Woman experiencing UTI symptoms and wondering how a woman gets a urinary tract infection

How does a woman get a urinary tract infection?

Written on March 12, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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More than half of all cis and trans women will have a urinary tract infection (UTI) at least once in their lifetime. UTIs are also sometimes called bladder infections. Women are 30 times more likely to get a UTI than men. You are more likely to get a UTI if you are pregnant and as you age [1]. Knowing how a woman gets a UTI in the first place is helpful information to have, given the unfortunate likelihood that you will someday experience that painful, burning peeing experience that is so common for all those with female anatomy.

What is a UTI?

UTIs are painful and sometimes serious infections. A UTI happens when germs (bacteria) from your skin, rectum (anus), or other sources spread up into your urinary tract [2].

UTIs start in your urethra (the tube running from your bladder, where urine is stored, to the outside of your body). The most common UTI symptoms are [2]:

  • Pain or burning when peeing (urination)
  • An urgent need to pee
  • Feeling like you have to pee all of the time, even if you just urinated
  • Aching, burning, pressure, or a painful sensation in your lower abdomen (pelvis)
  • Cloudy or funny-smelling urine
  • Difficulty urinating

The bacteria (and the infection they cause) can spread from your urethra into your bladder (called cystitis). Untreated cystitis can lead to a kidney infection (called pyelonephritis) [1].

Although all urinary tract infections generally require treatment (usually with medications called antibiotics), kidney infections can quickly become more severe and require emergency medical treatment [1]. The most common symptoms of worsening cystitis or kidney infection (pyelonephritis) are [2]:

  • Fever
  • Chills
  • Back or side pain
  • Nausea or vomiting
  • Pelvic pain
  • Bloody urine

What are the most common causes of UTIs in women?

Organisms that naturally live in your vagina or rectum most commonly cause UTIs when they are transported into your urethra and bladder. The bacteria E. coli causes 80%–90% of all UTIs in women [3].

Viruses, fungi (like the Candida responsible for yeast infections), and even some sexually transmitted bacteria and viruses can cause UTIs, although less commonly. The STIs that can cause a UTI are herpes, gonorrhea, chlamydia, and mycoplasma [2].

How does a woman get a urinary tract infection?

People with a vagina, uterus, and ovaries most commonly get a UTI when they accidentally spread bacteria from their gut to the opening of the urethra. This happens if you accidentally wipe from back to front or during sexual intercourse. The bacteria that cause a UTI live on the skin around your anus, regardless of how you wipe, how often you shower, or how clean you are. In fact, using scented body soaps, douches, powders, or other so-called feminine hygiene products can increase irritation and your risk for UTIs [2].

Having any kind of sex can shift bacteria toward the front. Once the bacteria are on the outside of your vulva (the skin and lips on the outside of your vagina), it’s just a short hop up the urethra into the bladder, where they multiply and cause the painful infection so many women develop. Research shows that you are more like to get a UTI when you are first with a new partner, possibly because you have sex more often at the start of a relationship [4].

It is possible to get a UTI without having sex, however. Just because someone has a UTI does not mean they are sexually active. Some of the other conditions that might make it more likely that you get a UTI are [2]:

  1. A suppressed immune system (as with diabetes and other immunodeficient diseases)
  2. Having a surgical procedure or needing to use a catheter (a tube inserted into the bladder) for any reason
  3. Blockages in the urinary tract, such as kidney stones or a bladder prolapse that trap urine in the bladder

Why do women get UTIs more frequently than men?

Sometimes biology seems to be stacked against those with vaginas. That is definitely the case when it comes to UTIs. There are several reasons why the men in your life very rarely will have to deal with a UTI [1-5]:

  • Women’s urethras are shorter (shorter ladder for bacteria to climb up into your bladder).
  • Women’s urethras are closer to the anus, and bacteria-containing gut.
  • Women get pregnant, and men don’t.
  • Women go through menopause, and men don’t.
  • Women use diaphragms and spermicides, both shown to increase the risk of UTIs.
  • Women are more likely to have repeated (recurrent) UTIs over their lifetime.

Why do women get UTIs more than once?

Women are more likely than men to have recurrent UTIs. Healthcare providers classify UTIs as recurrent if you have more than two UTIs in six months or three to four diagnosed UTIs in one year [1]. As many as 4 in 10 women who get a UTI will get at least one more within six months [6].

