Q: How can I have intercourse without dreading a UTI?

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You say you’re in your late 60s and happily partnered. In spite of everything you do—including showering before intimacy and drinking water and cranberry juice—you can practically count on a urinary tract infection (UTI) after intimacy. Your doctor has offered a couple of prescription products and you’re wondering what else you might do. 

This isn’t an uncommon occurrence. The most effective treatment is to “estrogenize” your genitals. The absence of estrogen in menopause creates very thin, fragile tissues of the external genitals, urethra, and base of the bladder, making women much more prone to bladder infections. 

This isn’t a cleanliness issue; you can’t sterilize your skin. You can empty your bladder after intercourse, but other than that you can’t scrub your way out of it.

There are seven prescription options to return health to the genitals (six are vaginal treatments; one is oral). There’s also a new product with which I’ve seen some success. Called Utiva, it’s a unique cranberry extract that helps reduce the likelihood of recurring UTIs. It is only available online.

An antibiotic after sex is fine, if sex is quite infrequent; it’s not a great solution for frequent sex. I would not recommend the clotrimazole/betamethasone cream: That is an antifungal (anti-yeast) and topical steroid and unless you have documentation that is the infection issue (and a UTI is not fungal), this is not beneficial. The topical steroid should be used in a very limited fashion; chronic application to those tissues can be problematic.

I hope this helps.