You might already have an exercise program for toning your abs, biceps, triceps, hamstrings, and quads. By stressing your muscles through exercise, you can improve stamina, posture, and mood, reduce the risk for chronic disease, and generally support your overall health.

How about your pelvic floor?

Your pelvic floor muscles support your pelvic organs, including your bladder. They are sometimes compared to a hammock—a layer attached to your sit bones (i.e., bones in the lower part of your pelvis), tail bone, and pubic bone—that keeps your pelvic organs in place.

Just like any muscle group, your pelvic floor can weaken over time. This happens as we age, but it can also happen after certain circumstances, such as pregnancy, childbirth, or prostate surgery. Being overweight can take a toll on pelvic floor muscles, too.

Just like any muscle group, your pelvic floor can weaken over time.

It’s easy to keep your pelvic floor muscles in shape. Kegel exercises (also called pelvic floor muscle training) have been around for decades. They were first developed by American gynecologist Arnold Kegel in the 1940s. But they’re not just for women. Men benefit from Kegels too.

Why should men and women do Kegels?

Urologists often recommend Kegel exercises to people with overactive bladder, pelvic organ prolapse, and other urologic issues, such as incontinence (urine leakage). Strengthening and toning pelvic floor muscles can help with these problems.

Kegels can have sexual benefits, too. Men may have improved erections. Women who do Kegel exercises regularly often find that vaginal penetration becomes more comfortable. Orgasms may intensify for both men and women.

One you learn the technique, Kegel exercises are easy to do. You need no special equipment, and they can be done anywhere. They’re also discreet; nobody will know when you’re doing Kegels.

Note: Kegels aren’t appropriate for everyone. In some cases, pelvic floor problems develop because the muscles are too tense and are difficult to relax, making Kegels less effective. Your doctor can guide you on your personal situation.

How do I get started with Kegels?

While Kegels are simple, they need to be done correctly, so talk to a doctor or other healthcare professional before making them part of your routine.

The most important aspect of Kegel exercises is making sure you’re working the right muscle group. Here are some ways to make sure:

• Imagine that you’re about to pass gas. Squeeze the muscles that would stop you from doing so. The pulling sensation you feel when you squeeze indicates your pelvic floor muscles.
• The next time you urinate, stop the urine flow midstream, paying attention to the muscles you use. If you can stop the flow, you have found your pelvic floor muscles.
• Women might try putting a finger inside their vagina, then imagining they’re stopping their urine stream. When squeezing the muscles, they should feel a tightness around their finger.

It can take time and practice to determine which muscles to target.

Each time you squeeze those muscles, you’re doing a Kegel.

At first, try holding each Kegel for a second or two. Then relax for a few seconds. Then Kegel again. This pattern of repeated squeezing and relaxing is the core component of a Kegel exercise program.

Over time, as your pelvic floor starts to strengthen, you should find that you can hold Kegels for longer durations. Ten seconds is a good goal, but if you can’t do it at first, that’s fine. Your ability to hold the Kegel for longer periods of time should improve with repetition.

Create a Kegel exercise plan

Once you’ve gotten the hang of Kegels, make them a daily routine. Some experts recommend doing Kegel exercises 3 times a day in sets of 10 to 15 squeeze-relax repetitions (sometime called reps).

You can also vary your position. Consider doing some of your Kegels while standing, others while sitting, and the rest while lying down.

Another way to vary your Kegels is to do short or long reps. Short reps are quick in succession: you hold each Kegel for a couple seconds, relaxing for a few seconds in between each one. For long Kegels, you hold each Kegel for a longer period (such as 10 seconds) with an equal rest time in between each one. Doing short and long reps gives your pelvic floor more comprehensive training.

A word about weights: Some people use special weights or cones to enhance their Kegel practice. You might see some of these products for sale. Such devices should be purchased and used only with the guidance of a qualified healthcare professional.

Tips for doing Kegel exercises

As you start out with Kegels, keep these tips mind:

• Make sure you’re relaxing your pelvic floor muscles between each Kegel squeeze. This resting period is part of the program and to avoid injury, it’s important not to skip it.
• Make sure the muscles in your stomach, back, thighs, and buttocks stay relaxed while you do your Kegel exercises. Focus on your pelvic floor only.
• Breathe normally. Don’t hold your breath while you’re doing Kegels.
• Don’t do Kegel exercises while you’re urinating. This can actually weaken the pelvic floor and damage your kidneys and bladder.
• Don’t overdo it! As the saying goes, “all things in moderation.” This idea applies to Kegels. If you do too many Kegels, your pelvic floor can become too tight, and that can lead to urine leaks, pelvic organ prolapse, and sexual pain.

Getting Results

Once you start a regular routine of doing Kegels, you should start seeing a difference in about 4 to 6 weeks. This might mean fewer urine leaks, fewer trips to the bathroom, or improved sexual health. However, for some people, improvement takes longer, so we encourage you to stick with it.

Resources

Healthline.com

Crouch, Marcy, PT, DPT, CLT, WCS
“Yes, You Really Can Do Too Many Kegels. Here’s What Happens”
(December 11, 2020)
https://www.healthline.com/health/parenting/yes-you-really-can-do-too-many-kegels-heres-what-happens

National Association for Continence

“Kegel Exercises: A Step-By-Step Guide”
https://www.nafc.org/kegel-exercises

“Kegel Exercises for Men”
https://www.nafc.org/kegel-exercises-for-men

National Institute of Diabetes and Digestive and Kidney Diseases

“Kegel Exercises”
(Last reviewed: April 2014)
https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises

Urology Care Foundation

“Kegel and Pelvic Floor Exercises”
(April 1, 2019)
https://www.urologyhealth.org/healthy-living/care-blog/2019/kegel-and-pelvic-floor-exercises

VoicesForPFD.org (American Urogynecologic Society)

“Pelvic Floor Muscle Exercises and Bladder Training”
(2016)
https://www.voicesforpfd.org/assets/2/6/Bladder_Training.pdf

“Pelvic Floor Muscle Strengthening”
https://www.voicesforpfd.org/assets/2/6/Kegel_Exercises.pdf

WebMD

Fries, Wendy C.
“Kegel Exercises: Treating Male Urinary Incontinence”
(Medically reviewed: July 21, 2020)
https://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence

What You Should Know About Kidney Stones During Pregnancy

Kidney stones are a fairly common urological problem, affecting about 1 in 10 people at some point in their life. But kidney stones can be a particular challenge for pregnant women. The way stones are diagnosed and treated may need to be adjusted during pregnancy for the safety of the mother and her baby.

Still, pregnant women with kidney stones have several treatment options. And it’s important to know that without treatment, kidney stones can lead to premature labor, so it’s necessary to address them.

