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Invisible Illness Contributor

By Hannah Nelson

Invisible Illness Contributor

Hannah Nelson is a freelance content writer and the creator of Hannah Rose Writes, a blog on microbes, vaginal health, and natural medicine.

Image by Hannah Nelson x mbg creative

April 29, 2023

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I’d had only one UTI in my life before contracting three within a month and a half, in the winter of 2020. I was 25. Earlier that year, I’d moved to Seattle and met my boyfriend, who has stayed by me through my entire journey. I never imagined this experience would lead to years of unresolved health challenges, and that reducing the suffering of other women in positions like mine would become a part of my life’s purpose.

After those first three UTIs, my primary care practitioner at the time decided to order a culture for ureaplasma, a type of bacteria that lives naturally in many women’s vaginal microbiomes. It’s naturally occurring and so isn’t considered an STI; however, it can be transmitted through sex and cause infections such as UTIs if its population grows too quickly. The test came back positive, and my doctor prescribed a single round of an antibiotic. 

Unfortunately for me, that wasn’t the end of my UTI journey. More UTIs followed in March and June of that year, at which point I had my IUD removed, having been told that it could have been colonized with bacteria. The June UTI lasted for two months, as a subtle burning, even after I took antibiotics. 

After doing some of my own research, I asked my gynecologist at the time for moxifloxacin, which clinical research indicated was effective at preventing the recurrence of ureaplasma infection. She prescribed it, and I finally had some relief.

At this point, however, I wasn’t only trying to solve the UTI problem: I was also experiencing symptoms of vaginitis1. I tried balancing my vaginal pH with boric acid, but it only led to inflammation that made my symptoms worse. 

In November I saw a doctor who specialized in vaginitis, who attempted to treat my symptoms with two more kinds of antibiotics. Around the same time, I was fortunate to have a friend who told me about her positive experiences with naturopathic medicine for an unrelated condition. Desperate for my symptoms to end, I decided to pursue new approaches.

The first naturopathic practitioner I worked with taught me the relationship between hormones and vaginal health. She tested my levels of all three types of estrogen as well as other sex and adrenal hormones (including cortisol) and recommended treatment accordingly. She also put me on the vaginal ring, which contains localized estrogen and has been shown to decrease UTI occurrence and prolong the time between occurrences.

These helped, but my symptoms weren’t fully resolving, so she referred me to another practitioner who specialized in identifying and treating chronic infections. 

From our very first consultation, this provider’s instinct was that my mycobiome2—the small, fungal component of the microbiome, which interacts with the whole microbiome and affects vaginal health—may have been compromised from all of the antibiotics I’d taken. 

While vaginal mycobiome testing doesn’t exist (to my knowledge) and the vaginal mycobiome3 has not been fully sequenced, I do believe whatever state my mycobiome was in may have had something to do with the recurrent infections. 

Together, we worked on restoring foundational health, supporting my immune system by bolstering my gut health, and giving my body herbal antimicrobial support.

Guided by the results of a test called the GI-MAP, which sequences all of the microorganisms living in your digestive tract, we worked to rebalance my gut microbiome with different kinds and strains of probiotic bacteria, like phages and yeast, including Saccharomyces boulardii.

The botanical medicine was the most helpful. I took a powerful herbal supplement formulated for UTIs both as a prophylactic and when I felt a UTI coming on—and, in my experience, it helped to keep them at bay so I didn’t have to take more antibiotics. Among other ingredients, it contained juniper, which contains berberine, a plant alkaloid known for its antimicrobial properties4 and ability to manage dysbiosis (in the gut and urinary tract).

Eventually, I took a two-week dose of fluconazole. Since then, I haven’t experienced any more vaginal infections.

During my recovery journey, I was testing my vaginal microbiome with Evvy. According to my results, the Lactobacillus crispatus5—a protective bacteria for vaginal health—that once dominated my vaginal microbiome5 was compromised. Right now, some research is underway to develop living medicines for UTIs and reproductive health, including vaginally administered L. crispatus probiotics. What’s missing is a more complete understanding of microbial communities that promote vaginal health.

Vaginal infections are isolating. They affect your energy, mindset, goals, and relationships—and yet they aren’t exactly something you’d want to talk about with your parents, coworkers, or even your friends. They’re medical problems, which makes them personal, and on top of that, they have to do with sexual health, which is largely taboo.

I realized that I had become afraid of sex, given that it often led to infection. I moved with and worked through that fear by giving myself the sexual education I never had, starting with Emily Nagosaki’s Come As You Are and Lori Brotto’s Better Sex through Mindfulness.

Then, I participated in a coaching program centered on cultivating joy by listening to your body, emotions, and inner voice. As a result, I started a blog where I write on my experiences in detail, incorporating research related to the clinical science behind them. I’ve started to be more vocal on social platforms as well, because I believe that one way to bring attention to opportunities to improve research and clinical practice is to rewrite the narrative around the vagina.

After my own experiences, I truly hope to inspire a shift in the way we treat UTIs and vaginal infections. 

Research has pointed to6 the existence of a gut-vagina axis, a gut-bladder axis, and a vagina-bladder axis, but right now, there’s very little research about the connection of gut and vaginal health, especially how it may pertain to many women’s recurrent UTIs. I hope we’ll see more studies in this area.

I also want more awareness in the medical community about factors that impact women’s sexual health. For anything other than a simple, one-off UTI or vaginal infection, I’ve learned there’s likely more going on that cannot be resolved by peeing before and after sex or practicing good hygiene.

And for anyone experiencing recurrent infections, I highly encourage doing research on your own and advocating for yourself. You are the best person to make decisions about your care, and that includes finding specialists who can help and whose approach resonates with you.

My boyfriend has stayed by me through all of this, and while I know the odds of experiencing another infection at some point in my life are against me, I have increased interoception, knowledge of how to take care of myself, and hope that research, improved diagnostics, and new therapeutics will inform treatment in the future.