Andrew Siegel MD 3/14/2020
Urinary leakage is typically an unwelcome and undesirable occurrence for which medical help is often sought. When it happens during sex, it becomes a couple’s problem–no longer just an individual’s problem–and can be embarrassing and negatively affect emotional, psychological, and social well-being and lead to avoidance of sexual intimacy. Today’s entry explores this predicament–that can occur in both genders– and its possible solutions.
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“Coital incontinence” is medical-speak for urinary leakage that can occur any time during sex, from arousal, to the onset of foreplay, to the time of sexual climax. Men may experience leakage with arousal, tactile stimulation, with intercourse, and at the time of ejaculation (“climacturia”), whereas women may experience leakage with arousal, foreplay, at the time of penetration, throughout intercourse and at the time of climax.
Many with sexual-related incontinence also experience urinary control issues during other activities. The precise prevalence of sexual incontinence is difficult to ascertain, but it is certainly not uncommon and the actual number of those who experience this may be even greater than thought because of a general “no ask” and “no tell” phenomenon in which doctors are reluctant to ask about it and patients are disinclined to bring it up.
A healthy sexual response involves being “in the moment” and free of concerns and worries. Those who suffer with sexual incontinence often become distracted during sexual activity, preoccupied with their lack of control over their problem, fear of leakage and concerned 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 the withdrawal from participation in sexually intimate situations, which can have a harmful effect on relationships.
Female Sex-Related Urinary Leakage
There are distinct forms of female sexual incontinence, including leakage with penetration, intercourse, and climax. Incontinence during penetration or intercourse can often be explained by the change in position of the bladder, bladder neck and urethra caused by the presence and splinting effect of the erect penis within the vagina, whereas leakage during climax is usually on the basis of involuntary bladder contractions that occur at the time of orgasm.
Leakage with penetration typically occurs in women with weakened pelvic support, often 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 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 their bladder back into its normal 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 the urethra. This situation also can occur in the absence of a dropped bladder, under the circumstance of stress urinary incontinence, which is involuntary leakage of urine with coughing, sneezing, exercising and other physical activities that is most often due to weakened urethral support. Penile penetration and thrusting may provoke the issue similarly to what happens in a woman with weakened bladder support.
On the other hand, 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. 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” typically causing symptoms including urinary urgency, frequent urinating and urgency incontinence.
At the time of climax, some women are capable of “ejaculating.” 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). Some women are able to “ejaculate” large volumes of fluid at climax and studies have shown this to be urine released because of an involuntary bladder contraction accompanying orgasm.
Male Sex-Related Urinary Leakage
In most cases, urinary leakage that occurs with sexual activity happens as a consequence of surgical removal of the cancerous prostate gland. Incontinence can occur with sexual stimulation, with sexual intercourse and/or with sexual climax. It most commonly occurs during the first year after surgery and thereafter tends to improve.
Although ejaculation is typically “dry” after surgical removal of the prostate gland, it is estimated that 20% or so of men following radical prostate surgery may ejaculate some urine at the time of sexual climax. Even though the ejaculatory fluid consists of urine and not semen, the sensation at climax is often the same. Urine is generally sterile, so there is limited potential for spreading an infection to a partner
Coping Strategies for Female Sex-related Incontinence
- Empty your bladder as completely as possible immediately before sex.
- If you have a dropped bladder, manually push the bladder back in to “unkink” the urethra and optimize 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.
- Clench it or drench it! Do pelvic floor muscle exercises (Kegels) on a regular basis to strengthen the voluntary urethral sphincter muscle; additionally, pelvic floor training can benefit cystocele, stress urinary incontinence and overactive bladder.
- 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 that are used for overactive bladder can be helpful for incontinence that occurs with sexual climax.
- For females, sling surgery for stress incontinence and pelvic reconstruction for cystocele can be curative.
Coping Strategies for Male Sex-related Incontinence
- Empty your bladder as completely as possible immediately before sex.
- Decrease fluid and caffeine intake for several hours prior to sex.
- Clench it or drench it! Do pelvic floor muscle exercises (Kegels) on a regular basis to strengthen the voluntary urethral sphincter muscle.
- Get in the best physical shape possible and exercise regularly (Pilates and yoga emphasize core strength and can be particularly helpful).
- Consider using a condom to collect any leaked urine or, alternatively, a penile constriction loop to compress the urethra.
- Sling surgery or artificial urinary sphincter implantation can be an effective means of management if simpler measures fail to improve the condition. If significant erectile dysfunction coexists, a penile prosthesis implantation with the mini-jupette modification has been proven to be highly effective for both the ED and the urinary leakage.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, coital incontinence, foreplay incontinence, incontinence with orgasm, incontinence with vaginal penetration, urinary incontinence, urinary leakage during sex
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