What are kidney stones?

Kidney stones are small, crystallized masses that form in the kidneys or ureters (the tubes connecting the kidneys to the bladder). Most stones are made from calcium, but they can also be formed from uric acid, struvite, and cystine, which are naturally occurring compounds in the human body. Kidney stones come in various shapes and sizes and can be smooth or jagged, small as a pea, or as large as a golf ball.

Most kidney stones are small enough to pass through the urinary tract on their own. A person with a small kidney stone might not have any symptoms.

But larger stones can block urine flow and cause a significant amount of pain. In fact, abdominal pain is one of the most common symptoms of kidney stones. Some people have nausea and vomiting, along with a need to urinate more urgently and frequently. Blood in the urine is another symptom.

How common are kidney stones in pregnant women?

It’s estimated that kidney stones occur in about 1 of every 500 to 3,000 pregnancies, so having kidney stones during pregnancy is fairly rare.

However, research suggests that risk for first-time kidney stone formation is higher at certain points in a pregnancy.

In 2021, the American Journal of Kidney Diseases published a study on the topic. Researchers found that in pregnant women, risk for developing first-time symptomatic kidney stones increased during the second and third trimesters of pregnancy.

Interestingly, the peak time to develop kidney stones was during the first 3 months after delivery. About a year after the delivery date, risk returned to pre-pregnancy levels.

Risk was higher in pregnant women who were obese.

Why are pregnant women more at risk for kidney stones?

Pregnant women are more prone to kidney stones for the following reasons:

• Pregnant women are more susceptible to dehydration. A growing baby puts pressure on a woman’s bladder, increasing the need to urinate. As a result, pregnant women might not drink as much fluid as they should, and dehydration can lead to kidney stones.
• Changes occur in urine composition during pregnancy. Pregnant people tend to have more calcium in their urine, and most kidney stones are calcium-based.
• Hormonal changes in pregnant women make it more difficult to clear urine from the body. Pregnant women have higher levels of the hormone progesterone, which contributes to urinary stasis (halting of or slowing of urine flow). As a result, stone-forming compounds have more opportunity to crystallize.

How are kidney stones diagnosed in pregnant women?

Diagnosis starts with a medical history. Designing a personalized treatment plan requires knowing more about your symptoms, your pregnancy, and your medical background.

Lab tests are also an important diagnostic tool. These include blood tests and urine tests. Urine tests may reveal if stone-forming substances are present.

Imaging tests may also be ordered. These tests can reveal the location, size, and shape of any kidney stones:

• Ultrasound. Ultrasound technology uses sound waves to create images of internal organs. (It’s also used to monitor the development of a baby in the uterus.) No radiation is used with ultrasounds, so they are perfectly safe for both the patient and the fetus. For a kidney stones diagnosis, ultrasound technicians focus on the kidney and pelvic area.
• Magnetic resonance (MR) urography. Urography refers to imaging of the urinary tract: kidneys, ureters, bladder, and urethra. Magnetic resonance (MR) technology creates images using magnet and radio waves. Like ultrasound technology, MR does not use radiation.
• Low-dose computed tomography (CT scan). A CT scan (sometimes called a “cat scan”) uses x-rays to create images. Because this method does involve radiation, it is recommended for the second and third trimesters only, not the first trimester.

How are kidney stones treated in pregnant women?

Kidney stone treatment in pregnant women requires a team approach. Urologists work with obstetricians and other healthcare specialists to make sure treatment is safe and appropriate.

Initial therapies may include the following:

• Observation. Generally, treatment starts with observation, a “wait and see” approach, as most stones pass on their own. Some doctors recommend bed rest, increased fluid intake, and a low-salt diet.
• Pain relief. Patients might be given pain relievers, such as acetaminophen. Other medications, such as non-steroidal anti-inflammatory drugs (NSAIDS) might be prescribed depending on the stage of the pregnancy. Patients should take their medication exactly as prescribed.
• Hydration. Patients may be advised to drink more fluids. Others may receive hydration via intravenous (IV) fluids at the doctor’s office to help stones pass.

If stones do not pass easily, procedures to extract stones or effect passage of urine around stones are considered. If symptoms are not severe, such procedures might be delayed until after the baby is born. In the case of more serious symptoms, trouble urinating, or a urinary tract infection, the patient may undergo treatment during the pregnancy. (In emergencies, these procedures might take place right away.)

The treatment team will carefully consider choices related to any anesthesia and related drugs given during these procedures.

Procedures to extract stones or effect passage of urine around stones include the following:

• Ureteroscopy. Patients undergoing ureteroscopy receive anesthesia. Once it has taken effect, the urologist places a long, thin instrument called a ureteroscope through the urethra and bladder to the ureter or kidney. The ureteroscope is like a tiny telescope that allows the doctor to see into the affected area. The ureteroscope also has a grasping mechanism that allows it to either remove the stone or break it into smaller stones that can pass through urine.
• Stent. A stent is a plastic tube that is surgically placed in the ureter to keep it open. With a stent, urine—and the stone—may flow through the ureter more easily. Stents are temporary; in pregnant patients, they are usually replaced every 4 to 6 weeks.
• Nephrostomy tube. A nephrostomy tube is a type of catheter used to drain urine from the kidney. Typically, urine flows from a kidney to the bladder through a ureter that connects these two organs. With a nephrostomy tube, urine bypasses the ureter and bladder. The surgeon creates a special opening called a stoma on the patient’s side. The nephrostomy tube runs from the kidney and through the stoma, connecting to a urine collection bag outside the body.

  Like stents, nephrostomy tubes are temporary and may need to be changed periodically. Patients receive thorough instructions on the care of their tube and the changing of their urine collection bag.

Resources

American Academy of Family Physicians

“Magnetic Resonance Imaging (MRI)”
(Last updated: June 23, 2020)
https://familydoctor.org/magnetic-resonance-imaging-mri/

American Journal of Kidney Diseases

Thongprayoon, Charat, et al.
“Risk of Symptomatic Kidney Stones During and After Pregnancy”
(Published: April 15, 2021)
https://www.ajkd.org/article/S0272-6386(21)00402-9/fulltext

American Urological Association

Assimos, Dean, et al.
“Surgical Management of Stones: AUA/Endourology Society Guideline (2016)”
(Published: 2016)
https://www.auanet.org/guidelines/guidelines/kidney-stones-surgical-management-guideline

Healthline.com

Seladi-Schulman, Jill, PhD
“Caring for Your Nephrostomy Tube”
(Update: September 18, 2018)
https://www.healthline.com/health/nephrostomy-tube-care

MedlinePlus.gov

“CT Scans”
(Page last updated: April 12, 2021)
https://medlineplus.gov/ctscans.html

