'Survivor' players wear the same underwear for up to 39 days with potentially life-threatening consequences

• "Survivor" players can wear the same underwear for up to 39 days, which comes with health risks.
• This can lead to painful urinary-tract infections, which multiple people spoke about having.
• Competitors used to get swimsuits to change into, but the last time they got them was in 2018.

When "Survivor" players compete for a million dollars on national television, they accept the risks involved with living on a remote island with limited food and water.

For starters, those on the CBS show must compete in the same outfit until they make it to the finale or are voted off the island.

This often means wearing the same pair of underwear for up to 39 days, which can come with painful, uncomfortable, and serious consequences.

Multiple players Insider spoke to said they'd experienced urinary-tract infections while on the island or shortly after they left

Four of the five female "Survivor" players whom Insider spoke to told us they had or contracted urinary-tract infections during their time on "Survivor." Three of these women competed during season 39, "Island of the Idols."

Urinary-tract infections are usually caused when bacteria enter the urinary tract through the urethra and begin to multiply.

Late into her season, the "Survivor: Island of the Idols" competitor Karishma Patel said she experienced a "really bad" UTI.

"It was a constant, 24-hour pain that I couldn't shake no matter what," Patel said. "If anybody's ever had a UTI, it is one of the most painful things you can go through."

Her fellow player Janet Carbin recalled approaching Patel when she saw her doubled over in pain at camp.

"I remember her laying in the hammock and looking like she was in pain, and I was like, 'What's going on?'" Carbin said. "She's like, 'I can't sleep. I have a UTI.'"

Patel told Carbin that the on-location medic was giving her antibiotics to help clear her infection. Carbin said she started experiencing pain from her own UTI later that same day.

"She was brave enough to say something about hers, and I knew mine was starting, and I was in denial about it," Carbin told Insider.

But Carbin also recalled being worried that if she had a UTI and needed an antibiotic she could get kicked off the show. In 40 seasons of "Survivor," 15 players have been medically evacuated from the show, some for severe infections.

Carbin said she confided in Patel, who sneaked into her stash of antibiotics to offer some to Carbin. After, Carbin said, she visited the medic to get her own antibiotics, which cleared up her infection "in a heartbeat."

But Patel said she struggled with some side effects from her medication.

"It didn't work on me, unfortunately," Patel said. "Instead, it caused some pretty bad side effects like fatigue, dizziness, and diarrhea."

Patel said she had several days on the island when she was forced to choose between debilitating pain from the UTI or the adverse side effects from the antibiotic itself.

Players with vaginas are most at risk, and they can deal with some serious consequences if their UTI isn't properly treated

Urologist Dr. Premal Patel told Insider that constantly wearing a "less-than-hygienic kind of clothing" for such a long time is bound to come with risks.

"If they're unable to change the pair of underwear and they're spending a long time in the sun, that welcomes in dirt, sand, sweat, bodily fluids, rashes, or any of the skin conditions," Dr. Patel said.

Plus the warm, moist environment created by wearing wet clothes for a long time, plus poor hygiene, can increase one's risk of contracting a UTI.

Generally, people with vaginas have a higher chance of contracting urinary-tract infections.

Gynecologist Dr. Mary Jane Minkin said it comes down to "simple anatomy." A vagina has a shorter urethra and is closer to the bladder; the penis has a lengthened urethra, so "there's a much greater journey for bacteria, which are trying to ascend, to get in from the outside world."

Still, Dr. Patel said, wearing the same pair of underwear for such a drastic amount of time "could possibly increase" anyone's risk of infections regardless of anatomy. And urinary-tract infections can spread to vital organs, like kidneys, if left unattended or treated improperly.

Patel said her UTI ended up escalating to a frightening degree by the time her season ended and she flew back to the United States. Days after the infection began, she said, "traces of that infection" spread to her bladder and she had to go to the hospital.

"I was on IV antibiotics to get that cleared out of me," she said.

The three-time competitor Andrea Boehlke - who did have a swimsuit during her season - also said she contracted a urinary-tract infection on season 34 "Game Changers." She said she was in "a lot of pain" when she returned home.

"I realized that I had a UTI, but the UTI had actually turned into a kidney infection," Boehlke said.

The kidney infection was so severe, Boehlke said, that she ended up in the hospital for a week and lost another 10 pounds on top of the weight she had already lost during the competition.

During her hospital stay, Boehlke said, the infection started affecting her other organs as it spread through her bloodstream.

"My heart was in a weakened state," Boehlke recalled. "My whole body was out of whack."

Fortunately, multiple players told Insider, CBS covered their medical costs - including exams, treatments, and therapy - after their season ended.

Players have limited options for cleaning their clothes - and doing so can put them in compromising positions

Having only one outfit forces "Survivor" players to find unique ways to keep their clothes as clean as possible to cut down on the spread of bacteria.

For example, the three-time competitor Malcolm Freberg boiled his clothes in the pot players use for cooking rice. Dr. Patel said it's not "ideal" to clean clothes in something people cook food in but agreed that boiling clothes is a surefire way to kill any bacteria.

