Coital incontinence: the problem women won’t talk about

LEAKING urine during sexual intercourse, otherwise known as coital incontinence, can have a significant impact on a woman’s quality of life. Dr Gareth Reid, consultant urologist, said the true incidence of this condition is unknown because, unfortunately, most women do not discuss this with their doctors.

Coital incontinence can be divided into two distinct types: incontinence at the time of penetration, and incontinence during orgasm. Dr Reid explained that coital incontinence is rarely ever found as a symptom by itself; instead it is usually associated with other forms of urinary incontinence.

“In women who leak during penetration, this is usually associated with a type of incontinence called stress urinary incontinence. In stress urinary incontinence, there is leakage of urine associated with increased pressure in the abdomen,” he said, adding that there is also loss of urine when an individual laughs, coughs, sneezes, or climbs stairs.

Dr Reid said loss of urine from sneezing, coughing and laughing occurs because the pelvic floor muscles, or the sphincter that helps to maintain continence, becomes weakened.

He said similarly in coital incontinence, there is a weakening of the pelvic floor muscles or the urethral sphincter, and as a result, during intercourse, if the pressure in the abdomen increases beyond the ability of the weakened pelvic floor muscles or sphincter to maintain continence, then there is leakage of urine.

“This can be quite a disturbing scenario. In fact, about one-third of women who suffer from stress incontinence report a decreased desire to have sex due to fear and embarrassment,” the doctor said.

But he said this form of coital incontinence can be helped by simple manoeuvres such as:

1. Emptying the bladder prior to intercourse

2. Decreasing the amount of fluid you drink prior to sex

3. Experimenting with sexual positions that will decrease the pressure on the abdomen and the bladder

4. Pelvic floor muscle exercises, such as Kegel exercises

5. Weight loss.

In the event that there is limited improvement, there are more invasive treatment options, such as electrically stimulating the pelvic floor muscles or certain simple surgical operations.

“Perhaps the best form of therapy for this condition is having an open, understanding partner who is well aware of the problem so that the couple can work together to improve their sexual health,” Dr Reid said.

Additionally, he explained that coital incontinence that occurs during orgasm is not a well-understood phenomenon, and it appears to be associated with another type of incontinence called urge incontinence.

He said in that situation patients have what is known as an overactive bladder.

“As the bladder fills, long before it reaches its full capacity, a woman will feel an urge to pass her urine that cannot be delayed. If it is delayed for a long period, she will likely have an episode of incontinence,” he said.

He said coital incontinence during orgasm seems to be related to this overactive bladder; however, simple techniques, such as limiting the fluid intake prior to sex or emptying the bladder, may have positive results. “Otherwise there are certain medications that work on the receptors in the bladder in an attempt to decrease the overactive state. These medications unfortunately do not work as well for coital incontinence as they do for an overactive bladder. But they may provide some improvement,” he said.