“Ultrasound”
(Page last reviewed: December 15, 2020)
https://medlineplus.gov/lab-tests/sonogram/

Medscape

Harrison, Pam
“Pregnancy Increases Risk for Symptomatic Kidney Stone”
(April 28, 2021)
https://www.medscape.com/viewarticle/950073

Nature Reviews | Urology

Semins, Michelle J. and Brian R. Matlaga
“Kidney stones during pregnancy”
(Published online: February 11, 2014)https://www.nature.com/articles/nrurol.2014.17″ https://www.nature.com/articles/nrurol.2014.17

Accessed via: https://svmi.web.ve/wh/intertips/7.UROLITIASIS-Y-EMBARAZO.pdf” https://svmi.web.ve/wh/intertips/7.UROLITIASIS-Y-EMBARAZO.pdf

NEJM Journal Watch

O’Dwyer, Marie Claire, MB BCh BAO, MPH
“Are Pregnant people More Likely to Develop Kidney Stones?”
(September 22, 2021)
https://www.jwatch.org/na54060/2021/09/22/are-pregnant-women-more-likely-develop-kidney-stones

UpToDate

Preminger, Glenn M., MD and Gary C. Curhan, MD, ScD
“Kidney stones in adults: Kidney stones during pregnancy”
(Topic last updated: November 11, 2021)
https://www.uptodate.com/contents/kidney-stones-in-adults-kidney-stones-during-pregnancy

Urology Care Foundation

“Pregnancy and Kidney Stones”
(Summer 2019)
https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/summer-2019/did-you-know-pregnancy-and-kidney-stones

“Preventing and Treating Kidney Stones”
(Summer 2014)
https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/summer-2014/preventing-and-treating-kidney-stones

Urology Marketing Center

“Kidney Stones”
https://www.hsadeghi.com/patient-education/kidney-stones/

Physicians have been using urinalysis, or urine testing, as a diagnostic tool for about 6,000 years. Nowadays, with updated and improved methods, it remains an effective, quick, and easy way to find out more about your overall health. In fact, you may have already had one at an annual physical or other medical appointment.

In our office, we use urinalysis to diagnose urologic conditions, like kidney stones and urinary tract infections. We also use urine tests to monitor your progress if you’ve already been diagnosed.

What do we look for?

A urinalysis has 3 main parts: a visual test, a microscope test, and a dipstick test

In general, a urinalysis has 3 main parts:

A visual test

The color of your urine can tell us a lot. Normal urine is usually clear or pale yellow. But if it has a red, pink, or brown tint to it, that could signify blood in your urine (hematuria). If it’s cloudy, you might have an infection. If it’s foamy, that could be a sign of kidney disease.

A microscope test

We use a microscope to look for what isn’t so obvious. For example, blood can be present in your urine even if it looks normal. This is called microhematuria. The blood cells are so small, you can’t see them with the naked eye. They can be detected only with a microscope.

In addition, a microscope test can show bacteria and white blood cells – two signs of infection. It might also show us crystals in your urine that could eventually develop into kidney stones.

A dipstick test

This test tells us whether certain chemicals or other substances, such as proteins and sugars, are in your urine. It measures your urine’s acidity (pH). A higher pH might indicate kidney stones, urinary tract infections, or other urological conditions. It also measures the concentration (also called the specific gravity) of your urine, which tells us how hydrated you are.

The dipstick itself is a strip of specially-treated plastic that we place in your urine sample. If certain chemicals are present or fall within abnormal ranges, areas of the dipstick will change color.

Sometimes, a dipstick test is done with tablets placed in the urine sample. But the general idea is the same; the tablets can detect certain chemicals in the urine.

Taken together, all of these analyses give clues that help us diagnose your urological problem. We’ll also conduct a physical exam and consider your health history, family medical history, medications, and lifestyle habits to get a complete picture.

We use urinalysis to diagnose urologic conditions, like kidney stones and urinary tract infections

How do I prepare for a urine test?

We can do a urinalysis here at the office. Or you might prepare your urine sample at home and bring it to us. We’ll give you specific instructions ahead of time. For example, we might ask for a fasting urine sample taken first thing in the morning. If that’s the case, then you’ll collect your urine before eating anything that day.

We might also advise you not to take certain medications or supplements beforehand, as these can affect the results. Similarly, some foods and beverages can make urine change color. We’ll let you know the specifics for your urine test. And as always, if you have any questions, please give us a call.

What is a “clean-catch” sample?

Giving a urine sample is fairly simple, but it’s important for it to be a clean-catch sample. When you urinate, germs from your genital area can mix in with urine. The clean-catch method eliminates this mixing as much as possible.

For this test, we’ll give you a clean catch kit. Your kit will contain sterile wipes, a sterile cup, and a label with your name on it.

• Start by washing your hands thoroughly with soap and water. Take the lid off the cup.
• Use the sterile wipes to clean your genitals before you urinate. Women will wipe the inner folds of their labia and the area around their urethra. Men will clean the tip of their penis. (Uncircumcised men should retract their foreskin first.)
• Next, start urinating into the toilet bowl. Then stop for a moment. In other words, hold the flow of urine.
• Carefully position the cup so that urine can flow into it.
• When the cup is about halfway full, stop the flow again. Put the cup aside and finish urinating into the toilet bowl.
• Put the lid securely on the cup without touching the inside. Be sure not to touch the urine either.
• We’ll let you know where to place your sample. If you collect your sample at home, it should be refrigerated unless we tell you otherwise.

Once your sample is analyzed by the lab, we’ll contact you and go over the results and next steps.

Urinalysis doesn’t always give a complete picture of your health, but it will tell us what needs watching and follow-up. Remember, we are always here to answer your questions.

Resources

European Association of Urology

“Urine Test”
(Last updated: February 2021)
https://patients.uroweb.org/tests/urine-test/

HealthCommunities.com

“Urinalysis”
(Page last modified: July 23, 2015)
[Accessed via www.archive.org]

Mayo Clinic

“Urinalysis”
(October 23, 2019)
https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-20384907

MedlinePlus

“Clean catch urine sample”
(Page last updated: January 5, 2021)
https://medlineplus.gov/ency/article/007487.htm

“Urinalysis”
(Page last updated: June 9, 2020)
https://medlineplus.gov/urinalysis.html

National Kidney Foundation

“What is a Urinalysis (also called a “urine test”)?”
https://www.kidney.org/atoz/content/what-urinalysis

StatPearls [Internet] via PubMed.gov

Milani, Daniel A. Queremel and Ishwarlal Jialal
“Urinalysis”
(Last update: May 9, 2021)
https://pubmed.ncbi.nlm.nih.gov/32491617/

Urology Care Foundation

“What is a Urinalysis?”
https://urologyhealth.org/urology-a-z/u/urinalysis

WebMD

“The Truth About Urine”
(Reviewed: February 15, 2020)
https://www.webmd.com/urinary-incontinence-oab/truth-about-urine

Exercise and Incontinence

You’re on your morning run, or playing tennis, or in a cardio class. Whatever you’re doing, your blood is pumping, and you’re working up a sweat. You’re crushing it!

