UTIs while transgender

Aug 02, 2018 | Kimberly Williams

It's no news that on a daily basis, transgender people are up against major obstacles when it comes to getting the healthcare they need, or just using public restrooms. Urinary tract infections in transgender people stem from bigger problems: the uncertainty of the safety of public restrooms and healthcare providers’ lack of education regarding transgender health. This article will focus on how urinary tract infections affect trans people, as well as solutions for prevention.

How do UTIs happen? 

A UTI occurs when bacteria, such as E.coli is introduced to the urethra. Bacteria then adhere  to the urethra or bladder and multiply, causing an infection.  UTIs can occur from a number of things: holding in your urine for prolonged amounts of time, forgetting to pee after sex, wiping back to front, or having a new sexual partner etc.

For people with vaginas:

Your urethra is the tube that carries urine out of your body. The opening of the urethra is close to the anus, where bacteria such as E.coli is present. Because it is shorter than the urethra of those who have penises, it is easier for bacteria to make its way up and cause a UTI.

Chase Ross, a trans activist who makes videos for the trans community recounts his story of a bladder infection a few years ago: 

“To prevent UTIs...empty your bladder when you are full.  Now this is where the trans aspect comes in alright because sometimes we don't feel comfortable going to the bathroom... I was not comfortable going to the bathroom in 2010 turn 2011. That entire year I just I could not use the bathroom. I held it in when I would go to school, I would not use the bathroom. I was terrified because I looked like I was in the middle. I didn't know if like women would like scream if I went to the bathroom, and it was just a very confusing time, so I held my pee in for about 12 hours a day.”

Ross explains that holding in his urine resulted in a severe bladder infection that left him using a catheter for six months. When you hold urine in your bladder for prolonged amounts of time, it is likened to holding stagnant swamp water in your bladder, because bacteria is able to flourish. If you go hours without voiding, it exposes your bladder to harmful bacteria.

Other factors that can cause UTIs for people with vaginas:

  • Improper wiping from back to front, which introduces fecal bacteria to your urethra.
  • Not urinating enough from dehydration. You avoid drinking water to avoid using the restroom.
  • Forgetting to urinate after sex.
  • Switching directly to vaginal sex after anal sex.
  • Having a weakened immune system from diabetes, short-term, or long-term illnesses.  
  • Some people are more UTI-prone than others because of genetic components of the bladder lining. 

For people with penises:

UTIs occur less often for people with penises. This has to do  with the fact that the urethra is longer, and is situated further away from the anus than those of people with vaginas. After the age of 50, the chances of getting a UTI increase each year.

Dr. Alexandra Hall, a physician at University of Wisconsin, has a decade of experience in transgender health care. She discusses that while the the taping method for tucking gives you the most control, yet it takes time and you have to undo and re-do that process every time you pee. "Delayed urination increases your risk of getting a urinary tract infection, though the risk is lower when you have a long urethra.” The Transgender Equality Network Ireland states “Tucking for a long period of time can cause a build-up of bacteria causing urinary tract infections and may cause long term damage.”

Other factors that can cause UTIs for people with penises:

  • If you have had procedures on your urinary tract in the past, or have had problems controlling when your urinate.
  • If you have a long term illness such as diabetes, it may be harder for your body to fight off an infection.  
  • An infected prostate or enlarged prostate gland can lead to recurrent UTIs.
  • Catheter use. Bacteria can enter the urethra when a catheter is inserted causing a UTI.
  • Kidney stones and bladder stones can disrupt your urine from flowing through the urinary tract as it should, which can cause bacteria to get more easily trapped.

Healthcare while transgender

For many individuals in the trans community, we know going to the doctor is easier said than done. Dani Castro, project director at the University of California, San Francisco Center of Excellence for Transgender Health tells Gizmodo, “Most of us don’t go for prevention...We go when it’s an emergency.”

