problem.

Another thought: the practical realities behind UTIs in females are a bit different than those in males for what should be self evident differences in mechanical engineering. For reasons that remain unclear, doctors often seem to fail to consider this. The bacteria that cause all the trouble live in the intestinal tract and vagina as well as on the skin. It is possible that your particular portfolio mix of bacteria has become rebalanced to favor types and quantities of types of microorganisms more likely to lead to UTIs as well as the vaginal yeast infections that so often precede incidents of UTIs. (Were you ever treated long term with antibiotics for, say, acne or Lyme Disease? This can lead to a rebalancing of bacteria populations.) With this in mind, you might try taking a "probiotic" supplement available at your local health food store to see if a shift in your digestive tract flora can help. There is one made by Jarrow (www.jarrow.com) called Femdophilus that is apparently one of the few supplements to go through a legitimate clinic trial, the results of which suggested that use of the stuff can lead to a reduction in the incidence of yeast infections and indirectly to a reduction in the incidence of UTIs.

Sorry for the lengthy typing. Memail me if you want that doc reference.

P.S. Please keep in mind that many, many women deal with this to varying degrees at different times in life for a variety of reasons. You are not alone with this. It is almost always more of a royal pain in the ass nuisance than a sign of a big, bad, it's-going-to-kill-you problem. And it can be dealt with: you just have to find the right doctor; do your homework; and sometimes think a little outside the box.

P.P.S. DO NOT give up on the sex!
posted by cool breeze at 2:42 PM on November 30, 2010 [3 favorites]


RedEmma's statement about low lubrication is an interesting one, given that a lot of resources (and your timer practice) seem to emphasize avoiding bruising or tearing. That to me would emphasize more lubrication, not less, though it would need to be sterile.

What are you using for birth control? Several sources also seem to indicate a connection to spermicidals as increasing the risk.

And a hundred times agreement with the folks who say those snarky unhelpful comments from doctors are bullshit. I beat this drum all the time but I'll say it again: there is no reason to be less fussy about the person who you trust to take care of your body than you are about your mechanic or gardener. Ditch those losers.

You might look for a specialist - use the finder on the Urogynecologic society site.
posted by phearlez at 2:51 PM on November 30, 2010


This is total conjecture, but have you had the bacteria causing the infection typed? I ask because most UTIs are caused by e-coli, but I know from personal experience that strep can cause UTIs as well. If you have an e-coli infection, well, you're getting the bad stuff introduced into your urethra during intercourse. I would think that any position from behind would reduce contact with your urethra. If your UTI is strep or staph based, sex may be irritating an existing infection. Doggy style would still help if that's the case. Additionally, if you do have an atypical infection, you may not be on the right antibiotic. I had a UTI that would just...not...go...away because the doctor hadn't bothered to test the infection type.

Also anecdotal, but cranberry juice is way more effective than the pills. You just have to find the straight stuff and cut with a little water or ginger ale.
posted by lunalaguna at 2:52 PM on November 30, 2010


Some women, including myself, have a tighter and more condensed configuration of lady parts than others. This means that for us, we have to be very careful to avoid contamination between our rectal region and our vulvas/urethras because the distance particulates have to travel is significantly less. It's also possible that your bladder is much closer to the upper wall of your vaginal canal and is therefore much more sensitive to friction than normal. For me, that's definitely the case, so intercourse is something I have to sort of navigate carefully.

I am going to nth the suggestion that you take daily doses of cranberry juice. It is the best and safest way to prevent UTIs because the alkaline nature of the cranberry juice modifies the walls of your bladder and urethra so that inflammation and eā€¢coli can't take a hold there. I'd also consider taking peridium, which you can get at Target and Wal Mart for like $8 a box, because it will relax the pain of the UTI so that your body can make more out of the cranberry juice benefits. I've found that without peridium, I'm constantly straining and just making things worse, and the cranberry juice just doesn't take effect as wholly as it should.

As for the position question, I've found that doggy style significantly increases my UTI potential by like 50%.

Boo, UTIs, and shame on those douchebag doctors who would cavalierly dismiss your symptoms in the way that they did. I'd kick 'em all for you if I could. :)
posted by patronuscharms at 3:04 PM on November 30, 2010


Lots of great advice here already, I'm just popping in to say, when I went through this, straight up cranberry juice with NO SUGAR (Lakewood is a good brand) and cut it with Fresca. Ginger ale could never make it palatable for me, but Fresca did the trick. Good luck, I know this is completely miserable.
posted by Medieval Maven at 3:35 PM on November 30, 2010


If your husband has a foreskin then he might not be cleaning under it well enough.
posted by meepmeow at 5:35 PM on November 30, 2010


Mod note: From the OP:
I have been checked for interstitial cystitis, bacterial vaginosis, and vesicoureteral reflux; I've also had a full STD panel done several times. Everything came back negative.

I have been diagnosed with recurrent UTIs, with reinfection and not relapse.

We are not using birth control; we cannot get pregnant and are monogamous.

I've been to two OB-GYNs, 3 nephrologists (some of the UTIs have turned into kidney infections), and countless GPs with this problem. Since I'm not really asking for medical advice here, the advice to find a doctor on board with my problem is definitely true, but isn't really germane (sorry if I sound snippy). I am trying to get a good doctor, but I actually don't think this is a problem that a doctor could help with. I can have PIV if I follow my regimen, which is awesome; I'm just wondering if I could branch it out a bit in a safe way. I came up with this regimen myself after reading a lot of research about UTIs, but I couldn't find research on sex positions specifically or on length of time for intercourse.

The reason that I think position might have something to do with the UTIs is that some sex positions certainly aggravate the urethra more than others. To that end, Serene Empress Dork's suggestion is very helpful.