And then it happens. You feel a little urine leak. Your concentration falters and you feel a sense of dread. Is there a restroom nearby? Will anyone notice?

Urinary incontinence while you’re exercising is pretty common, but that doesn’t make it any less inconvenient or embarrassing. The good news is that there are treatments available to resolve incontinence. You can maintain the exercise program that’s so crucial for maintaining good health.

Why do I leak urine when I exercise?

The culprit is stress urinary incontinence (SUI). Typically, the sphincter muscles in your urethra contact to keep urine in your bladder. When you urinate, these muscles relax, and urine is released.

With SUI, pressure on your bladder or urethra makes the sphincter muscles open, sometimes only momentarily, letting urine out. You might notice urine leakage when you laugh, cough, sneeze, too. That’s also considered “stress” urinary incontinence because it’s the pressure caused by movement that puts pressure on the bladder/sphincter and leads to the leakage of urine.

Other types of urinary incontinence are urge incontinence and overflow incontinence.

What can I do about stress urinary incontinence?

First, come see us. We can evaluate your symptoms and help you work out a treatment plan to offer you long-term relief. Here are some of the options:

Non-Surgical Approaches

Pelvic floor exercises and therapy

Kegel exercises are an easy way to strengthen your pelvic floor muscles. They involve squeezing and releasing these muscles several times a day. We will teach you how to do them. We might also refer you to a pelvic floor physical therapist.

Keeping your pelvic floor muscles strong is essential throughout your SUI treatment. It’s a good idea to exercise them every day.

Bladder training

This approach starts with a bladder diary. You’ll keep a log of how much and how often you drink fluids, urinate, and leak urine. With this information, we’ll work out a urination schedule. For example, you might start by urinating every hour. Gradually, you’ll increase the amount of time between bathroom visits, training your bladder to hold urine for longer periods.

Vaginal pessary (for women)

Some women have SUI due to pelvic organ prolapse, when pelvic organs, such as the bladder or uterus, drop into the vagina. A vaginal pessary is a silicone device you can place in your vagina to give these organs more support. There are several different types of pessaries. Some you can insert and take out yourself; others stay in place for up to three months. We’ll guide you through the process.

Clamp/clip device (for men)

Men can wear a special clamp on the penis that presses against the urethra and restricts urine flow. This device cannot be worn constantly, but it may help in short-term situations.

Surgical Approaches

Stress urinary incontinence can also be treated surgically. Some of your options might include:

• Slings. A sling is typically made out of a soft mesh material. In both men and women, a sling can be surgically placed under the urethra to provide support.
• Urethral injections (for women). A woman may choose to have a bulking agent injected into her urethra to thicken it and provide support. This is a short-term solution, however, and you may need to have repeat injections after a year or so.
• Burch procedure (for women). This technique is also called a bladder neck suspension or retropubic colposuspension. During this procedure, stitches are used to attach the bladder neck and urethra to surrounding abdominal tissue. This supports the urethra and sphincter muscles (the muscles that open and close the urethra).
• Artificial urinary sphincter (more common in men). An artificial sphincter is a surgically implanted device. It includes a cuff that is placed around the urethra, a reservoir placed in the abdomen, and a pump. In men, the pump is usually placed in the scrotum; in women, it is placed in the labia. The cuff is filled with fluid and keeps the urethra closed. When you need to urinate, you activate the pump. The fluid then travels from the cuff to the reservoir so that urine can be released. After a few minutes, when you’re finished urinating, the fluid flows back into the cuff to close the urethra again.

Can I still exercise with SUI?

As you can see, there are permanent solutions for urine leaks during exercise. Once you see a urologist and start taking action, you can free yourself from strategies that just hide the problem, like wearing dark clothes and using absorbent products. You’ll no longer have to plan your workout around bathroom breaks, and you’ll have more beverage options when you hydrate.

You’ll also have more choices for exercise, since you won’t be limited to low-impact workouts that put less pressure on your bladder. Instead, you’ll be able to pick other activities, try new ones, or mix and match for variety.

Don’t let incontinence keep you from staying fit. Many people stop their exercise program because of urine leaks, but physical activity is an essential part of staying healthy. Avoiding exercise can raise your risk for other health problems, like obesity and diabetes.

Remember, we are always here to answer your questions and suggest solutions. Just give us a call.

Resources

American Academy of Family Physicians (familydoctor.org)

“Bladder Training for Urinary Incontinence”
(Last updated: June 3, 2020)
https://familydoctor.org/bladder-training-urinary-incontinence/

American Urological Association

Kobashi, K.C., et al.
“Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline”
(2017)
https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guideline

European Association of Urology

“Artificial Urinary Sphincter Implantation in Women”
(Last updated: May 2021)
https://patients.uroweb.org/treatments/artificial-urinary-sphincter-implantation-women/

EverydayHealth.com

Vann, Madeline R., MPH
“Exercising With Stress Incontinence”
(September 14, 2015)
https://www.everydayhealth.com/incontinence/exercising-with-stress-incontinence.aspx

National Association for Continence

“The Best Incontinence Products for Working Out”
https://www.nafc.org/bhealth-blog/the-best-incontinence-products-for-working-out

“Don’t Quit Exercising Because of Urinary Incontinence”
https://www.nafc.org/bhealth-blog/dont-quit-exercising-because-of-urinary-incontinence

UpToDate

“Patient education: Surgery to treat stress urinary incontinence in women (The Basics)”
https://www.uptodate.com/contents/surgery-to-treat-stress-urinary-incontinence-in-women-the-basics

“Patient education: Urinary incontinence in men (The Basics)”
https://www.uptodate.com/contents/urinary-incontinence-in-men-the-basics

Urology Care Foundation

“Bladder Health Exercises”
(July 1, 2015)
https://www.urologyhealth.org/healthy-living/lifestyle-and-exercise/bladder-health-exercises

“Stress Urinary Incontinence (SUI)”
https://urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)

“Stress Urinary Incontinence – What You Should Know”
https://www.urologyhealth.org/resources/incontinence-stress-urinary-incontinence-what-you-should-know

Managing Stress Could Improve Male Fertility

You probably know that stress can have some negative effects on your health. That missed deadline at work can trigger a pounding headache. Worrying about a sick family member might keep you awake all night. And an unexpected car repair bill can leave a queasy feeling in your stomach.

