Sex as a Trigger, Avoidance as the Consequence: Characterizing Postcoital Recurrent UTI in Women

To characterize the clinical, behavioral, and treatment profiles of women with recurrent urinary tract infections (rUTIs) who identify sexual intercourse as a trigger and to compare them with women whose rUTIs occur independently of sexual activity.

This cross-sectional study utilized an anonymous, Internet-based survey distributed via social media and women's health forums between May 2025 and March 2026. Participants were stratified into postcoital (PC) and non-postcoital (NPC) groups based on self-reported perception of a temporal relationship between intercourse and symptom onset, without clinical or microbiological confirmation. Comparative analysis was performed using chi-squared and Fisher's exact tests; because the two groups differed significantly in age, a pre-specified age-restricted subgroup analysis (18-35 years) was performed as an alternative to multivariable regression, which was not considered statistically robust given the sample size.

Of 82 respondents, 42 (51.2%) identified sexual intercourse as a UTI trigger. Comparison of PC and NPC women revealed that the PC phenotype was significantly more likely to avoid sexual intercourse (73.8% vs. 50.0%, p = 0.046) and to report damage to their intimate relationships (59.5% vs. 35.0%, p = 0.045). These differences persisted within the 18-35 age subgroup. Despite this additional burden, overall quality of life impairment was high and statistically comparable across both groups (73.8% vs. 80.0%, p = 0.69). Significant management gaps were identified specifically in the PC group: consistent pre-treatment urine culture performance was substantially lower (45.2% vs. 75.0%, p = 0.012), and vaginal estrogen use was less frequent in eligible women (14.3% vs. 37.5%, p = 0.031).

Postcoital rUTI is associated with disproportionate sexual avoidance and relationship damage, independent of age and overall disease burden; given the cross-sectional design and self-reported group classification, these findings are best regarded as hypothesis generating rather than as establishing a definitive clinical phenotype. Targeted clinical inquiry, consistent microbiological documentation, and proactive PC prophylaxis may help address the relational harm this condition appears to impose, pending confirmation in prospective studies.