Episode 255: Your UTIs Might Not Be UTIs — What Your Bladder, Your Vestibule, and Your Hormones Have in Common

If you've ever had urinary symptoms that antibiotics didn't fix — and your cultures kept coming back negative — this episode is for you.A new 2026 study in the Journal of Sexual Medicine followed 253 women with recurrent UTIs and persistent urogenital symptoms despite negative urine cultures. What researchers found reframes everything: 85% of these women had hormonally mediated vestibulodynia, 75% had pelvic floor hypertonicity, and only 15% had a classic urologic cause for their symptoms.This isn't a bladder problem. It's a hormone problem — and the vulvar vestibule, urethra, and bladder are one integrated, estrogen- and androgen-responsive system. Whether it presents as genitourinary syndrome of menopause (GSM) in a postmenopausal woman or hormonally mediated vestibulodynia in a younger one, the tissue-level pathophysiology is the same.In this episode, Dr. Carolyn Moyers breaks down:• Why persistent urinary symptoms after negative cultures have a hormonal explanation• The shared embryologic origin of the vestibule, urethra, and bladder trigone — and why it matters• How androgen deficiency drives vestibular inflammation, pelvic floor guarding, and bladder dysfunction in a self-perpetuating cycle• Why this affects premenopausal women too — 98.9% of premenopausal patients in the study had below-range free testosterone• What the Rubin et al. 2025 data adds: vaginal prasterone (DHEA) was associated with meaningfully lower UTI rates in women with vulvovaginal atrophy — treating the hormone environment changed the urological outcome• What integrated treatment looks like — vaginal estrogen for GSM, compounded estradiol/testosterone gel for vestibulodynia, pelvic floor PT for hypertonic muscles• The honest limits of this research: selection bias, non-uniform hormonal evaluation, absence of long-term outcome data — and what prospective studies still need to answerThis episode builds directly on Episode 149 — When Sex Hurts with Dr. Jill Krapf. If you haven't listened to that one, it is linked below and is essential companion listening.https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731🔗 References & Resources:• Agrawal et al., Journal of Sexual Medicine, 2026 — Hormonally Mediated Vestibulodynia and Persistent Urogenital Symptoms• Rubin et al., Menopause, 2025 — Prevalence of UTIs in Women with Vulvovaginal Atrophy and the Impact of Vaginal Prasterone• Sky Women's Health Podcast — Episode 149: "When Sex Hurts" with Dr. Jill Krapf [link in show notes]• skywomenshealth.com🔗 Connect with Dr. Carolyn Moyers📸 Instagram: @drcarolynmoyers🎥 YouTube: @drcarolynmoyers🌐 Website: www.skywomenshealth.com