Stress might have an effect on your fertility as well. While the scientific data isn’t firm, several studies have suggested a link between stress and male infertility.

For example, research has shown that stress may lead to a decline in testosterone, a hormone needed for sperm production.

Research also suggests that men under stress may have poorer semen quality. That means that sperm cells aren’t well-formed and could have trouble swimming and fertilizing an egg cell.

While day-to-day stress is difficult enough, the situation can become compounded if you and your partner have been trying to conceive for a while.

Research also suggests that men under stress may have poorer semen quality

Fertility treatment is complex. You’re juggling appointments with specialists and opening up about a very personal part of your life. You and your partner are likely having emotional ups and downs – feeling sad, optimistic, frustrated, disappointed, hopeful, sometimes in a short period of time.

What can you do? It’s easy for us to say “relax.” But that could be one of the keys to increase your chances of conceiving.

We can’t stop stressful events from happening. But we can control how we react to them. Here are some time-tested stress management strategies that may also work for you:

Put a positive spin on it. If you can, reframe the way you view a problem. Is there a way to turn a negative into a positive? Can you break down a problem into small steps and handle them one at a time? Remind yourself that you are doing the best you can.

Try perspective-building activities. You may have heard the expression, “Don’t sweat the small stuff, and remember… it’s ALL small stuff.” Well, built into disciplines such as meditation, yoga, and tai chi, are exercises that help put the challenges of everyday life into perspective. These activities might help release you from the thought patterns that can lead to unproductive stress. Even just listening to music you enjoy may help transport you to a place where you can view challenges from a fresh perspective.

Participate in activities you enjoy. When you’re involved in activities that bring you joy, it also helps put stress in perspective, or at least puts stress on the back burner. Contemplating fun activities gives you something to look forward to and to reflect back on and has the effect of pushing stress-inducing thoughts to the side. It’s important to find out what brings you peace and happiness and incorporate it in your routine.

Take care of your relationship. You and your partner are a team, not just in your desire to have a child, but in all that you do. Providing the support to your partner that you would hope to receive from her helps you each shield one another from stress-inducing events.

Take care of yourself. It’s easy to let self-care slide when you’re feeling stressed. Make sure you’re eating right, getting enough sleep, and exercising. Exercising regularly is a good way to manage anxiety and depression, too (it impacts brain chemistry). It’s important to limit your use of alcohol or recreational drugs because they have a harmful impact on your physical and emotional health over time and can themselves become stress agents.

Ask for help. Recognize that you may not be able to do everything yourself and there’s no shame in asking for a hand. If your work schedule or responsibilities are too demanding, see if you can adjust your hours or delegate some of your work. The same applies to activities outside of work. See if there is a way to get some help with your to-do list. Even handing off simple chores such as running errands or home maintenance tasks can help reduce your stress levels.. Try not to overextend yourself and feel free to say “no” if someone is asking too much of you – or if you find you’re asking too much of yourself.

Reach out to others. Confiding in a trusted friend or relative may bring comfort, and that person might have insight for dealing with a stress-inducing problem that would otherwise been unobtainable. Support groups, where you can share insights with others experiencing similar challenges, may also be available to you, or to you and your partner.

See a professional. Therapists can help us see our lives with a new perspective. If you find that your stress levels are escalating or tough to manage, seeing a counselor is a wise choice. An objective third party can make suggestions you might not have thought of. If you’d like to see a therapist, let us know. We can refer you to a local professional.

We can’t guarantee that stress management will improve fertility, but taking good care of yourself during this difficult time will produce benefits for you and your partner. Together, you’ll be able to handle what comes next.

Resources

American Heart Association

“3 Tips to Manage Stress”
(Last reviewed: June 7, 2017)
https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/3-tips-to-manage-stress

MedicalNewsToday.com

Whiteman, Honor
“Stress linked to male fertility”
(May 30, 2014)
https://www.medicalnewstoday.com/articles/277543

MedlinePlus.gov

“Learn to manage stress”
(Reviewed: October 7, 2018)
https://medlineplus.gov/ency/article/001942.htm

National Institute for Mental Health

“5 Things You Should Know About Stress”
https://www.nimh.nih.gov/health/publications/stress/index.shtml#pub4

Nature Reviews Urology

Nargund, Vinod H.
“Effects of psychological stress on male fertility”
(Abstract. Published: June 9, 2015)
https://www.nature.com/articles/nrurol.2015.112#Abs3

Reproductive Biology and Endocrinology

Ilacqua, Alessandro, et al.
“Lifestyle and fertility: the influence of stress and quality of life on male fertility”
(Full-text. 2018)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260894/pdf/12958_2018_Article_436.pdf

ScienceDaily

Columbia University’s Mailman School of Public Health
“Stress degrades sperm quality, study shows”
(News release. May 29, 2014)
https://www.sciencedaily.com/releases/2014/05/140529100719.htm

SexHealthMatters.org

“Keep Your Relationship Strong During Infertility Treatments”
(October 2, 2019)
https://www.sexhealthmatters.org/sex-health-blog/keep-your-relationship-strong-during-infertility-treatments

Hematuria is the general term for blood being present in your urine. Microhematuria (sometimes called microscopic hematuria) is a subtype of hematuria. With microhematuria, the red blood cells in your urine are so small, they can’t be seen with the naked eye. The cells can be seen only with a microscope during urinalysis. 

So, with microhematuria, when you glance at the toilet, your urine won’t look much different from the way it always looks.

Most of the time, microhematuria isn’t a cause for alarm. But you don’t want to ignore it, either. Sometimes, it’s caused by a more serious health condition, such as kidney stones or bladder tumors. We’ll do some further testing to determine the cause. 

What causes blood in the urine? 

Microhematuria can be caused by a variety of conditions. Some are simple. For example, if you’ve worked out really hard (like running a marathon), you might have some blood in your urine. Hematuria can also be a side effect of medications. If that’s the case, we’ll review your prescriptions and see what can be adjusted. 

Other causes are more complicated. Some of the more common causes are: 

• Kidney or bladder stones
• Kidney infection
• Bladder, prostate, or kidney infections
• Urinary tract infection
• An enlarged prostate (also called benign prostatic hyperplasia or BPH)
• Bladder, prostate, or kidney cancer
• Sickle cell disease or other blood disorder
• Blood-clotting disorders (hemophilia) or blood thinner medications
• Polycystic kidney disease
• Sexually transmitted infections
• Trauma to the kidneys

Sometimes, the cause can’t be found, and hematuria clears up on its own. 

Finding out why there is blood in your urine. 

