Introduction

Urinary tract infections (UTIs) are very common, especially among women, with up to 60% experiencing one at some point. About 25% of these women will have recurrent UTIs (rUTIs), which negatively affect their quality of life, social relationships, sexual relationships, and self-esteem, causing issues like irritability and tiredness. Women with rUTIs often experience sexual problems, such as pain during intercourse, anxiety or fear about getting another UTI, and lubrication issues.

The bladder’s glycosaminoglycan layer, made of chondroitin sulfate (CS) and hyaluronic acid (HA), protects against bacteria. When this layer is weak, bacteria can more easily cause infections. Treatments that restore this layer, like intravesical instillation of HA (introducing HA to the bladder through a catheter), can reduce rUTIs and improve sexual function.

A recent study showed that an oral mix of HA, CS, quercetin, and curcumin helped urinary symptoms in bladder cancer patients. However, no studies have focused on oral HA and CS for rUTI symptoms. Since rUTIs are common and impact sexual and urinary health, finding effective oral treatments is important.

This study tested an oral preparation of HA, CS, N-acetylglucosamine, and vitamin C to see if it improves sexual and urinary symptoms in women with rUTIs.

Methods

This study was a small, single-center trial involving sexually active premenopausal women (>18 years) with rUTIs. Participants were recruited between March 2022 and April 2023, and they provided informed consent. They were randomly assigned to either an intervention or control group using a computer-generated list.

Participants included women who had frequent UTIs, defined as more than two symptomatic episodes within six months or more than three within a year. Women under 18, using hormonal contraception, pregnant, breastfeeding, or with certain medical conditions were excluded.

All participants underwent thorough medical and sexual history assessments, physical exams, and urine tests. Their sexual function was measured using the Female Sexual Function Index (FSFI), and urinary symptoms were assessed using the International Prostate Symptom Score (IPSS).

The intervention group received an oral capsule containing HA, CS, N-acetylglucosamine, and vitamin C, along with a cranberry-based supplement twice daily for three months. The control group received only the placebo (cranberry) supplement during this period. After three months, the treatments were switched, with the first group receiving only the placebo supplement and the control group receiving the active intervention along with the placebo supplement for the next three months.

The study aimed to evaluate improvements in sexual and urinary symptoms. Data collection followed ethical guidelines, and statistical analysis determined the effectiveness of the treatments.

Results

The study involved 50 women, with a median age of 33, mostly in stable relationships. Constipation was common (68%), averaging 5 UTIs per year. Most UTIs were caused by E. coli. The groups were similar in baseline characteristics.

Sexual function, measured by the FSFI score, improved more in the intervention group at 3 months compared to the control group (median FSFI score 30.8 vs 28.1). Half of the intervention group saw a significant improvement in sexual function (52% vs 24%). Urinary symptoms, measured by IPSS, also improved more in the intervention group (median IPSS 5 vs 7). More participants in the intervention group experienced clinically meaningful improvements in urinary symptoms.

After switching treatments, the control group showed significant improvement in sexual function, making their scores similar to the intervention group. Urinary symptoms improved in the control group but not significantly in the intervention group after crossover.

Logistic regression analysis indicated that being in the intervention group and having lower baseline FSFI scores were predictors of significant improvement in sexual function. Similarly, younger age, higher baseline IPSS, and being in the intervention group were predictors of improvement in urinary symptoms.

Discussion & Conclusion

The findings of this study showed that participants taking the HA, CS, N-acetylglucosamine, and vitamin C supplement showed significant improvements in both urinary and sexual symptoms compared to a control group. These benefits persisted even after stopping the supplement, and those in the control group who later started the supplement experienced similar improvements.

Sexual function and urinary symptoms are closely linked in rUTI cases. Many individuals with rUTI suffer from sexual dysfunction due to inflammation and other issues. HA helps by protecting the bladder lining, hydrating tissues, and reducing inflammation. This study’s findings align with previous research showing HA’s benefits for sexual and urinary health.

While the trial demonstrated the supplement’s effectiveness, it had limitations such as a small sample size and lack of a true placebo group due to the inclusion of the cranberry-based supplements. Future studies with more participants and longer follow-ups are needed to confirm these promising results. Overall, the supplement shows potential as a supportive therapy for improving symptoms in individuals with rUTI.

References:

• Boeri, L., De Lorenzis, E., Lucignani, G., Turetti, M., Silvani, C., Zanetti, S. P., Longo, F., Albo, G., Salonia, A., & Montanari, E. (2024). Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: A randomized crossover trial. The Journal of Sexual Medicine, 21(7), 627–634. https://doi.org/10.1093/jsxmed/qdae052