A decrease in libido is a natural part of aging, but in my gastroenterology (GI) practice, a lot of the women having bedroom issues are in their 20s and 30s.
Anatomically, your digestive tract and reproductive organs are next-door neighbors, but there’s an even more intimate relationship between the “below the belt organs” that supersedes their physical proximity to one another. It has to do with the microbiome—the trillions of bacteria that live in and on the human body, mostly in your gut but also in nooks and crannies like your genitals.
We’ve spent most of the last century figuring out how to eradicate our microbes, and we’re just now realizing that the vast majority are friends rather than foes that actually play a vital role in keeping us healthy. Gut bacteria help to digest our food, synthesize important vitamins that our bodies can’t make on their own, neutralize harmful compounds, and maintain the integrity of the gut lining so that nutrients can get into the body but toxins are kept out.
In the vagina, helpful Lactobacillus species produce acid that repels problematic bacteria, protecting us from sexually transmitted diseases and other infections (and keeping the fetus safe during pregnancy).
Most of the patients I see suffer from manifestations of an imbalanced microbiome—a condition known as dysbiosis. Some of the signs and symptoms are localized to the GI tract, like bloating and gas; but others, including yeast infections, brain fog, fatigue, rashes, joint pain, anxiety, food cravings, allergies, and autoimmune disorders, reflect the universal role our microbes play in preventing disease. And what’s more, a healthy, balanced microbiome is essential for a healthy, satisfying sex life.
By far, the most common risk factor for dysbiosis is overuse of antibiotics. Just five days of a broad-spectrum antibiotic can destroy up to one-third of your essential microbes—and there’s no guarantee they’ll ever all come back. Less desirable pathogenic bacteria and yeast species (which, as luck would have, it tend to be a lot hardier) quickly multiply to fill the void, bringing with them plenty of symptoms.
Many of the antibiotics being over-prescribed these days are for upper respiratory tract infections, and conservative estimates suggest that as many as half are unnecessary. But there’s another alarming, but hidden epidemic of dysbiosis that’s occurring, and it may be wreaking havoc on your sex life. It’s the common practice of taking antibiotics after intercourse to prevent urinary tract infections (UTIs).
During sex, especially the more energetic kind, bacteria from the anus and groin can gain access to the bladder through the urethra, causing a temporary increase in microbial load that may result in inflammation—a condition called cystitis. (Honeymoon cystitis in the case of the newly coupled that may be experiencing more friction than usual down below). In fact, more than half of all UTIs in premenopausal women occur within 24 hours of having sex.
Depending on how sexually active you are, all those preventative doses of antibiotics can add up, depleting your friendly Lactobacillus population and replacing them with pathogenic microbes that can run amuck in your vagina, causing burning, itching, and pain with intercourse. To add insult to injury, some studies suggest that the rate of recurrent UTIs may actually be higher in women treated with antibiotics for urinary symptoms, versus those who are allowed to recover on their own—a more inconvenient option, but one that may ultimately save the day in terms of your microbial health and your libido.
Other helpful practices include drinking lots of water to flush the urinary system, emptying your bladder immediately after intercourse, avoiding spermicides and diaphragms that can trap bacteria, and taking D-mannose—a naturally occurring substance found in cranberries that can prevent pathogenic bacteria like E. coli from setting up shop in the bladder.
If you’ve been using antibiotics to prevent post-coital UTIs and you’re finding that sex is less enjoyable than it should be, your vaginal microbes might be in need of some rehab. I recommend a three-pronged approach of avoidance, encouragement and repopulation:
• Avoid antibiotics if at all possible.
• Encourage the growth of good bacteria by consuming prebiotics—high-fiber foods that literally feed your good bugs, like oats, artichokes, asparagus, garlic, lentils, and leeks. Fermented foods like sauerkraut and kimchi also increase the numbers of good bacteria, and staying away from sugary, starchy foods that encourage the growth of yeast species is a must.
• Repopulate your vagina with live bacteria in the form of a robust probiotic. Probiotics are taken orally in the form of a pill, powder, or liquid.
It may take some time before you see meaningful results, but this approach offers the possibility of real and lasting relief, rather than an antibiotic quick fix that ultimately ends up being ruinous to your sex life.