Once we’ve detected blood in your urine, we’ll do a full urological exam. If you’re a man, this might include a digital rectal exam. Women might have a pelvic exam. We’ll also ask you questions about your medical history and the medications you take. In addition, we’ll ask about your family’s medical history. Your answers to our questions will help us determine if you have any risk factors for bladder or kidney issues.

Based on your history and your symptoms, we’ll determine whether you are at low risk, intermediate risk, or high risk for certain urological conditions, like kidney stones or cancer. Then, we’ll talk together about next steps.

Low Risk

If you’re at low risk, we might have you come back in within 6 months for another urinalysis. We may also suggest the following two tests that can give us more information:

• Cystoscopy. This test allows us to see the inside of your bladder and urethra (the tube that urine passes through on its way out of your body) by using a cystoscope, a thin tube-shaped instrument. This test can be done here at the office, at an outpatient clinic, or in a hospital. It usually takes about 5 or 10 minutes, and you’ll likely be given local anesthesia or a numbing agent. 

If we notice any tissue abnormalities, a biopsy can be taken during the cystoscopy. That tissue will be examined with microscope. 

• Kidney ultrasound. This test uses sound waves to construct images of your kidneys. It’s also called a renal ultrasound. Further imaging tests, as described below, might be done at a later time.

We know that care decisions can be challenging. Be assured that we are here to answer all your questions!

If you decide not to have a cystoscopy or kidney ultrasound, and you still have blood in your urine after a subsequent urinalysis, you will probably fall into the intermediate risk category.

Intermediate Risk or High Risk

If you are at intermediate or high risk, we’ll recommend cystoscopy and a kidney ultrasound as described above. We’ll also talk to you about upper urinary tract imaging, which may include the following:

• CT scan. Computed tomography scans (often called “cat” scans) use X-rays to give us detailed images of your kidneys, bladder, and ureters (the two tubes that connect your kidneys and bladder). A CT scan can give us information about stones, infections, cysts, and tumors. 

• MR urography. MR stands for magnetic resonance. (You might be more familiar with the term magnetic resonance imaging or MRI.) If you are unable to have a CT scan, you might have MR urography, which provides images using radio waves.

• Retrograde pyelography. If you are unable to have a CT scan or MR urography, we might conduct a retrograde pyelography exam. This test uses X-rays along with a special dye injected into your ureters. This dye helps gives us a better view of your ureters and kidneys. Note: If you have a family history of kidney cancer or a genetic syndrome that increases your risk, we’ll most likely conduct imaging tests no matter what your risk level is.

Until we know more about your microhematuria, we encourage you to relax, though we know that can be easier said than done. And we understand that this is a lot of information to take in all at once. By all means, feel free to ask us any questions you have. We’ll take this process one step at a time. 

Resources

American Academy of Family Physicians

“Microscopic Hematuria”
(Last Updated: May 12, 2020)
https://familydoctor.org/condition/microscopic-hematuria/ 

American Urological Association

Barocas, D.A., et al.
“Microhematuria: AUA/SUFU Guideline”
(2020)
https://www.auanet.org/guidelines/microhematuria

Healthline

Sawyers, Tessa
“CT Scan vs. MRI”
(Updated: August 10, 2020)
https://www.healthline.com/health/ct-scan-vs-mri

Medscape

Babaian, Kara N., MD, FACS
“What is the role of upper urinary tract imaging in the diagnosis of bladder cancer?”
(Updated: December 30, 2020)
https://www.medscape.com/answers/438262-38704/what-is-the-role-of-upper-urinary-tract-imaging-in-the-diagnosis-of-bladder-cancer

National Institute of Diabetes and Digestive and Kidney Diseases

“Hematuria (Blood in the Urine)”
(July 2016)
https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine 

UpToDate.com

Feldman, Adam S., MD, MPH
“Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)”
(Last updated: August 16, 2018)
https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics 

Urology Care Foundation 

“How Blood in the Urine is Tested and Treated”
(October 14, 2020)
https://www.urologyhealth.org/careblog/how-blood-in-the-urine-is-tested-and-treated 

“What is Cystoscopy?”
https://www.urologyhealth.org/urologic-conditions/cystoscopy 

“What is Hematuria?”
https://www.urologyhealth.org/urologic-conditions/hematuria

“What is Retrograde Pyelography?”
https://www.urologyhealth.org/urology-a-z/r/retrograde-pyelography

Male Birth Control: Present and Possible Future

Perhaps you and your partner are finished having children. Or you just know you don’t want children in the future and want to make sure no unplanned pregnancies happen. If this is the case, you might be looking for permanent methods of birth control.

Is a vasectomy the answer? For many men the answer is “yes.” Since vasectomy became common in the 1970’s it has provided men and families a safe, effective, minimally-invasive form of birth control with a fast recovery period. A vasectomy involves cutting two tubes called the vas deferens – the pathways that sperm travel through. The cut ends are then tied or sealed together with heat, blocking the path of sperm. (Note: A vasectomy doesn’t take effect immediately, as some sperm cells remain in the vas deferens and will need clear out. You and your partner will still need to use contraception until there are no more sperm cells in the pipeline.)

Vasectomies are usually considered permanent. A vasectomy reversal is an option if a man changes his mind, but the procedure can be expensive, and reversals are not effective 100% of the time. This may give some men reason to consider alternatives to vasectomy. Nowadays viable sperm can also be surgically retrieved for use with IVF (in vitro fertilization) procedures, even years after a vasectomy.

Vasectomy Alternatives

Are there alternatives? Yes.

Condoms

Male condoms can be an effective form of birth control – 98% effective, in fact – as long as you use them the right way. Condoms can reduce the risk of sexually transmitted infections (STIs), too – again, when used correctly. Many men unknowingly use condoms incorrectly, often because they learned how to use a condom informally or casually when they were younger and perhaps sexually inexperienced. (If you’re not sure you’re using condoms correctly, we can provide you with accurate educational material.)

Options for Women

Your partner has temporary contraceptive options, too. Female condoms, hormonal contraceptives, birth control pills, intrauterine devices (IUDs), and diaphragms are all possibilities for temporary birth control. Her gynecologist can help her choose which methods are best for her.

Women may also consider tubal ligation (sometimes called “getting your tubes tied”), a surgical procedure that cuts and seals the fallopian tubes, preventing sperm cells from reaching an egg. This method is permanent, however. It’s also more complex than a vasectomy, and it may have more complications, a longer recovery period, and a higher cost.

What about withdrawal?

Some men wonder whether withdrawal (coitus interruptus or “pulling out” before ejaculation) is a viable contraceptive method. This approach is not considered reliable, as sperm cells can be present in pre-ejaculate (precum) and find their way into the vagina before the man withdraws his penis. The method also requires determination and perfect timing on the part of the man, which can be hard to control in the midst of intercourse. (One more point to consider – withdrawal alone provides no protection against STIs.)

