When you start taking an SGLT2 inhibitor like Farxiga, Jardiance, or Invokana for type 2 diabetes, you’re getting a drug that does more than lower blood sugar. It helps protect your heart, cuts your risk of kidney failure, and can even help you lose a few pounds. But there’s a side effect that catches a lot of people off guard: genital infections. About 1 in 8 women and 1 in 20 men on these drugs get them. They’re not usually serious-but they’re annoying, uncomfortable, and can make you want to quit the medication altogether.
The reason? Your urine gets sweet. SGLT2 inhibitors work by making your kidneys dump extra glucose into your pee. That sugar doesn’t just disappear-it stays in the warm, moist area around your genitals. And guess what loves sugar? Candida fungus. It’s the same bug that causes yeast infections. With more food available, it multiplies fast.
Here’s the good news: you don’t have to live with it. Most of these infections are preventable. And you don’t need fancy tools or expensive products. Just three simple habits-hygiene, hydration, and timing-can cut your risk by more than half.
Hygiene: Clean Right, Not Just Often
Washing your genitals every day isn’t enough. How you wash matters more than how often.
Women should always wipe from front to back after using the toilet. This stops bacteria from the rectum from getting near the urethra or vagina. After peeing, rinse with clean water. No need for soap every time-just water. If you do use soap, pick a gentle, fragrance-free kind. Avoid alcohol wipes, scented wipes, or douches. They strip away natural defenses and make infections worse.
For uncircumcised men, the key is retracting the foreskin before washing. Buildup under the foreskin is a breeding ground for fungus. Gently pull it back, rinse with water, then let it return to its normal position. Don’t force it. If you can’t retract it comfortably, talk to your doctor.
Wear cotton underwear. It breathes. Avoid tight jeans, synthetic leggings, or thongs. They trap heat and moisture. If you sweat a lot during the day, change into dry underwear. Keep things as dry and airy as possible.
Hydration: Dilute the Sugar, Not the Problem
Drinking enough water isn’t just for kidney health-it’s your first line of defense against genital infections.
When you’re dehydrated, your urine gets concentrated. That means more sugar per drop. More sugar = more food for yeast. Aim for 2 to 3 liters of water a day. That’s about 8 to 12 glasses. If you’re active, in hot weather, or have a fever, drink even more.
Don’t wait until you’re thirsty. Thirst means you’re already behind. Keep a water bottle with you. Set a reminder on your phone if you need to. If you’re not sure you’re drinking enough, check your urine color. Pale yellow? You’re good. Dark yellow or amber? Drink more.
There’s no magic number, but studies show patients who consistently drink enough water have lower rates of infections-even if they’re on the highest dose of SGLT2 inhibitors.
Timing: The 5-Minute Rule That Saves You Trouble
The most effective way to prevent these infections isn’t just washing-it’s washing at the right time.
Research from the Diabetes Journals shows that rinsing your genital area with water right after you pee and before you go to bed cuts infection rates by 40%. Why? Because that’s when sugar levels in your urine are highest. The longer the sugar sits, the more chance fungus has to grow.
Make it part of your routine. After you flush, rinse. No extra time needed. Just turn the faucet on, rinse for 10 seconds, pat dry with a clean towel. Do it before bed too-because overnight, everything gets warmer and damper. That’s prime infection time.
For people with mobility issues or arthritis, this can be hard. If you can’t reach or bend easily, ask a partner, caregiver, or occupational therapist for help. There are long-handled washcloths and no-rinse cleansers designed for this. Don’t skip it because it’s inconvenient. The payoff is worth it.
What About Other Diabetes Drugs?
SGLT2 inhibitors are the only oral diabetes drugs that cause this specific side effect. Other common ones like metformin, DPP-4 inhibitors (like sitagliptin), or GLP-1 agonists (like semaglutide) don’t increase genital infection risk. Their rates are about the same as placebo-around 1-2%.
