Urinary tract infections (UTIs) are an important reason for medical attention. Risk factors include sexual intercourse. Urinary tract infections have a significant impact on the quality of life of patients and can also lead to alterations in sexual life. However, the characteristics and satisfaction of sexual intercourse in women with UTIs also need to be assessed.
This study aims to evaluate the symptoms associated with urinary tract infections and their influence on quality of life and sexual activity.

We conducted a study of patients with recurrent UTIs (rUTIs) and controls without UTIs, assessing the symptoms associated with acute cystitis, its effect on the quality of life and its effect on sexual function. Patients were assessed using the Acute Cystitis Symptoms Score (ACSS) questionnaire and sexual function will be assessed using the Female Sexual Function Index (FSFI) questionnaire. The questionnaires are completed online using a survey designed in Google Forms. The study has been evaluated and approved by the ethical committee of the centre responsible for the study.

Three hundred and eighty-three women with recurrent UTIs and 156 controls completed the survey. The mean age was 41.6 (13.79) [mean (standard deviation)] and 38.4 (12.88) years (p=0.012), respectively. Although the percentage with a predisposition to constipation in patients with UTIs was higher (37.8% in cases and 31.4% in control); there were no significant differences in the number of sexual partners and bowel habits between groups. The percentage of menopausal women is 19.9% for controls and 31.3% for those with rUTI (p=0.026). Urinary tract infections lead 46.1% of cases to at least moderate interference with work activities and 56.9% in social life.
About the evaluation of sexual life, most of the items were affected in patients with recurrent urinary tract infections. Sexual desire was considered low or very low in 53.0% and 35.3% of cases and control (p<0.001), respectively. 35.4% and 7.1% of patients with rUTI (p<0.001), respectively, reported low or very low confidence in becoming sexually aroused during sexual activity. Difficulty in achieving adequate lubrication during sexual activity was reported by 30.5% and 18.7% (p<0.001) of cases and controls, respectively. 29.5% of cases and 19.2% of controls reported difficulties in reaching orgasm (p<0.001). Pain or discomfort with penetration was reported more than half the time by 30% of women with infections and 16.4% of controls (p<0.001). Pain after penetration was considered at least moderate in 43.6% of controls and 19.2% of controls (p<0.001). The percentage of women moderately or very satisfied with sexual intercourse is 42.0% in patients with repeat UTIs and 73.1% in controls (p<0.001).

Sexual intercourse has classically been described as one of the main risk factors for recurrent urinary tract infections in women. However, the characteristics and satisfaction of sexual intercourse in women with UTIs also need to be assessed. Our study shows data suggesting a higher percentage of constipation in women with UTIs. We observed that most of the items assessed in terms of sex life show a worse score in women with recurrent urinary tract infections. It is worth noting the high percentage of women who report pain during or after penetration and are not satisfied with their sex life.

It is not only sexual intercourse that should be considered as a risk factor for recurrent UTIs. Patients with recurrent UTIs reported worse sexual satisfaction, low desire, and difficulties in achieving adequate lubrication and reaching orgasm. Moreover, pain and discomfort are frequently reported. It is necessary to evaluate the sexual life of our patients and the management of UTIs must also take into account how to improve the sexual life.

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