Archive for April, 2016

Female Sex-Related Urinary Leakage

April 29, 2016

Andrew Siegel MD 4/30/16







I have previously written on the topic of male urinary leakage during sexual excitement and climax:  This entry covers the issue in females.

“Coital incontinence” is the medical term for leakage of urine that occurs during sexual intercourse. This involuntary loss of urine can occur either at the time of vaginal penetration, during the act of intercourse itself or during orgasm. It can be a devastating problem that affects one’s emotional, psychological, and social well being. This is not a topic that many women feel comfortable discussing with their physicians and therefore is under-reported and under-studied. It is important to know that coital incontinence is a manageable situation. 

A healthy sexual response involves being “in the moment,” free of concerns and worries. Women who develop coital incontinence often become mentally distracted during sexual activity, preoccupied with their lack of control over their problem, fear of leakage during intercourse and concerns about what consequences this might have on their partner’s sexual experience. This can cause a feeling of being unattractive and unsexy and an overall negative perception of body image, which can affect sex drive, arousal, sexual fulfillment and ability to orgasm. In addition to being embarrassing, it often results in women withdrawing from participating in sexually intimate situations, which can have a harmful effect on relationships.

There are two distinct forms of coital incontinence: leakage with penetration/intercourse and leakage with climax.

Leakage With Vaginal Penetration or During Intercourse

Leakage with penetration typically occurs in women with weakened pelvic support, often in women with a condition known as a cystocele (a.k.a. dropped bladder), in which the bladder sags to a variable extent through a weakness in its structural support such that the it enters into the vaginal space and at times can emerge outside the vaginal opening. This condition often causes an anatomical kink, resulting in symptoms of urinary obstruction including a weak, slow, intermittent stream and incomplete bladder emptying. Many women with dropped bladders need to use their fingers to manually push the bladder back into its normal anatomical position in order to straighten out the kink to be able to urinate effectively. What happens at the time of penetration is that the penis displaces the bladder back into its normal anatomic position and “unkinks” the urethra, resulting in a gush of urinary leakage.  Urinary leakage can also occur for the same underlying reason after penetration–during the act of intercourse itself– as penile thrusting shifts the bladder position and straightens out the urethra.  Either situation does not make for a happy couple.

Leakage With Sexual Climax

Leakage with sexual climax usually happens because of an involuntary contraction of the bladder that occurs along with the contraction of the other pelvic muscles during orgasm. With climax, there is a rhythmic contraction of the pelvic floor muscles, anal sphincter, urethral sphincter and several of the core muscles. This form of urinary leakage–often with large volumes of urinary incontinence– in many cases is due to an overactive bladder, a bladder that “contracts without its owner’s permission” causing symptoms including urinary urgency, frequent urinating and urgency incontinence.

Who Knew? “Squirting.” At the time of climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be excess lubrication and others to be  glandular secretions (from Bartholin’s and/or Skene’s glands). There are certain women who “ejaculate” very large volumes of fluid at climax and scientific studies have shown this to be urine released because of an involuntary bladder contraction that accompanies orgasm.

How To Prevent Coital Incontinence:

  • Empty your bladder as completely as possible before sex.
  • If you have a dropped bladder, manually push the bladder back in to optimize your bladder emptying before sex.
  • Decrease fluid and caffeine intake for several hours prior to sex.
  • Experiment with sexual positions that put less pressure on the bladder.
  • Do pelvic floor muscle exercises (Kegels) on a regular basis to strengthen the voluntary urethral sphincter muscle; additionally, pelvic floor training can benefit cystoceles and overactive bladders.
  • Get in the best physical shape possible and exercise regularly (Pilates and yoga emphasize core strength and can be particularly helpful).
  • Medications: two classes of bladder relaxant medications used for overactive bladder can be helpful for incontinence that occurs with climax.

Wishing you the best of health,

2014-04-23 20:16:29

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