Bladder infections...and condoms

If you've ever had a urinary tract infection, you probably already know that using a diaphragm increases your risk. But you may be surprised to hear that, according to a new study, there's another contraceptive culprit: spermicide-coated condoms.

The common wisdom is that a diaphragm can predispose a woman to the irritating ailment in part because it puts pressure on the urethra. But in studies a few years ago Stephan Fihn, an internist at the University of Washington in Seattle, saw evidence that it was the spermicide--and not the device--that leads to infection. So Fihn decided to investigate condoms coated with the widely used spermicide nonoxynol-9.

He and his colleagues interviewed 1,200 women, half of whom had recently had a urinary tract infection. The researchers asked about a list of possible risk factors, including frequency of sex and method of contraception.

Women who had suffered a recent infection, it turned out, were much more likely than the healthy women to have used condoms coated with spermicide. In fact, analysis showed, the use of these condoms more than once a week tripled a woman's chance of getting a urinary tract infection.

Fihn notes that nonoxynol-9 kills not only sperm but harmful bacteria and viruses, such as herpes and HIV--and helpful bacteria as well. "It's pretty non-specific," says Fihn. "It kills everything." And with the good bacteria gone, other bacteria have access to the area, most notably E. coli. These germs cause no problems in the gastrointestinal tract, where they normally live, but can cause pain and irritation if they travel up the urethra into the bladder.

Every year millions of women suffer from urinary tract infections. For many of them the benefits of using spermicide with a condom--including better odds of preventing sexually transmitted diseases and pregnancy--outweigh the increased risk of the ailment, says Fihn.

But women who are repeatedly plagued by these infections may want to switch to another method of contraception, such as birth control pills.

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Vital Signs by Katherine Griffin, John Hastings, and Sarah Henry.

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