Recurring Urinary Tract Infections (UTIs): Causes & Treatment

Question
I am 27 years old, have no children and my last cycle began on July 28 2005.

Dear Doctor-

My issue is giving me a bit of concern. My uncircumcised boyfriend and I have been sexually active for around 9 months. Prior to this relationship this problem has never happened. Partially due to my relationship was with a woman I suppose.Since our first encounter I have had 4 or 5 UTI's, I have been on antibiotics several times and have tried cranberry juice as well as an OTC product known as Cystex. I urinate right after sex is over. We do not use condoms as I have an alergy to the latex but we do use VCF contraceptive film and foam. Also, we've both been tested for all known STD's and are both 100% clear, as well as My boyfriend is -very- aware of keeping both his penis and his hands as clean as possible before intercourse or any sexual contact.

 With all that background... here's my issue. This time I do -not- have pain while I urinate... it occurs at the -end- of the stream and is very brief but very uncomfortable. Is there anything I can do to stop this from happening -again-? As I really don't want to be on and off of antibiotics for the rest of my life. I do not have health insurance yet from my employer... so a costly medication is currently not an option.

Thank you for your time and expertice,
Heather Miller

Answer
Sometimes, depending on the position you are in while you are having intercourse, there is irritation or inflammation of the trigone of the bladder, causing a bladder infection, cystitis, or a UTI. In Eurpoe, there are much less UTIs because they do not use the missionary position (with the male in the top position and the female lying on her back), In that position, the penis tends to irritate the trigone of the bladder causing more UTIs or bladder infections. Try having sex with your partner lying on his back. YOu straddle his erect penis and lower yourself slowly onto the penis, rocking yourself until you are comfortable. Then proceed as usual. This position changes the angle of the penis and it does not rub against the trigone of the bladder, causing less UTIs.  However, if, in spite of changing your position during sex, you still have recurrent UTIs, you may have to use continuous prophylactic antibiotics to prevent the problem. Nitrofurantoin is the drug of choice. Discuss it with your doctor. Good luck.