Dr. Evelin Dacker returns to answer a listener’s question about common and chronic UTI’s that occur after sex. She breaks down the how and why, and addresses prevention and treatment. She explains how naturopaths can restore balance to your vaginal ecology without creating a medical wasteland, and recommends some home remedies so that you too can help your vagina help itself.

EPISODE TRANSCRIPT (CLICK TO OPEN)

LEAH: Welcome to Good Girls Talk About Sex. I am sex and intimacy coach Leah Carey and this is a place to share conversations with all sorts of women about their experience of sexuality. These are unfiltered conversations between adult women talking about sex. If anything about the previous sentence offends you, turn back now! And if you’re looking for a trigger warning, you’re not going to get it from me. I believe that you are stronger than the trauma you have experienced. I have faith in your ability to deal with things that upset you. Sound good? Let’s start the show!

[MUSIC]

LEAH: Hey friends. Today, for the very first time, I’ve invited a guest on to answer a listener question and you’ve actually met her before. Her name is Dr. Evelin Dacker, and she told us her story in Episode 8 of the podcast, My Sex Education Came from Judy Blume, and she’s also the creator of the STARS method, which you’ve heard about in Episode 76, Can We Make Out Now? So, here’s my conversation with Evelin about post-sex UTIs and other infections.

So, friends, I just got this question from a podcast listener and it’s something I have absolutely no expertise in, so I’ve brought in for the very first time, we’ve got a guest expert here to answer. Dr. Evelin Dacker is a board-certified integrative and holistic family physician who specializes in sexual health and consent. She has a unique approach to wellness because she incorporates pleasure as an important aspect for healing trauma and illness, and you know that I’m on board with that. She was also the Executive Director of Sex Positive Portland from 2018-2020, which is how I came to know her and love her.

Evelin, welcome! Thank you so much for joining me.

EVELIN: Thank you for asking me.

LEAH: I am so pleased to have you here. So, I’m just going to pass onto you the question that I’ve been asked that I cannot answer because it has to do with physical sexual health. So, here we go, “Is there any chance you can address why women get constant infections after sex? I have two friends who have said this. The doctor just gives Macrobid and says, “Take one before and after sex”, so I’m supposed to just take an antibiotic for the rest of our life? What the hell!”

So, Evelin, what the hell?

[LAUGHTER]

EVELIN: Yeah, so that question is not very clear, and at the same time, I know exactly what she’s talking about.

[LAUGHTER]

EVELIN: Because the antibiotic she’s given. So, let’s go back and talk a little bit about infections and anatomy. So, our vaginal canal sits right in between our anus and our urethra. So, if you think of a tunnel, on top of the tunnel is the urethra, which goes to the bladder, and below it is the anus.

And what infection she’s talking about specifically is a urinary tract infection that some women do get chronic UTIs, urinary tract infections, from intercourse and this can be anatomical, as well as just transmission of bacteria from all those areas. The number one bacteria that we find when women have these recurrent urinary tract infections is E. coli, and E. coli is found in your G.I. tract, so in your rectum.

So sometimes, what happens through any intercourse or any insertion of fingers or dildo in the vaginal canal creates enough friction where the bacteria migrates. It could migrate through actually the vagina into the urethra and cause cystitis. And this is why a lot of times you hear people say, “Pee before and after sex. Pee before and after inserting anything in your vagina, and pee before and after masturbation, especially if you’re using your hand and kind of going all around that area”, because there is bacteria that could be transferred from one area into another.

LEAH: So, it’s just not if you take a dildo, and insert it into your anus, and then without washing it, insert it somewhere else. It’s actually that the bacteria is migrating on its own?

EVELIN: Yes.

LEAH: Okay.

EVELIN: Just through the friction and what you’re doing. So, it is a really good idea to make sure that your bladder is empty, so there’s no urine sitting in the ureters, in the urethra, in the bladder, so that it doesn’t migrate and go deeper into the bladder, deeper into the kidneys is where we get concerned. And right now, I’m just speaking about urinary tract infections.

The other reason that someone may get urinary tract infections is as they age, the vaginal tissue becomes thinner and less elastic. So post-menopausal women tend to have more recurrent urinary tract infections, because the vaginal tissue gets thinner, and this is the reason sometimes we give hormones or tell them to use a lubricant, even a non-hormonal lubricant just to keep that area moist even when they’re not having sex. So, this is also a reason to wipe from front to back and not back to front.

For women who just anatomically get urinary tract infections, there’s other things that you can do other than just peeing and taking antibiotics. My favorite way is taking something called D-Mannose, and it’s actually a carbohydrate sugar that lines the urethra and actually prevents the bacteria from migrating. It’s like Xylitol that you use in your upper respiratory. It kind of prevents the bacteria from taking hold and creating an infection.

