By Dr. Katie Coleman, PT, DPT, WCS, CSCS
A client confessed to me the other day that she has urinary leakage during sex. “It was mortifying!” she exclaimed. “What the heck was that all about?”
In general, peeing during sex (or coital urinary incontinence as it’s referred to in the medical jargon) occurs between 10% and 27% in incontinent women (3,4,5). Coital incontinence can be the cause of loss of libido, anorgasmia (inability to achieve orgasm), lack of sexual activity, and in general a worsening in sexual satisfaction1. As any other urinary and/or sexual complaint, urinary leakage during intercourse is frequently underreported. In general, a vast proportion of women with urinary incontinence do not seek help for this symptom because they do not regard incontinence as abnormal, or because they have low expectations of treatment (2).
Coital urinary incontinence is traditionally divided into two forms on the basis of the timing of occurrence during intercourse: (i) incontinence at penetration, and (ii) incontinence during orgasm.
A well-designed prospective study found a strong correlation between coital incontinence at penetration and during orgasm with the most likely culprit being overactivity of the detrusor, the main muscle responsible for bladder contractility (3).
Another study found that an orgasm can act as a trigger for involuntary detrusor contractions in women affected by detrusor overactivity; this is sometimes associated with a simultaneous relaxation of the urethral sphincter9. The authors of the study suggested incontinence during orgasm is multifactorial, likely an interplay between muscle and sphincter coordination.
Treatment for coital urinary incontinence generally involves a combination of therapies: pelvic floor muscle training, surgery, and pharmacotherapy show satisfactory cure rates (2). Let’s dive into the research:
Pelvic Floor Muscle Training
Pelvic floor muscle training results in statistically significant improvements in women's sexuality and a reduction of the episodes of incontinence during intercourse. One study found a statistically significant reduction in number of women having problems with sex-life, social life, and physical activity in the exercise group after six months of pelvic floor muscle exercise (10). An additional study showed a significant post-treatment improvement in all the investigated scores of sexual functions (desire, arousal, lubrication, orgasm, satisfaction, and pain). At the end of 12 months of pelvic floor exercises, the coital incontinence episodes per week were significantly reduced (11).
Pharmacologic treatment
One study looked at prescribing tolterodine 4 mg ER once daily with a success rate of 60% reduction in incontinence at orgasm (1).
Surgery
Another study showed that if a reliable urodynamic diagnosis is made, coital urinary incontinence at penetration can be cured by the Burch culposuspension surgery in 81% of cases in the presence of urodynamic stress incontinence and 70% in those with incontinence at orgasm. This small study suggests that coital incontinence is likely to be cured or improved when stress incontinence has been successfully treated by Burch culposuspension (5).
Coital incontinence can be an unwelcome and often underreported symptom of muscular dysfunction. Luckily, there are treatment options available that can help improve a woman’s ability to have a pleasurable sexual encounter. If you are suffering from any of these symptoms noted above, please reach out to Elevate Physical Therapy to discuss the best treatment options for you.
References
1. Serati M, Salvatore S, Uccella S, et al. Urinary Incontinence at Orgasm: Relation to Detrusor Overactivity and Treatment Efficacy. European Urology. 2008;54(4):911-917. doi:10.1016/j.eururo.2007.11.008
2. Serati M, Salvatore S, Uccella S, Nappi RE, Bolis P. Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women’s Sexuality. The Journal of Sexual Medicine. 2009;6(1):40-48. doi:10.1111/j.1743-6109.2008.01055.x
3. Hilton P. Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom. BJOG:An international journal of O&G. 1988;95(4):377-381. doi:10.1111/j.1471-0528.1988.tb06609.x
4. A. Moran, P. L. Dwyer, S. P. Ziccon P. Urinary leakage during coitus in women. Journal of Obstetrics and Gynaecology. 1999;19(3):286-288. doi:10.1080/01443619965084
5. Baessler K, Stanton SL. Does Burch colposuspension cure coital incontinence? American Journal of Obstetrics and Gynecology. 2004;190(4):1030-1033. doi:10.1016/j.ajog.2003.10.709
6. Salonia A, Zanni G, Nappi RE, et al. Sexual Dysfunction is Common in Women with Lower Urinary Tract Symptoms and Urinary Incontinence: Results of a Cross-Sectional Study. European Urology. 2004;45(5):642-648. doi:10.1016/j.eururo.2003.11.023
7. Coyne KS, Margolis MK, Jumadilova Z, Bavendam T, Mueller E, Rogers R. Overactive bladder and women’s sexual health: what is the impact? J Sex Med. 2007;4(3):656-666. doi:10.1111/j.1743-6109.2007.00493.x
8. Coyne KS, Margolis MK, Brewster‐Jordan J, Sutherland SE, Bavendam T, Rogers RG. Evaluating the Impact of Overactive Bladder on Sexual Health in Women: What Is Relevant? The Journal of Sexual Medicine. 2007;4(1):124-136. doi:10.1111/j.1743-6109.2006.00315.x
9. Khan Z, Bhola A, Starer P. Urinary incontinence during orgasm. Urology. 1988;31(3):279-282. doi:10.1016/0090-4295(88)90160-4
10. Bø K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand. 2000;79(7):598-603.
11. Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):401-406. doi:10.1007/s00192-007-0452-3