Think You Have Another UTI? This May Be What's Really Going On
You know that familiar feeling. There's a burning sensation when you pee, you're running to the bathroom more often, and your pelvis just doesn't feel quite right.
So you do what you've done before and get tested for a UTI, only to hear that your urine culture is negative. If that sounds familiar, you may be left wondering what could possibly be causing the symptoms.
In a recent review of patients with persistent urinary symptoms, researchers found there may be more to the story than what's happening in the bladder. Hormonal changes and pelvic floor tension could be part of the picture, too.
About the review
Researchers looked back at the medical records of 253 patients who visited a specialty vulvar and recurrent UTI clinic between September 2021 and May 2023. All of the patients had symptoms that looked like recurrent UTIs, but had at least two negative urine cultures.
During their evaluations, clinicians looked for signs of hormonally mediated vestibulodynia, which can cause irritation and pain around the vaginal opening, as well as pelvic floor hypertonicity. This means the pelvic floor muscles are unusually tight and have trouble relaxing.
Premenopausal and perimenopausal patients also had their hormone levels checked when appropriate.
Most patients had other possible causes for their symptoms
The patients had a median age of 53. About 81% still had urinary symptoms despite their previous negative cultures, and 59% also reported pain during sex.
When researchers looked more closely at the patients' exams, they found that 85% had signs of irritation and pain around the vaginal opening that could be related to hormonal changes.
About 75% also had overly tight pelvic floor muscles. Only 15% had findings that pointed to a more typical urinary tract problem.
There was another notable finding among the premenopausal patients who had their hormones tested. Almost all of them, 98.9%, had free testosterone levels below the study's reference range.
That doesn't mean low testosterone was causing their symptoms. The researchers can't establish cause and effect from a retrospective chart review.
But the finding does raise the possibility that hormonal health may be one piece of the puzzle for some women with ongoing UTI-like symptoms.
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How hormones and the pelvic floor can play a role
The vulva, pelvic floor, and urinary tract are closely connected. When one area is irritated or uncomfortable, it can affect the others.
For example, hormonal changes can make the tissue around the vaginal opening more sensitive and prone to irritation, which can also show up as discomfort during sex.
That discomfort can cause the pelvic floor muscles to tighten.
If those muscles stay tense, they may contribute to urinary urgency, discomfort, and other symptoms that can feel a lot like a UTI.
This may help explain why someone can have very real burning, urgency, or pelvic discomfort even when a urine culture doesn't show an infection.
Of course, a negative culture doesn't automatically mean hormones or the pelvic floor are the problem. Persistent urinary symptoms can have many causes, and this review only points to some possible ones.
What to discuss with your provider
If you keep having UTI-like symptoms but your cultures come back negative, it may be worth raising other possibilities with your provider.
- Ask about your pelvic floor: Tight pelvic floor muscles may contribute to urinary symptoms, especially if you also have pelvic discomfort or pain during sex.
- Talk about hormonal changes: If you're premenopausal or heading into perimenopause, ask whether shifting hormone levels could be contributing to your symptoms and whether hormone bloodwork makes sense for you.
- Consider a broader evaluation: A vulvar exam and pelvic floor assessment can uncover issues that a standard urine culture won't, and it's a good moment to ask about everyday vulvar care.
If your symptoms continue despite negative cultures, your provider may also be able to refer you to a specialist in vulvar health, pelvic floor care, or recurrent urinary symptoms.
The takeaway
If UTI symptoms keep showing up without a positive culture, infection may not be the only explanation.
Hormonal changes and pelvic floor tension could be contributing factors for some women, making a broader evaluation worth discussing with your provider.
