A new study published in July 2026 found that applying estradiol cream around the opening of the urethra prevents recurrent UTIs in postmenopausal women just as effectively as the standard practice of inserting it into the vagina with an applicator.1
What the researchers found
Over 100 postmenopausal women with a history of repeat UTIs were split into two groups:
- Group 1: intravaginal. Inserted 1 gram of estradiol cream into the vagina twice weekly, the old-fashioned way.
- Group 2: periurethral. Applied 0.5 grams of estradiol cream around the urethral opening only, twice weekly. (It's worth saying plainly that "periurethral" means around the urethra, not inside of it. Nobody in this study put anything inside the urethra itself.)
Six months later, the two groups had prevented UTIs equally well. And roughly half of each group had no UTIs at all.1
But UTI prevention wasn't the only thing researchers were tracking. Interestingly, women using the periurethral application method reported far less vaginal itching than the women using the the intravaginal application method.1 And while more studies are needed, there's hope for those of us who find that using vaginal estrogen can lead to unintended itching or discomfort.
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in minutes.A small study, a familiar frustration
This new study is a small study. But it cuts across many of the frustrations women face when using vaginal estrogen.
- Cleaning the applicator is its own small chore. How do you even clean it? Are you supposed to boil it, run it through the dishwasher, or buy the disposable ones instead? Women have been improvising answers to this for decades.
- Is ditching the applicator even allowed? Oftentimes women will throw away the applicator, sometimes with a measure of secrecy or not being sure if this is "allowed". These women may find it simpler, less messy, or more comfortable to apply vaginal estrogen cream with a fingertip instead.
- Vaginal estrogen is supposed to stop discomfort, not make it worse. Itching is a rare side effect of using vaginal estrogen cream. But it can happen. And while there are workarounds, any vaginal irritation can lead many women to give up on vaginal estrogen altogether. What's exciting here is that this study points to an easy fix: side effects like vaginal itching might be minimized with a different application approach.
- Comfort matters even more for older patients. When there is significant atrophy present, as it can oftentimes be with older patients, inserting anything intravaginally can be uncomfortable or genuinely difficult. For older patients or their caregivers, more comfortable or convenient alternatives to the vaginal estrogen cream applicator are needed.
- The name undersells what it does. "Vaginal estrogen" sounds like it's only about vaginal dryness or sex. And it does help enormously with both. Yet women need to know that even though a treatment may be known as "vaginal estrogen," it can still have a tremendous effect on urinary health.
It's worth mentioning that vaginal estrogen is not something that women are meant to figure out on their own. And this should be a relief. What women need is a doctor who knows vaginal estrogen, and then help patients figure out how to use it in a way that works for them.
Our board-certified physicians available in all 50 US states. We offer an easy online consult and prescription delivery. You can also message your prescribing physician with any questions you may have.
Shop all vaginal estrogenWhat happens from here
While the FDA-approved product labeling outlines using the provided applicator for estradiol vaginal cream, doctors frequently recommend fingertip application. So if the applicator has been the reason your vaginal estrogen prescription sits unused in your drawer, this new study is worth bringing up with your prescribing physician.
At Interlude, our physicians prescribe vaginal estrogen for UTI prevention, and can talk through application methods as part of our easy online consult.