Male Birth Control Under Investigation

In the meantime, scientists are looking into other temporary, reversible male contraceptive options.

• Birth control pills. Scientists are studying hormonal oral contraceptives for men. While these pills have generally passed safety tests in humans, more research is needed to determine how effective they are.
• Hormonal gel. Scientists are also investigating a hormonal contraceptive gel that can be applied to the skin once a day.
• Reversible Inhibition of Sperm Under Guidance (RISUG). Like vasectomy, RISUG blocks the path of sperm cells. But instead of undergoing surgery, men receive an injection of a special gel that attaches to the walls of the vas deferens, forming a barrier that sperm cells can’t swim past. Clinical trials have shown RISUG to be effective, and the effects could last up to 10 years. It can also be reversed by injecting another substance that breaks down the gel and flushes it out.
• “Clean Sheets Pill.” How about a pill that allows men to feel the pleasure of orgasm without actually ejaculating? That’s the aim of the “clean sheets pill,” which men can take a few hours before sex. Much more research is needed, however, and some experts question whether men will be open to semen-free ejaculation.

Talk with Your Partner(s)

We encourage you and your partner to discuss your birth control options thoroughly. This is a decision you should make together, considering your feelings about family planning and your comfort with different contraceptive methods. If you’re single and/or having sex with multiple partners, we urge you to have the vital contraception/STI conversations with everyone you have sex with, including oral sex and anal sex.

Resources

Basic and Clinical Andrology
Khilwani, Barkha, et al.
“RISUG® as a male contraceptive: journey from bench to bedside”
(Published online: February 13, 2020)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017607/ 


BBC.com
Campo-Engelstein, Lisa
“Are we ready for men to take the pill?”
(October 22, 2019)
https://www.bbc.com/news/health-49879667

Birth Control Pharmacist
Gonzalez, Steven
“Updates In Male Contraceptive Agents”
(June 22, 2020)
https://birthcontrolpharmacist.com/2020/06/22/updates-in-male-contraceptive-agents/

Endocrine Society
“Dimethandrolone undecanoate shows promise as a male birth control pill”
(March 18, 2018)
https://www.endocrine.org/news-and-advocacy/news-room/2018/dimethandrolone-undecanoate-shows-promise-as-a-male-birth-control-pill

“Second potential male birth control pill passes human safety tests”
(March 25, 2019)
https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019–second-potential-male-birth-control-pill-passes-human-safety-tests

LiveScience
Rettner, Rachael
“World’s First Injectable Male Birth Control May Soon Arrive in India”
(November 20, 2019)
https://www.livescience.com/male-birth-control-risug.html

Mayo Clinic
“Withdrawal method (coitus interruptus)”
(April 8, 2020)
https://www.mayoclinic.org/tests-procedures/withdrawal-method/about/pac-20395283

MedlinePlus.gov
“Tubal Ligation”
(Page last updated: August 10, 2020)
https://medlineplus.gov/tuballigation.html

National Health Service (UK)
“Condoms: Your Contraception Guide”
(Page last reviewed: September 19, 2017)
https://www.nhs.uk/conditions/contraception/male-condoms/

Urology Care Foundation
“Quick Snip: Should You Get a Vasectomy?”
(Fall 2014)
https://www.urologyhealth.org/patient-magazine/magazine-archives/2014/fall-2014/quick-snip-should-you-get-a-vasectomy

Vasectomy.com
Radcliffe, Shawn
“Birth Control for Men: ‘Clean Sheets’ Pill”
(November 28, 2018)
https://www.vasectomy.com/article/vasectomy/alternatives/birth-control-for-men-clean-sheets-pill

Verywellhealth.com
Stacey, Dawn, PhD, LMHC
“Male Birth Control Options”
(April 29, 2020)
https://www.verywellhealth.com/male-birth-control-injections-3970355

You’re getting older. You wake up needing to use the bathroom every few hours. And even after you pee, you feel like you still have to. You might need to strain to get any kind of flow going.

You can’t get a good night’s sleep. Your friends ask you to join them on a day-long hike in the mountains, but you decline because you’re not sure there will be bathrooms nearby. Your partner expresses some concerns about your overall health. You wonder what’s going on?

Prostate growth can squeeze the urethra and disrupt urine flow

To many men, especially over the age of 50, this scenario has a familiar ring. These are all signs of a common, treatable condition: Benign prostatic hyperplasia (BPH) otherwise known as an enlarged prostate. Most of the time, the prostate gets bigger as men age. About half of men between the ages of 51 and 60 have some degree of BPH, according to the American Urological Association (AUA). The rates increase as men get older.

For some men, BPH is no problem. For others, prostate growth squeezes the urethra and disrupts urine flow.

Fortunately, there are lots of ways to treat an enlarged prostate.

Choosing a BPH treatment can be a challenge. It’s normal to have lots of questions:

• Should I wait and see what happens?
• Should I try medication?
• Should I go with a minimally-invasive procedure? (And what does “minimally-invasive” really mean, anyway?)
• Should I have surgery?
• What are the risks of each treatment?
• What will my recovery be like?
• How long do the results last?

Treatment terminology can be confusing, too, with acronyms like TURP, TUIP, TULIP, HoLEP, HoLAP, TUMT and more. How can you determine which treatment options are right for you?

Your urologist can be both a trusted resource and a faithful advocate. Rely on your doctor’s training and experience as you weigh the pros and cons of your options. Don’t hesitate to ask questions.

Let’s look at some considerations doctors make when guiding BPH treatment decisions:

How severe are your symptoms?

Not all men have bothersome symptoms. Or their symptoms might happen just every once in a while. These men might decide on watchful waiting, holding off on any treatment and seeing if the symptoms worsen.

On the other hand, men whose symptoms affect their day-to-day life will probably choose a more active treatment path.

How large is your prostate?

On average, the prostate gland is about the size of a walnut and weighs about an ounce. Prostate growth varies from man to man.

If your prostate is growing modestly, your symptoms might not be severe. Typically, the larger your prostate, the more troublesome your symptoms will be. Some treatments are often recommended specifically for men with larger prostates. Your urologist will be able to discuss the treatment that is best suited for your particular condition.

How’s your overall health?

Are you generally healthy and fit, or do you have other medical conditions, like diabetes or heart disease, that complicate things?

For example, the AUA cautions about alpha blocker medications for men who need cataract surgery. This can be discussed and coordinated with your urologist and ophthalmologist. There are other minimally invasive treatments that can be used for men who can’t have surgery due to their overall health. Convective water vapor ablation (destroying excess prostate tissue with steam) might be a better option for men who don’t have success with BPH medications. Again, this and other treatment options should be discussed with your urologist to fit your particular needs.