One of the major causes of recurrent UTIs is antibiotic resistance—meaning the medication your healthcare provider prescribes to treat your UTI does not kill the bacteria responsible for the infection. Antibiotic resistance in the bacteria that cause UTIs can happen from over-prescribing antibiotics, prescribing the wrong antibiotic (not doing a urine culture), or if a person stops taking their prescribed UTI treatment before they have finished all of the pills [6].

Why are women more likely to get UTIs during menopause?

Menopausal women have lower estrogen levels which makes it easier for them to get UTIs [7]. The low estrogen levels change the protective balance of the vagina and urethra, which normally makes it more difficult for E. coli to attack the urethra and bladder.

If a woman does not ovulate each month (as happens in the perimenopausal transition), her estrogen levels fall. Falling estrogen levels also cause genitourinary syndrome of menopause (GSM) in many women (estimates range from 27%–84% of postmenopausal women) [8]. Women with GSM are more likely to experience recurrent UTIs.

GSM is underdiagnosed and undertreated because too many women suffer in silence, thinking that their painful urination, frequent urination, or frequent UTIs are just a part of “getting old” [8]. Without treatment, GSM can get progressively worse. There are several safe and effective ways to treat GSM that can help reduce the chances that menopausal women have to suffer from recurrent UTIs [5].

Why are UTIs more common in pregnancy?

UTIs are more common in pregnancy for several reasons. First, pregnancy-related hormone changes affect the growth of certain bacteria in your gut and vagina [4]. These same hormonal changes cause a widening of the urethra, so bacteria have a wide open door to your bladder.

Pregnancy typically causes higher levels of sugar in your urine, especially if you develop diabetes during your pregnancy. As a result, bacteria can multiply more quickly with their favorite energy source, making it easier for pregnant women to get a UTI. Additionally, the weight of your growing fetus can shift your bladder’s position, making it easier for E. coli to access your bladder [7].

These factors explain why UTIs are the most common infection during pregnancy. Untreated UTIs in pregnancy are more likely to spread to the kidneys and cause potentially life-threatening infections [4]. In addition, untreated UTIs and kidney infections in pregnancy can increase the chances that a woman might go into labor too early, have a low birth weight baby, or develop problems with her blood pressure [1].

What should you do if you think you have a UTI?

If you want to get rid of your UTI ASAP, it is best to have your UTI diagnosed by a healthcare provider with something called a clean-catch urine sample [2]. Getting tested for a UTI so that you can be treated quickly with the correct medication is especially important if you are pregnant, are older, have frequent UTIs, or are immuno-compromised.

The laboratory will check your urine sample for signs of infection, inflammation, and bacteria. From your urine sample, the laboratory will be able to tell your healthcare provider which antibiotic will best treat your UTI (avoiding antibiotic resistance and reducing your chance of a recurrent UTI). Waiting to test to see whether you have a UTI or trying less-effective natural treatments could make your UTI symptoms worse and you sicker.

While not an option for pregnant women, women with recurrent UTIs, or women with other medical conditions such as diabetes, telehealth does offer some options for the virtual treatment of UTIs [2]. Everlywell’s fast, convenient, and privacy-protected telehealth visits with nurse practitioners can help you make sense of your symptoms right away. They can advise you on how to find the right test for your symptoms, potentially prescribe medications, and offer recommendations for how to prevent recurrent UTIs. Visit Everlywell's option for UTI treatment online to schedule your appointment today.

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References

  1. Urinary tract infections. Office on Women’s Health. URL. Published February 21, 2022. Accessed March 6, 2023.
  2. Urinary tract infection (UTI). Mayo Clinic. URL. Published September 14, 2022. Accessed January 23, 2023.
  3. Urinary Tract Infections. National Kidney Foundation. URL. Published 2010. Accessed March 6, 2023.
  4. Delzell J & M Lefevre. Urinary tract infections in pregnancy. Am Fam Physician. 2000;61(3):713-720. URL.
  5. Rosenblum N. Update in female hormonal therapy: What the urologist should know: NYU case of the month, December 2020. Rev Urol. 2020;22(4):182-185. URL.
  6. Why do I get urinary tract infections so often? Cleveland Clinic. URL. Published August 26, 2021. Accessed March 6, 2023.
  7. Ferrante KL, Wasenda EJ, Jung CE, Adams-Piper ER, Lukacz ES. Vaginal estrogen for the prevention of recurrent urinary tract infection in postmenopausal women: a randomized clinical trial. Female Pelvic Med Reconstr Surg. 2021;27(2):112-117. doi:10.1097/SPV.0000000000000749. URL.
  8. The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society. Menopause: The Journal of The North American Menopause Society. 2020;27(9):976-992. URL.
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