So, my patients who’ve had a lot of recurrent UTIs, I say take D-Mannose three times a day when you have sex. Also, probiotics, there’s actually a brand out there that’s just for vaginal and for women. You can even just use like a women’s probiotic and put it in your vagina to keep your microbiome healthy as well.

LEAH: Oh wow.

EVELIN: Yeah. So, for chronic recurrent urinary tract infections, really urination, hygiene, D-Mannose and if you’re of a certain age or your hormones are low, you’re on birth control pills and your hormones might be a little bit lower, then using some extra lubricant or a hormone product in your vagina is some of the options.

But there’s other kinds of infections that we get and other kinds of things, and they fall into a term called vaginitises. Now, these are different than what we call sexually transmitted infections even though some of these vaginitises occur through sexual intercourse. And when I talk about sexual intercourse, I do not mean just a penis in a vagina. I mean anything in a vagina, so I’m just using these medical terms because they’re what’s in my brain.

[LAUGHTER]

EVELIN: But I want to be very clear that it doesn’t have to be a biological penis that enters in your vagina that causes it. But there are some things that biological penises do, such as they do ejaculate and, ejaculation can cause a shift in the pH in a woman’s vagina that then changes the microbiome and causes a decrease in the natural good bacteria, and allows an overgrowth of Gardnerella bacteria. So, that could happen, but it’s not limited just to penises. It actually happens with vaginas too. So bacterial vaginitis, which is an overgrowth of Gardnerella bacteria, actually has an increased risk if you have female to female genital contact.

LEAH: Wow.

EVELIN: Yeah, and not really quite sure. Is it just scissoring or is it mouth and fingers and all of the things that we do that creates a shift in that pH and introduces new bacteria? So, with women who this occurs with, I always say, “Wash your hands.”

In fact, it would be a great idea if every single partner, before we get sexy, you actually go and wash your hands, because there could be so much that you carry under your nails, in your cuticles, that you don’t even think about.

LEAH: Which we should always be washing our hands during the pandemic.

EVELIN: Exactly.

[LAUGHTER]

EVELIN: But we forget. We get in the mood and we forget.

LEAH: Sure.

EVELIN: It was interesting. I’ve only ever had one partner who every time we got together, the first thing he did was wash his hands, and I was like, “That’s amazing.”

[MUSIC]

LEAH: Back when the pandemic was still new and we thought transferring our lives to Zoom was a temporary condition, I read an article about one of the reasons that Zoom can be so fatiguing. It had to do with how our animal brain expects that if we can see something, it means we can also touch it.

The disconnect of being able to see people we care about without being able to reach out and hug them causes an added layer of fatigue onto our new reality of video communication. Now, I can’t promise that participating in a video PJ party for grownups will ease that disconnect. Honestly, it won’t. But you’ll be amazed at how being part of this gathering will leave you feeling seen, heard, and connected in a way that helps break through the Zoom fatigue.

My PJ parties for grownups are a place for you to have the kind of conversations we have on this show, to dish about the stuff that’s great in your sex life, commiserate about the things you wish were better, and ask questions you would never dream to ask in the light of day. I facilitate a two-hour gathering that’s designed to help you feel safe, comfortable, and connected.

Each PJ party is limited to 7 people each, so there’s plenty of time for everyone to participate. And, because consent is primary, you will never be pressured into talking about anything you’re not ready for. You can participate as much or as little as you’re comfortable with. You may begin as a group of strangers, but you may just meet your new best friend.

A recent participant said that while she talks to her male partner about sex a lot, she realized during our PJ party how much she misses having these conversations with other women. She said, “This group is making me aware of 10,000 more things I want to share and process!”

Registrations are currently open for a party on Thursday, February 25th at 7 PM Eastern, 4 PM Pacific. Register by yourself or register with a friend and get 20 dollars off. Information and registration is at www.leahcarey.com/pjparty. That link is in the Show Notes in the app you’re listening on now and it’s leahcarey.com/pjparty. Spaces are limited, so register today!

[MUSIC]

EVELIN: The other type of vaginitis is a yeast infection, and a lot of women have had this. I think yeast infections are caused a lot by our diet and sometimes if we have too much sugar or carbohydrates, because that’s what they live on. That’s why when you make bread, you put some sugar in the yeast. It makes it grow. So, a yeast infection, some women, again, it has to do with their pH. It has to do with their microbiome. Taking a good probiotic, doing a little insertion of yogurt, plain without sugar yogurt, can help prevent yeast infections in the vagina as well.

LEAH: You would do that as a preventive measure?

EVELIN: If you’re somebody who gets this a lot, I would say try that. Also, somebody who gets this a lot, I would say take a women’s probiotic, and then if you feel off, put it in your vagina as well. And that’s a treatment for bacterial vaginosis is to use boric acid, not Borax.

