prevention

Does anal sex have a higher risk of getting a UTI for a female-bodied person than vaginal sex? —Keeping It Clean

LM: Thanks for your question, Keeping It Clean! I’ll be writing as the context expert for today’s question, answering your question from the perspective of a college student. It’s worth noting up front that, while you can develop at UTI (urinary tract infection) from sexual activity, UTIs are not STIs (sexually transmitted infections). They can develop from sex, but they can also occur from any contact with bacteria, such as wiping “back-to-front” after using the restroom.

AA: I will be writing today as the content expert. There are a couple of things to consider when thinking about UTIs and how sex can play a role in developing a UTI. The short answer to your question is no--anal sex does not have a higher risk of UTIs than vaginal sex for a female-bodied individual. UTIs occur when bacteria get into the urethra and cause an infection. While anyone can get a UTI, female-bodies are more susceptible due to the short length of the urethra.

ureter.jpg

[Image description: diagram of the renal/urinary system, including kidneys, ureter, bladder, and urethra. Image source: https://www.organsofthebody.com/images/what-is-ureters.jpg]

LM: The vagina is very close to the urethra compared to the anus, so for female-bodied individuals, penetrative vaginal sex carries a higher risk of causing a UTI than penetrative anal sex. However, there are a lot of bacteria in the rectum, so it’s still possible to get a UTI from anal sex. Fortunately, there are plenty of ways to prevent UTIs, which we’ll discuss next, and treatment is readily available.

AA: There are a number of ways to prevent UTIs:

  • Pee before and after sex to help eliminate bacteria that may have entered into the urethra during the sexual encounter.

  • Drink plenty of fluids and don’t wait to use the restroom when your body needs to go.

  • Don’t douche! While it is good to keep your genitals clean, there is no need to use soap or other douching products inside of the vagina.

LM: If you’re having anal intercourse of any kind (penetrative, oral, etc.), it’s also very important not to go straight from anal play to vaginal play, to avoid transferring bacteria from the rectum to the vagina. Be sure to use a new condom or dental dam when switching from vaginal to anal sex and vice versa, and consider saving any anal play for last.

AA: Some common symptoms of UTIs are:

  • Burning or pain with urination

  • The feeling that you have to pee all the time

  • Frequent urination

  • Occasionally, blood in the urine


If you find that you are experiencing any of these symptoms and believe you have a UTI, contact your healthcare provider. Treatment for UTIs is easy and effective, usually involving a round of antibiotics.

LM: According to the Mayo Clinic, UTIs are very common with over 3 million cases a year in the United States. While UTIs are common, it’s important to remember that they can have more serious complications if left untreated, so even if you’re unsure you have a UTI, it’s best to check with a clinician.

AA: Thank you again for your question, as UTIs are not something we talk about very often. Using the strategies we mentioned above can help you keep UTIs at bay, whether from anal or vaginal sex or something else, but if you do get one, get in touch with your healthcare provider to get it treated.

What can I do on a daily basis to reduce sexual assault at Harvard?

AG: Thanks for writing to Sexual Literacy! This is a really important question. Change will happen when people--students, faculty, administrators--come together and actively work to make our campus safer and more supportive to survivors. This is hard and takes effort but it is possible. The first thing we can do is just to be aware of the reality of sexual assault on college campuses. The most recent sexual climate survey showed that 25.5% of both Harvard women and TGQN (trans, genderqueer, and gender nonconforming) individuals as well 6.5% of Harvard men have experienced some kind of nonconsensual sexual activity during their time here. Of the female undergraduates who reported experiencing non-consensual penetration by force or incapacitation, 87% reported the incident took place in a House or Dormitory. This is not some urban myth--it is happening and it is happening way too frequently.

MS: AG, thank you for speaking to the importance of creating trauma-informed environments, and the role each of us play in acknowledging our attitudes and actions as well as their impact on community norms. Trauma-informed responses, environments, and policies consider the historical and cultural context of how trauma is experienced, and is often created and provided in partnership with the person or groups seeking care. It is a holistic approach that can be implemented by administrators, students, staff, faculty, friends and family, as long as there is a commitment to collaboration, transparency, empathy, and compassion.  A piece of being trauma informed is recognizing that all members of communities are impacted by interpersonal violence, whether firsthand or vicariously, and may have different experiences or responses.  

AG: I do think it’s important to understand that to completely eliminate the risk of sexual assault we would all basically have to lock ourselves in our rooms. It’s not realistic. But you’re right - there are tangible things that we can do to confront it and to make our campus safer.

MS: A crucial first step is to recognize that we all are capable of experiencing harm and of causing harm.  Without that understanding, it is really hard to communicate openly and to practice accountability when we do harm someone, even if unintentionally.

AG: Talk about it. Engage with your friends and peers. Having these hard conversations with each other about the structures and mentalities that allow sexual assault to exist is a hugely important starting place. Remind each other about the importance of communication during hook-ups and then continue to hold yourselves accountable.  

MS: Yes! In order to safely and respectfully explore ourselves and others, understanding our own beliefs and biases surrounding sexuality, consent, and gender is important. The more information and context we have about someone we are interested in - whether for a casual hook-up or a longer term sexual and/or emotional relationship - the better we are able to set expectations, navigate conflict, and have more fun! Consider a staff or peer-facilitated workshop that deconstructs the culture that we live, work, and play in here at Harvard - what are the cues we are giving out and receiving, and how do we know someone is down for…whatever?

AG: But then don’t let the conversations end there. Take this awareness to parties, to other dorm rooms and final clubs, and be a vocal and active bystander. If you see something that doesn’t seem right, please say something. Check in and look out for your friends (and if something does happen, please listen and believe and support them).

MS: Being an active bystander can be difficult if we don’t feel supported and validated by our communities when we take action - we know from the AAU Sexual Climate Survey that while more than 34.3% of Harvard women and 24.8% of Harvard men reported having witnessed someone acting in a sexually violent or harassing manner, 52.5% of those women and 51.5% of men reported not taking any action. Active bystander behavior is difficult if you don’t know what to look for, and don’t have established community norms around standards of behavior and accountability to validate checking in - whether it’s harmful beliefs, language, or actions.

AG: Acknowledge when or if you are in places or positions that allow you to exercise power over another person and think about the ways that this can affect the dynamic or their sense of comfort. Ask for consent without demanding a certain response and then accept the answer that’s given to you.

MS: Yes! Also, participating in conversations that examine where you have social influence and access, where you are modeling behavior for other students as a leader, and where you have capital to create policies and procedures that facilitate more equitable, comfortable environments is critical to changing campus culture.

Keep talking,

AG

Student

MS

Meera Seshadri, MSPH

Associate Director, OSAPR