The "Survivor: Island of the Idols" player Lauren-Ashley Beck - who said she also contracted a UTI on her season and received antibiotics "immediately" after filming wrapped - cleaned her outfit with a "ton of hand sanitizer," which competitors are given access to.

Hand sanitizer can reduce the number of bacteria on something but won't kill all germs. Minkin also advised against putting hand sanitizer near one's perineum (the area between the anus and scrotum or vulva), though, because "it's pretty tough stuff for a delicate tissue like that."

No matter which method competitors use, Dr. Patel said, players should ensure their clothes dry completely before they put them back on. He said "constant wetness is not great" and causes skin to break down.

But waiting for clothes to dry isn't always a comfortable or practical option when you're being filmed and have nothing else to wear.

Carbin said she felt exposed when trying to clean her clothes, especially when it came to underwear.

"The only way we could wash our underwear was to run around naked," Carbin said.

Patel said she tried to time her laundry routines carefully for the same reason so that she wasn't "flashing everyone" but could try to dry her clothes as much as possible before putting them back on.

The "Survivor: Island of the Idols" competitor Elaine Stott said she tried to be cautious about wearing wet clothes. During challenges, she opted to wear just underwear so she wouldn't get her pants wet.

After challenges, she said she would take her wet underwear off and wear her dry pants to "free lip" - air-dry her vagina - back at camp because she was worried about possible infections.

Until season 36, players were able to bring swimsuits to change into

For many seasons, "Survivor" players had swimsuits that they could wear as an alternate outfit. But the last time players were shown in swimsuits was season 36, "Ghost Island," which aired from February to May 2018.

It's unclear why exactly players stopped receiving swimsuits, but that same month, May 2018, the show's host Jeff Probst told The Hollywood Reporter that actor and director Tyler Perry suggested that "filthier" swimwear make it onto the show.

"Next season we aren't giving them swimming suits at all, just a sewing kit," Probst joked about "Survivor" players in the interview.

The season 37 "David vs. Goliath" competitor Davie Rickenbacker - who confirmed his 2018 season didn't receive swimsuits a few months after Probst's comment - said he blames Perry's supposed influence.

He said he believes bathing suits "were withheld" because Perry suggested the show "look more authentic." Perry, a fan of the show, previously contributed to "Survivor" in 2013, when he suggested a "special idol" twist.

A source close to Perry clarified to Insider that the actor never suggested players don't receive swimwear but rather suggested bathing suits look more aged to fit in with the nature of the show.

Multiple season 39 players told Insider they were confused when they didn't receive swimwear for their season because they were asked to submit bathing-suit options before going on the show.

"We were talking about it amongst each other, and we think that there was a push towards making us look more like we were shipwrecked," Patel said.

As of the most recent season, season 40 "Winners at War," swimsuits were still out of gameplay. It was Tyson Apostol's fourth time on the show and first time competing without a swimsuit.

"I had the sickest swimsuit, too, and was so pumped to wear it on the show, but they never gave us our swimmies," he said.

Representatives for Probst didn't immediately respond to Insider's request for comment.

A swimsuit or even just a spare pair of underwear could make a huge difference for players, especially those with vaginas

In rare cases - typically if a garment is lost or unwearable - players have gotten clothing items replaced. But most competitors are stuck with one pair of underwear for the entirety of their season.

Dr. Patel said he would encourage the network to consider giving players swimsuits or, at the very least, a change of clothes.

He said if players had a second outfit they could change out of wet clothes and dry them overnight. They could avoid sitting around in wet bottoms, which Minkin strongly discourages.

"That's a wet, moist, warm environment - it's not great for keeping you free from bacteria and yeast," Minkin said.

Dr. Patel said an extra set of clothes might also help competitors clean and dry their clothes without being forced into vulnerable positions. He pointed out that cisgender male contestants might be more comfortable being topless while their clothes dry, while others "may not have that luxury."

Carbin said she thinks bringing the swimsuits back could help prevent some players' health problems while keeping "the theme of the show realistic."

In fact, Carbin said, many "Survivor" fans questioned the lack of swimsuits during her season.

"I think the viewers would prefer to see people in bathing suits because so many viewers asked us, 'Why don't you guys wear bathing suits?'" she recalled. In response, Carbin told fans that it "wasn't our choice."

Players want to create an open dialogue about health risks so 'Survivor' can keep improving

Carbin made it clear that she loves "Survivor" and said she never viewed the inherent health risks on the show as a "disadvantage" but simply an additional challenge to overcome.

"I had a UTI, Karishma had a UTI, Lauren had a UTI. You know what? We were strong enough to handle it and deal with it," Carbin said.

She invited CBS to "take a look" into some of these potentially underexplored topics, like vaginal health, because there's "nothing wrong" with taking precautions.

Stott also said she'd happily compete again, risks and all. But she agreed that there are steps "Survivor" can take to help players with vaginas "fight stuff they really shouldn't be battling anyway."

"It's a show that we love," Stott said. "So why wouldn't we want to make it 50 million times better for everybody?"

Representatives for CBS didn't immediately respond to Insider's request for comment.

Follow along with our series of interviews to see what else the former players told Insider.