Boric acid is used as an ant killer, and you could find it on Amazon. You can find suppositories of it on Amazon, and it just helps change our PH. It solidifies our PH, so it also helps women who get recurrent bacterial vaginosis, and they want to prevent it, or they get one and they don’t want to go on antibiotics. And they just use the boric acid, I say, once at night for seven days.

LEAH: I think I was in college when I started getting really severe yeast infections recurrently, and boric acid was a complete game changer for me. Thank goodness I had a physician at the time who knew about some alternative stuff, instead of sending me to the pharmacy to get whatever that stuff is that you insert.

EVELIN: Yeah, and boric acid is great if your vaginitis actually is a bacterial vaginosis or a yeast infection, for yeast infections too.

When I have a patient who comes in with recurrent yeast infections, the first thing I say, “Stop gluten.” Because if they stop gluten, they usually actually stop a lot of carbohydrates and that helps. Because if I tell people, “Go off the sugar”, that’s so overwhelming. Going off of gluten is hard enough, but just going off of gluten can reduce your sugar intake enough that it might help you not get recurrent candidiasis.

LEAH: Fascinating. So, coming back to the original questioner, she was saying that the doctor suggested taking Macrobid before and after sex. Is that a common suggestion by doctors who don’t know as much about female sexual health?

EVELIN: It is. So, if you have recurrent UTIs from sex, the usual treatment is to take an antibiotic after sex, or for some women, take an antibiotic every day, one every day.

LEAH: Forever?

EVELIN: Depends. Again, it depends on her age and how bad it gets. It’s because a lot of people don’t want to dig, and think deeper, and it’s just the easy route to take. When you have ten minutes to see a patient, diagnose, and tell them what to do.

LEAH: Yes.

[LAUGHTER]

LEAH: And then you have to deal with those lady parts too, which are so complicated.

EVELIN: Right, right.

[LAUGHTER]

EVELIN: But anybody who is getting more than two urinary tract infections really needs to go to a physician who can dig deeper and say, “Okay. What is it? Is it anatomy? Are there other things we could do? Is it hygiene? Is it a PH problem?” There’s a lot of reasons, but there’s a lot to know. There’s a lot to know and most people don’t know a lot of it.

LEAH: Yeah. So, if somebody is listening to this and thinking, “Oh, I really should get to a doctor.” What kind of doctor? What kind of qualifications should they be looking for? So that they find someone who has the type of knowledge that you have.

EVELIN: If you know a naturopath, go see a naturopath.

LEAH: Okay. Great.

EVELIN: I’m a medical doctor. I have an MD degree. I also am a family physician. People think often that I’m a GYN because I do sexual health, but actually a family physician has so much greater breadth of knowledge.

A naturopath because they have a bigger tool box, and they’re not going to jump to medicine, and they’re going to listen to you better. And if not that, a women’s nurse practitioner will also have those skills. And then if you have a really good family practice doctor who listens and who knows more, or a really good gynecologist who listens and who knows more. Most OB/GYNs are actually surgeons, so they’re more focused on things they can do surgery on, but there are some GYNs who really don’t do surgery, and do more of this.

LEAH: Okay. Great. And I think it’s sort of the standard disclaimer, it’s important to say that you are providing information from your medical knowledge, but this is not medical advice, because people need to see their own medical provider.

EVELIN: Yes, yes. But knowledge is power and understanding. Sometimes, the more we know about our own bodies, the better we could then inform our providers and it’s hard. There’s a lot of us who don’t know a lot about our bodies and don’t know where to go with it, just like the caller, and it’s like, “Oh my gosh. This doesn’t sound right.” If it doesn’t sound right, then go see someone else, and a naturopathic physician usually has that breadth of knowledge that can help a lot of women out.

LEAH: Okay, great. Well, listeners, if you have other questions, specifically sexual health related questions or topics rather, please call the listener line 720-GOOD-SEX and if we get more questions, we will invite Evelin back to talk to us about all the good stuff. So, thank you so much for being here.

EVELIN: Yes, you’re welcome.

LEAH: I know that infections after sex are a major issue for some women, so I hope this was helpful. And thank you so much to Evelin for coming in and answering our questions.

As you know, I love to answer listener questions because then, I know for sure that I’m giving you the information you need. So, if you have a question about sex, relationships or female sexuality, call my listener line at 720-GOOD-SEX. That’s 720-4663-739.

And I’ve lined up a couple other expert voices to talk about things that aren’t within my wheelhouse, so if you have questions about post-partum sex or other pregnancy related questions, I’ve got you covered. And likewise, if you have questions about kink that fall outside my realm of knowledge, I’ve got an expert on call. So please call and ask your questions. The listener line is voice-mail only, so I promise that you won’t have to have a conversation with a live person. You can also call in the middle of the night, when your partner and kids are all fast asleep. So, leave your message anytime at 720-GOOD-SEX and voicemails are anonymous, so not even I know who is calling in.

