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Should You Sit Or Squat? We Finally Settled The Public Toilet Debate

Author:

Anna Cabeca, D.O.

May 19, 2017

Triple board certified OB/GYN

By Anna Cabeca, D.O.

Triple board certified OB/GYN

Dr. Anna Cabeca is a menopause and sexual health expert currently working in Georgia. She received her doctor of osteopathic medicine in gynecology and obstetrics from the Emory University School of Medicine.

May 19, 2017

To sit or not to sit, that is the question! Public toilet seats are a polarizing topic—no doubt about it. Some people swear that you're completely safe sitting on a public toilet seat and you'd be a hypochondriac of sorts to worry. But as a doctor who focuses on women's health, I get questions about this all the time.

If you've ever been in a public bathroom, dying to sit but plagued by the decision on whether it's sanitary or whether squatting is worth the strain, look no further. Turns out, it depends, but there are forces at play—like our microbiomes—that may be of more pertinent and consequential concern than contracting an STD. Below, I answer some of the most common questions about public toilet seat safety.

Can you get an STD or any other infection from sitting on a toilet seat?

The couple of infections that come to mind are herpes simplex virus and human papillomavirus. Other STDs (sexually transmitted diseases) like gonorrhea, chlamydia, and trichomonas are probably even less likely. The probability of receiving an STD from a toilet seat is low although not nonexistent. After looking into research and based on my own practice, the general consensus is that the exposure would have to be within seconds if not minutes and exposed to an abrasion, cut, break in the skin of the area that comes in contact with the toilet seat. In general, I am very cautious, however, because we are beginning to understand the microbiome, resistant organisms beyond STDs, and the relevance of those is yet to be determined.

What happens if there is pee on the seat when you sit down?

This is absolutely gross. If you've experienced that, as I have, the first reaction is horror and general disgust! Aside from the emotional annoyance, it is unlikely you will contract something from that. But if the individual has an infection, including trichomonas, which can colonize in the urinary tract, exposure to the moist, lush environment of the pelvic floor creates very small (but not infinitesimal) risk of an infection. Again, as we begin to understand the microbiome and antibiotic-resistant organisms, I would use all precautions.

Next time you sit on a peed-on toilet seat, simply wipe your bottom and the area that had contact with warm soapy water.

What happens if you No. 2, and backsplash from the toilet seat gets on your intimate areas?

If I was to rate grossness and risk, I would say this is more hazardous than sitting on a peed-on toilet seat. Bacteria from fecal matter, stools, and bowel movements are more likely in this scenario. They could be lurking in the toilet from earlier and might make contact with your intimate areas. Again the risks are very, very small here; however, note that exposure to the genital area, vulva, and vagina as well as the rectum is worse than a splash on the skin of your buttocks.

What's dirtier: the doorknobs or the toilet seat?

This is wildly variable and largely depends on what happened before you got there! A good rule of thumb when traveling is to wash your hands regularly, use a scarf or tissue to open doors, and implement the hover technique over the toilet seats.

With that, I recommend practicing your squats and lunges so you've got a good comfortable hover and don't have to put too much strain on your pelvic floor to do it properly!

What are your personal public bathroom practices and/or what do you recommend?

True, there can be a false sense of security when you're traveling to nicer places with well-decorated and seemingly clean bathrooms compared to airports or subways. Considering it is just a good idea to be cautious, I typically wear a scarf when traveling or long comfortable shirt and will use that to open doors occasionally. If I feel like I need to sit and take my time to have a bowel movement in a public restroom, I typically flush the toilet, wipe the toilet with a paper towel or toilet paper, then apply a toilet seat liner and rest comfortably on the toilet seat. In general, if it's just a No. 1, I will hover.

I've raised four girls, so I've gone through a gamut of paranoia in public restrooms. I'm not a freak about cleanliness but recommend that you either hover or lay toilet paper on the seat if a toilet seat liner is not available. It's an extra precaution and worth it (I think) even though there are much riskier exposures from shaking hands and the handrails in public places as well.

Personally, I'd prefer a handshake infection to a toilet-seat one but will aim to get neither.