By Taylor Brueseke, Fellow, Urogynecology and Reconstructive Pelvic Surgery
The urethra is the tube which passes urine from the bladder to the outside world. In women, the urethra is only about 3 to 4 cm (1.2 to 1.5 in) in length. So for any bacteria that may be present in the outside world to enter the bladder, that bacteria only needs to travel a short distance. And unfortunately, the bladder is a dark warm place that certain bacteria grow very well in. While there is no way to make the urethra longer, there are things you can do to try and keep bacteria from traveling through it.
Like the rest of the vagina, the urethra is sensitive to hormones – the most of important of which is estrogen. After women pass through menopause, the amount of estrogen in the body decreases. This causes the strength of the vaginal (and urethral) walls to decrease which can result in vaginal dryness and pain with intercourse. As the strength of the urethra decreases, bacteria are more easily able to pass through the urethra and enter the bladder which results in a UTI. This is the reason why doctors often prescribe estrogen supplementation for women with frequent UTIs who have passed through menopause. The lowest dose of this estrogen can be used in the form of a cream which is placed inside the vagina several times per week.
Another reason why bacteria can more easily enter the bladder of women is simply anatomy – the opening of the urethra is right next to the vaginal opening. The fact that the urethra is so close to the vagina, which is also so close to the anus, means that there are naturally a lot of bacteria near the urethra. Unfortunately, it’s not possible to get rid of all the bacteria in ANY part of the body. But practicing good hygiene, including remembering to wipe from front to back, can help keep bacteria from being dragged towards the urethra.