There's no mystery as to why this is the case. The 2015 National Center for Transgender Equality’s United States Transgender Survey, reports that a third of transgender patients had a discriminatory experience at the doctor’s office. Twenty-five percent of respondents “did not see a doctor when they needed to because of fear of being mistreated as a transgender person.” A 2011 National LGBTQ Task Force survey of 6,450 gender non-binary and transgender people reveals instances of patients concealing their identities from their doctor, and a lack of sensitivity in the medical field when handling trans issues. Doctors used the incorrect gender pronouns and mocked patients. Around twenty percent of the participants reported that they were denied health care.

2011 survey completed by 132 American and Canadian medical school deans concluded that undergraduates received a median of just five hours of training in lesbian, gay, bisexual and transgender-related content. Of those schools, 44 had zero hours of LGBT content in their clinical studies. This data underscores why transgender people fear being discriminated against, so what do you do if you are experiencing UTI symptoms?

What to do if you have UTI symptoms:

UTI symptoms include:

  • A strong, constant or recurring urge to urinate
  • A burning sensation when urinating
  • Only urinating small amounts when you do urinate
  • Cloudy urine instead of transparent
  • Blood in the urine, which often looks red, bright pink, or brownish like coca-cola
  • Pungent urine
  • Pelvic pain, especially in the center of the pelvis and around the area of the pubic bone for women
  • Feeling under the weather with possibly having a fever, chills, or body aches

The only way to cure a UTI is by taking antibiotics. If you are experiencing UTI symptoms, contact your healthcare provider as soon as possible. The longer you wait to see your doctor, the more likely the infection will become more dangerous, and spread to your kidneys. As mentioned before, activist Chase Ross discusses how getting treated for your UTI early on sidesteps the nightmare of having to be treated for a severe infection if you wait.

When you go to the doctor, they will ask you to give them a urine sample. This way, they can conduct a urinalysis or urine culture in a lab. This in no way requires any type of pelvic exam. Once they diagnose your UTI, they will prescribe you antibiotics.

Tips for going to the doctor for a UTI

  • If you are looking for a doctor who is experienced in dealing with trans issues, My Trans Health provides a database of vetted doctors to help you find the right one.
  • Take a friend or family member with you to your appointment.
  • You have the right to deny a pelvic exam. If your doctor says they need to conduct one, they must provide sufficient evidence as to why. UTI diagnosis does not require a pelvic exam. If you suspect they are requiring one out of their own curiosity, you are not obligated, and have the right to say, "No." 
  • If you suffer from recurrent UTIs, it may be necessary to detect abnormalities in the urinary tract. Your doctor might perform an ultrasound or a cystoscopy

For more tips about going to the doctor if you are transgender, look here.

How to prevent UTIs:

  • Go to the bathroom when your bladder is full. If you are uncomfortable using public restrooms, Refuge Restrooms is an app that maps out gender neutral toilets.
  • Drink plenty of water.
  • Urinate after sex. Do not have sex while being treated for a UTI.
  • If you tuck, do not tuck for longer than 4- 8 hours.
  • Avoid feminine sprays or douches if you have a vagina.
  • Wipe from front to back if you have a vagina.
  • Change the condom if you switch from anal sex to vaginal sex.
  • If possible, wear cotton underwear or go commando at night.
  • Drink Uqora—an effective way to cause out UTI-causing bacteria using natural, safe ingredients.

Urinary tract infections are a trans issue, exacerbated from the lack of safety regarding public restrooms and discrimination from healthcare providers. Remember, you deserve a responsible and knowledgeable health team. If you have questions or need support, Trans Lifeline is a hotline staffed by and for transgender people, with experts ready to chat to folks in distress or in need of support. Its numbers are (877) 565-8860 for the US and (877) 330-6366 in Canada. For the  Crisis Text Line, text START to 741-741. The Crisis Text Line is free, 24/7 support for those in crisis. Text from anywhere in the USA to text with a trained Crisis Counselor.

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