Basically, the methods to prevent UTIs that I have outlined are definitely working (and it's highly possible that they're not all necessary, but the system works and isn't that bad) but I'd like to be able to have sex in other positions. This would preferably be supported by research or anecdotal experience with sex positions for people who are prone to UTIs.
posted by jessamyn (staff) at 5:44 PM on November 30, 2010


Response by poster: A while ago I got locked in a horrible never-ending UTI/yeast infection cycle. You are doing all of the right things, it sucks you're still stuck in it.

Two suggestions:
- Month, two month absence from penis-in-vagina sex totally. This was not intentional when it happened--things just got too bad to do it. But it seemed to help things balance out.
- Megadosing the cranberry pills (like by the handful) and drinking only slightly diluted lemon juice (unsweetened) and cream of tartar mixed with water.

I can't tell you for sure if the combination of the two got rid of my UTIs, but it's possible taking a break from the PIV sex may allow your system some time to recover, with the cranberry pills and lemon juice and whatnot doing some extra cleaning of the pipes. No PIV will suck but there are lots of other awesome things one can do during sexy times!
posted by Anonymous at 6:00 PM on November 30, 2010


Well, fwiw, we basically don't do missionary at all because I almost always get a UTI from it. We're not a particularly creative couple so think of vanilla positions that aren't him on top/missionary and you probably have the lot of it.
I wouldn't think the issue is urinary tract stimulation so much as getting bacteria pushed up in the urinary tract, which happens in missionary and other penis rubbing clitoris positions (sorry to say).
posted by ch1x0r at 6:22 PM on November 30, 2010


Have you tried experimenting with other positions to see if that helps? If preventing knocking to your urethra is the main concern, then either doggy style or woman on top might be much better... though some sources seem to think that woman on top can contribute to them because of weird angling. Since this seems to be highly personal, you'll have to do some experimentation, unfortunately. If that doesn't work for you, you can try spooning sideways and kind of angled forward to allow him to enter from behind. That reduces the front of your pelvis and urethra from being repetitively knocked. Also, make sure that you're not using a douche or anything too abrasive when you're washing - this can definitely contribute to UTIs and yeast infections.

Here is one study that claims the group with the most UTI used the "female superior position" (woman on top) though it also notes that the other groups weren't all that different. I suspect some of this has to do with individual wiring.

Have you tried D-Mannose? D-Mannose is a sugar that some say prevents & treats UTIs -- I couldn't find any research but there are a bunch of anecdotes about its efficacy and dosage. Worth a shot?
posted by barnone at 7:11 PM on November 30, 2010


I had recurrent UTIs.

Cranberry pills aren't known for great quality control, and never worked for me.

What did work: reducing frequency of sex to every other day, peeing afterward, ditching the spermicidal condoms, and being gentle to my urethra. For me, that means using plenty of lube and not using positions that put lots of pressure there (including, as ch1x0r mentioned, penis-rubbing-clit positions). Straight in is probably your best bet. Get to know your angle.

If you decide to try spooning or other rear-entry positions, be careful about where else his penis is touching. You don't want it acting as a delivery vehicle for bacteria from your anal region.
posted by moira at 8:04 PM on November 30, 2010


Cranberry pills, acidophilus, and washing & peeing afterward seemed to work for me - UNLESS I got dehydrated. Lots of wonderful suggestions here. But, be sure to drink plenty of water!
posted by Leah at 8:24 PM on November 30, 2010


I'm sorry I can't help you with the position issue, but I can tell you what my doctor told me: that there's evidence that vitamin C can help prevent UTIs. I take it, though it seems that what makes the difference for me is peeing before and after.
posted by WorkingMyWayHome at 9:35 PM on November 30, 2010


When I was 19, I went through a long cycle of non-sex related UTIs (and discovered I was allergic to sulfa drugs). The various antibiotics I was prescribed would kill off one bacteria but allow another to flourish. What's helped me most is alternative treatment: cranberry pills, naming what's pissing me off and homeopathic 30c cantharis, which you can find at Whole Foods or a health food store (NO SNARKS). Sometimes I take Uristat, which relieves the burning, but doesn't get rid of the infection and turns your pee orange.

I still get UTI's every so often, but they are much less frequent and severe than in the past.
posted by brujita at 10:50 PM on November 30, 2010


An ex of mine was susceptible to recurrent UTIs. Missionary position seemed to have the best bet of triggering them, woman on top much less. Try varying your position. Not only for fun, but for SCIENCE!
posted by Hactar at 3:10 AM on December 1, 2010


I have had recurrent UTIs. I have interstitial cystitis and endometriosis. My urologist told me that endometriosis on the bladder can cause irritation and swelling that can encourage UTIs and/or IC. I had never experienced pain with the endometriosis and had no idea that I even had it until it was discovered during an unrelated abdominal surgery.

Everything moira said has been true for me also. The only method I have found to be absolutely sure not to get a UTI: make sure to urinate within 5 minutes after sex. That means having sex with at least a partially full bladder. It was hard to get used to at first, but at this point... whatever works.

Also, no one told me this until it was too late, but a major factor in recurrence is having an injured bladder. The lining loses its integrity when you get an infection and then it's easier to get another one. That's important to interstitial cystitis; for me, if I get a UTI now, it kicks off the IC again and I burn pretty much all the time until my bladder heals. It feels just like a UTI. There's only one drug on the market for IC right now--Elmiron, which costs some unfortunate citizens $250 a month after insurance. However, there's an supplement available all over the internet called Cystoprotek that works equally well and is made up of organic versions of all the substances in Elmiron. It only costs $50 a month. I cannot recommend it strongly enough to anyone who has IC or recurrent UTI's.
posted by heatvision at 8:52 AM on December 1, 2010 [1 favorite]


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