I’m excited to share this podcast introduction because I bet so many of you are going to want to dive right into it. I mean it has to do with wine! I met Jessica Yañez in an online work session for female podcasters. And as soon as I heard the name of her show, I was intrigued. It’s called Wine and Chisme, and I’m going to let her explain exactly what that means in this intro from her very first episode.

JESSICA: Hola, hola, mi gente! My name is Jessica Yañez, and you are listening to the very first episode of The Wine and Chisme podcast. You see, I am a wine lover. But I also love cheese. I am a self-professed cheeseaholic, and if you are a friend of mine, there is a high likelihood that you’ve been to one of my wine and cheese nights.

So, when friends get together and gather with wine and cheese, we chisme. And chisme is a Spanish word for gossip, the things that we’re willing to share with each other to get to know each other better. So. that’s what I mean when I say The Wine and Chisme.

Every week, we will be featuring a different type of wine based on the preference of the guest. I like what I like. I am not particular in regards to price point. We will make sure to share that with you and share the photos and the names, so you can enjoy a glass along with us. So, if you want to sit down with the same wine that we’re drinking, hey, awesome!

So, for tonight on this solo show, I am drinking a Bodega Norton. That is the brand and it is a Colección Malbec 2019. Now, if you’re unaware, Malbec is an Argentinian wine, and this one is very smooth. I’ve already taken a couple of sips. And if you can believe it or not, I got this wine at Trader Joe’s for 5.99.

LEAH: So that show is Wine and Chisme with Jessica Yañez and I hope you enjoy sharing a glass of wine and some great gossip!

[MUSIC]

LEAH: That’s it for today. Good Girls Talk About Sex is produced by me Leah Carey and edited by Gretchen Kilby. I have additional administrative support from Lara O’Connor and Maria Franco. Transcripts are produced by Jan Acielo.

And I’m incredibly grateful for the financial support from Good Girls Talk About Sex community members at Patreon. If you’d like to support me in telling these stories and answering your questions, head over to www.patreon.com/goodgirlstalkaboutsex. You can find Show Notes and Show Transcripts at www.goodgirlstalk.com. To ask a question about your sex life, your desires, or anything to do with female sexuality, call and leave a message at 720-GOOD-SEX.

And before we go, I want to remind you that the things you’ve probably heard about your sexuality are not true. You are worthy. You are desirable. You are not broken. I work with women just like you to reflect their true sexual nature back to them without the judgment, shame, or fear that can get in the way of us seeing it for ourselves. As a coach and PJ party hostess, I will guide you in embracing the sexuality that is innately yours no matter what it looks like. I’m here to help you sink so deeply into your true sexuality that the version of yourself that was scared to speak up for her own needs feels like a mirage from another lifetime.

Until next time, here’s to your better sex life!

[MUSIC]

BOOKMARK MOMENTS:
  • 1:06 – Listener question: Do I really have to take antibiotics the rest of my life to avoid post-sex UTIs?
  • 3:21 – Dr. Dacker breaks down the anatomy behind UTI’s.
  • 5:51 – Lube can have a non-sexual protective application.
  • 6:18 – D-Mannose is a carbohydrate sugar that lines the urethra and actually prevents the bacteria from migrating. OTC pro-biotics can help too.
  • 7:41 – Vaginitises can occur with any vaginal intercourse.
  • 9:58 – PJ Parties for Grownups!
  • 12:50 – Yeast infections are discussed.
  • 15:34 – Why the usual antibiotic-after-sex treatment is *not* the best.
  • 16:48 – Dr. Dacker explains why naturopaths are a great place to start when treating chronic infections.
  • 18:42 – Call the listener line {720-GOOD-SEX} if you have questions!
  • 20:17 – Podcast recommendation—Wine and Chisme with Jessica Yañez
PODCAST RECOMMENDATION:
  • Title – Wine & Chisme
  • Host – Jessica Yañez
  • Apple Podcasts description – The Wine & Chisme Podcast was created to share the stories of everyday people doing extraordinary things to serve their community. Our host, Jessica Yañez brings her love for wine and passion for storytelling together to highlight the stories that need to be told in communities of color. Chisme (Spanish for gossip) comes from the interviewees themselves as they “spill the wine” on their own terms. So grab a glass of wine and join us for the new Wednesday. #WineAndChismeWednesday
  • Instagram – TheWineAndChisme
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As of July 2020, all Good Girls Talk About Sex audio extras are now FREE!  They can be accessed at www.patreon.com/goodgirlstalkaboutsex

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EPISODE CREDITS:

Host / Producer – Leah Carey (email)
Audio Editor – Gretchen Kilby
Administrative Support – Lara O’Connor, Maria Franco
Music – Nazar Rybak