Blessed be the over-the-counter opportunity to turn your own pee orange. I am about to date myself right here before you, but in my early college years, I had the unfortunate experience of contracting a urinary tract infection a few times in the days before over-the-counter pain killers for UTIs such as Uristat (drug name: phenazopyridine) were made available. This meant that the time period between when you first had symptoms and when you could have a doctor take a urine sample and perhaps perform a pelvic exam before prescribing a drug you then had to take to the pharmacy and wait while it was filled and then finally take it was, suffice it to say, excruciating. The Mayo Clinic describes the symptoms of a UTI as "A strong, persistent urge to urinate" and "A burning sensation when urinating," but this does not convey the actual horror of feeling like you need to pee within seconds of having just peed coupled with the bone-chilling fear of the sensation that your nether regions are on fire that you feel when you do pee.
So even though my encounters with UTIs became less frequent as I aged, I heralded the advent of over-the-counter pain medication for UTIs. Finally, some relief between when you first show symptoms and when you make it to the doctor.
However, it turns out that some women may not be aware that phenazopyridine is just a painkiller, and that you need to go to a doctor to get antibiotics even if the phenazopyridine treats your symptoms effectively. PalMD at Denialism Blog, who has encountered this problem in his medical practice, linked a study showing that alarmingly high rates of women just use the painkiller and don't follow up with a doctor for antibiotics. More than a third of the women surveyed used the OTC medication and didn't get any treatment from a doctor. Considering that untreated UTIs can develop into kidney infections, this is no small deal. PalMD asks if it's ethical to allow phenazopyridine to be sold over the counter in this case. Where do we find a balance between allowing patients to control their own pain and the need for the most effective health care? Certainly, the pain of a UTI functions as a strong motivator to get yourself to a doctor, but as someone who has actually experienced this kind of pain before, I have to insist that relief is more a right than an abstract question of balance.
Obviously, a number of factors cause women to treat the symptoms, but not the disease. The most obvious factor is ignorance — many women don't know that phenazopyridine treats only the symptoms, and may assume that they are better because they feel better. Interestingly, though, the study's authors found that increased knowledge of how the drug works only had a mild effect on behavior.
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Individuals who had correct knowledge about phenazopyridine's analgesic effects were less likely to inappropriately use it and substitute it for medical care, even when we controlled for previous use of prescription phenazopyridine and history of UTI. However, correct knowledge has only a moderate effect on decreasing inappropriate use and substitution behaviors. Even if all consumers had correct knowledge about phenazopyridine, there would still be substantial inappropriate use and substitution. Thus, increasing knowledge alone cannot provide a complete solution.
Translated from study-speak: Women who knew that phenazopyridine was just a painkiller and doesn't actually cure the disease were still just taking the painkiller and not getting follow-up care that includes the necessary antibiotics. Why? Well, further studies are needed, but I have some theories.
The first thing that comes to mind is that 47 million Americans lack health insurance. UTIs are extremely common, with half of all women contracting at least one in their lifetimes, and so it's probably easy for uninsured women to justify the belief that they can handle this common condition alone and they don't need to spend a bunch of money they don't have paying a doctor and buying antibiotics. This isn't an uncommon gamble the uninsured take; a visit to any E.R. in America will reveal that many patients are there with ailments that wouldn't require a hospital visit if they had sought treatment when they first got sick.
But I can't help but wonder if the wary attitudes about sex in our culture also contribute to the problem. When you see a doctor for a UTI, you're often running the risk that she's going to have to ask you to plant your feet in the dreaded stirrups. This kind of very personal exam causes many women serious anxiety, so it's no wonder that many would rather avoid it as much as possible.
And given that a UTI is often caused by a recent bout of sexual intercourse, chances are a doctor's visit will lead to questions about your sexual history. A good doctor knows how to be discreet and respectful, but women run the risk that their doctor might be neither of those.
Which approach to getting women to the doctor will come easier?
Prior to this year's presidential election, universal health care was often thought of as a hopelessly long-term, utopian project. But universal health care is in our grasp now, and so while fighting for that, we can aim high for a world where we're more comfortable with our sexuality and our doctors are too.