Your treatment path may also depend on other urological issues you might be having, like bladder stones, bleeding from the prostate, blood in your urine, or difficulty emptying your bladder.

What’s your preference?

Some men are uncomfortable taking medications, or they might decide the side effects aren’t worth it. Others aren’t comfortable with having anesthesia or surgery. Still others might be reluctant to have procedures involving lasers, electric currents, or microwaves.

Other considerations: What are potential complications? What are the side effects? Will you have trouble with erections or ejaculation? Will there be significant pain? Does the treatment require a hospital stay? Will you have restrictions?

In some cases, your treatment decisions might be quite limited. In other situations, you might have a number of options to consider. You, your doctor, and your partner and family, if appropriate, can work together to come up with a BPH management plan that meets your needs.

Resources

UrologyHealth.org

“What is Benign Prostatic Hyperplasia (BPH)?”
(Updated: May 2019)
https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

UpToDate.com

Cunningham, Glenn R., MD and Dov Kadmon, MD
“Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
(Last updated: July 24, 2018 with literature review current through June 2020)
www.uptodate.com (by subscription)

Revised December 2022

Can COVID-19 be spread through sex?
It’s a good question—and an important one.

The COVID-19 pandemic is now in its fourth year. Since the beginning, scientists have been carefully studying the coronavirus, its transmission, and its long-term effects. They have been keeping up with numerous variants. And while great progress has been made, there’s still more to learn.

The effect of COVID-19 on sexuality has been one intense area of study. Scientists have investigated whether the virus can be transmitted during sexual activity. And the answer is yes.

How might COVID be transmitted through sex?

COVID-19 isn’t typically considered a sexually transmitted infection (STI), but the virus can still be passed during sex.

COVID-19 isn’t typically considered a sexually transmitted infection (STI), but the virus can still be passed during sex:

Respiratory droplets. The COVID-19 virus is spread through respiratory droplets. When a person exhales, tiny droplets containing water and other particles are expelled into the air. Even more droplets are released during talking, coughing, and sneezing. These droplets can contain the virus.

This means that sex, with its close contact and heavy breathing, can be risky. Droplets containing the virus can be inhaled by a partner, landing in their mouth or nose. If the virus gets mixed with saliva, it can be spread during kissing, too.

Touching surfaces. The droplets don’t just linger in the air. Droplets, along with the virus, can land on surfaces like clothes, skin, bed sheets, and sex toys. If a person touches these surfaces, then touches their eyes, nose, or mouth, it’s possible to get the virus.

Bodily fluids. The coronavirus can be spread through contact with feces, researchers say. So if sexual activity includes anal intercourse or any other fecal contact, there is a risk of transmission.

What about semen and vaginal fluids? Currently, scientists don’t think the virus is likely to spread through contact with these fluids, but it’s still possible.

“The detection of [the virus that causes COVID-19] in urine and semen is very rare; however, a possible risk of transmission through these bodily fluids has not yet been ruled out,” wrote the authors of an April 2022 study in Nature Reviews Urology.

Reducing COVID-19 risk during sex

Experts recommend following COVID-19 guidelines during intimacy.

Get vaccinated. COVID-19 vaccines and boosters are now widely available at clinics and pharmacies around the country. Vaccines reduce a person’s risk of getting COVID-19 in the first place, and if an infection does occur, vaccines lower the chances of serious illness or hospitalization. Sex partners should be vaccinated as well.

Wear masks during sex. It may not sound romantic, but wearing masks during sex can reduce the risk of COVID-19 transmission.

Don’t have sex if either partner has COVID-19 symptoms or has been exposed. It may be common sense to avoid sex if one partner is coughing or sneezing. But it’s important to remember that people can have COVID-19 without symptoms. (This is called being asymptomatic.) So a person can pass the virus to another even if they’re feeling well.

Test regularly. Before sex, get tested for COVID-19 at a clinic or with a home test. Be aware that a negative result doesn’t always mean a person is free of the virus. Some kits require a second test (usually within 24 to 48 hours) to confirm a negative result. Also remember that if a person tested negative for COVID-19 last week, they still could have picked up the infection since then and would need testing again.

In addition to COVID-specific guidelines, these safe sex practices are always a good idea:

Know a partner’s status. It’s critical to know whether a partner has a history of STIs or might have one at the time of a sexual encounter. People should also disclose if they have been exposed to COVID-19 (or if they think they have). Testing for both STIs and COVID-19 are effective ways to find out.

Always use a condom or dental dam during sex. That means every time. With every sex act. Not just every sexual encounter. So if couples have vaginal sex and oral sex in the same night, they need fresh protection for each event. What’s a dental dam? It’s a small layer of latex or polyurethane that serves as a barrier for oral sex. When properly placed over a person’s genitals or anus, it can protect both partners from infections. Dental dams are sold online or in drugstores. It’s also easy to make one: Snip the top and bottom off a condom with scissors and cut the condom lengthwise.

Limit the number of sexual partners. Casual sex and hookups can be risky, especially when partners don’t know each other well. Consider limiting sex with one committed, monogamous partner.

Wash up! People should wash their hands in soapy water before and after sex. Sex toys should also be thoroughly washed.

Having great sex

Enjoying sex during a pandemic takes some planning, but it also gives couples a chance to be creative. Here are some safe activities to think about:

Virtual sex. Couples can still share intimacy without physically being together. It might feel a little clumsy at first, but try to relax and give it a chance. Experiment by using a video-calling app, exchanging videos or photos, or sharing audio-only calls. Set the scene with some soft music or candlelight. Share fantasies. And who knows? After the pandemic is over, couples might have a new list of adventures to try in person!

Masturbation. Solo sex can be exciting, liberating, and fun. Relax and let the imagination take over. The sky’s the limit during fantasies. Making these connections in the brain can trigger deeply pleasurable physical and emotional satisfaction.

Resources

Centers for Disease Control and Prevention

“Dental Dam Use”
(Page last reviewed: June 2, 2021)
https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

“How COVID-19 Spreads”
(Last updated: July 14, 2021)
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

Mayo Clinic

“Sex and COVID-19: Can you get COVID-19 from sexual activity?”
(March 30, 2022)
https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/sex-and-coronavirus/faq-20486572

Nature Reviews Urology

Ebner, Benedikt, et al.
“The COVID-19 pandemic — what have urologists learned?”
(Published: April 13, 2022)
https://www.nature.com/articles/s41585-022-00586-1

NYC Health
“Safer Sex and COVID-19”(October 13, 2021)
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

Scientific American

Barber, Carolyn
“When Is It Safe to Have Sex after COVID?”
(March 9, 2022)
https://www.scientificamerican.com/article/when-is-it-safe-to-have-sex-after-covid/