But here’s the trade-off: SGLT2 inhibitors are better for your heart and kidneys. In the EMPA-REG trial, patients on empagliflozin had a 38% lower chance of being hospitalized for heart failure. In the CREDENCE trial, kidney disease progression dropped by 30%. These aren’t small wins-they’re life-changing.
That’s why doctors keep prescribing them. Even with the infection risk, the benefits outweigh the downsides-for most people. The key is managing the risk, not avoiding the drug.
When to Worry: Fournier’s Gangrene Is Rare, But Real
Most genital infections from SGLT2 inhibitors are mild. They itch, burn, or feel sore. You might notice redness or a white discharge. Over-the-counter antifungal creams (like clotrimazole) usually fix them in 3 to 5 days.
But there’s a rare, dangerous complication: Fournier’s gangrene. It’s a fast-spreading, life-threatening infection of the genital skin and tissue. Since 2013, there have been 22 confirmed cases in the U.S. linked to SGLT2 inhibitors. That’s about 1.9 cases per 10,000 patients per year.
Signs you need emergency care:
- Sudden, severe pain or swelling in the genitals or anus
- Fever over 38.5°C (101.3°F)
- Dark, dead-looking skin or a foul smell
- Feeling extremely unwell, dizzy, or confused
If you have any of these, go to the ER immediately. Don’t wait. This isn’t a yeast infection. It’s a medical emergency.
What If You’ve Already Had an Infection?
If you’ve had one genital infection on an SGLT2 inhibitor, your risk of another goes up. Studies show patients with a history of recurrent infections have a 5.7 times higher chance of getting them again.
Don’t automatically quit the drug. Talk to your doctor. You might be able to keep taking it-with stronger prevention. Some patients who switched to a lower dose, started drinking more water, and followed the 5-minute hygiene routine had zero repeat infections for over a year.
But if you’ve had two or more infections despite good hygiene, your doctor might suggest switching to another class of medication. That’s okay. Your health isn’t about sticking with a drug-it’s about finding what works for you.
Real People, Real Results
One woman in her 60s, on dapagliflozin for heart failure, had three yeast infections in six months. She was ready to stop the drug. Her diabetes educator gave her a simple handout: rinse after peeing, rinse before bed, wear cotton underwear. She did it. Six months later, no infections. She still takes her pill. Her heart is stable. Her blood sugar is under control.
A man in his 50s, uncircumcised, skipped washing under his foreskin. He got an infection. He thought it was just a rash. It came back twice. Then he learned to retract and rinse daily. No more infections. He says it’s now part of his morning shower-like brushing his teeth.
These aren’t miracles. They’re habits. Small, consistent, easy to forget-but powerful when done right.
What Your Doctor Should Tell You
When you’re prescribed an SGLT2 inhibitor, your doctor should spend 5 to 7 minutes explaining this risk. They should give you written instructions. They should ask if you’ve had yeast infections before. They should check if you can reach your genital area easily.
If they don’t, ask. Say: "I’ve heard this can cause infections. What should I do to prevent them?"
Most doctors know the guidelines. But busy clinics sometimes skip the talk. Don’t assume they’ll cover it. Take charge. Bring up hygiene. Bring up hydration. Bring up timing. You’re not being difficult-you’re being smart.
Bottom Line
SGLT2 inhibitors are powerful tools. They save lives. But they come with a simple, manageable risk: genital infections. You can’t avoid the sugar in your urine-but you can control what happens after it leaves your body.
Do this every day:
- Rinse your genitals with water after you pee.
- Rinse again before bed.
- Drink 2-3 liters of water daily.
- Wear cotton underwear. No exceptions.
That’s it. No pills, no creams, no expensive gadgets. Just four habits. Do them consistently, and your risk drops. Not to zero-but low enough that the benefits of the drug far outweigh the hassle.
If you’ve been avoiding SGLT2 inhibitors because of fear, it’s time to rethink. The infection risk is real-but it’s not a dealbreaker. With the right habits, you can take full advantage of what these drugs offer-without the discomfort.
