By Vandna Jerath, MD, FACOG
Coital incontinence or bladder leakage during sex can occur in 10-35% of women. Unfortunately, only about 3% of women actually discuss their symptoms with their doctor. And only 20% of women will admit to symptoms when directly asked.
We do not fully understand coital incontinence. It can occur in different women of different ages. Many factors are involved which can cause a woman to leak urine during sex. This can include pelvic floor damage or weak muscles from childbirth or having multiple babies, a simple bladder infection (UTI), medical conditions such as diabetes, multiple sclerosis (MS), or neurologic problems, a variety of foods and substances that may irritate the bladder, being overweight, a particular sexual position, anxiety, psychosocial stressors, or other sexual dysfunction.
The condition often causes anxiety in women which can lead to sexual dysfunction. It can also be difficult to distinguish from female ejaculation which is fluid expulsion from the skene’s glands during orgasm. Coital incontinence does not have to be limiting for a couple and there are ways to work with the condition. Urine is considered sterile so it will not really cause any problems for either partner and although the coital incontinence should be evaluated, it does not necessarily have to be treated in all women.
There are two types of coital incontinence:
- Incontinence which occurs with penetration – occurs 2/3rd of the time and is thought to be related to urinary stress incontinence which is an anatomical problem of the urethrovesical junction or weakening of the tissues that support the bladder neck. This is the type of incontinence women often experience when they leak during sneezing, coughing, or laughing.
- Incontinence which occurs during orgasm – occurs 1/3rd of the time and is considered to be related to detrusor overactivity which is usually due to bladder spasms. This type of incontinence often causes urinary urgency or leakage in response to a stimulus like the sound of running water.
As healthcare providers, we still have much to learn about the condition, but there are some basic aspects of the condition that we can focus on to minimize symptoms.
There are several interventions that can reduce or improve coital incontinence:
- Empty bladder – Make sure your bladder is empty prior to intercourse because if it is less full then there will likely be less leakage.
- Limit fluid intake – Make sure your bladder is less likely to fill up during sex.
- Avoid bladder irritants – There are several bladder irritants which include caffeine, alcohol, juices, fruits, acidic foods, spicy foods, artificial sweeteners, and chocolate which can cause your bladder to spasm and subsequently leak during sex.
- Communicate openly and honestly – Communicate with your partner regarding this condition and your sex life. Working through the situation together can lead to improved sexual health and a more satisfying sex life overall for the couple.
- Limit anxiety – Try to relax as it will only worsen the condition. It is important to take steps to evaluate and understand any risk factors for the condition.
- Experiment with sexual positions – It is time for something other than missionary style which often exacerbates the symptoms. Woman on top, side by side, and rear entry can improve the situation.
- Lose weight – If you are overweight, losing a few pounds may help. Losing between 7-10% of your body weight can improve your symptoms by decreasing the pressure in your abdomen.
- Comfort measures – Make the situation more manageable by being prepared, putting down a towel, having a bathroom close by, and using incontinence/hygiene products as needed.
- Do kegels – Exercise your vagina and make it stronger. The stronger your pelvic floor muscles are, the less you will leak. It would be good to do kegels before, during, and after intercourse.
- See your doctor or healthcare provider – It is important for your healthcare provider to do a thorough history and physical examination and rule out a UTI or other predisposing medical conditions. You may also need urodynamics testing to fully assess your symptoms.
- Pelvic floor therapy – Physical therapy of the pelvic floor and biofeedback can be an effective treatment method and improve symptoms. Newer biofeedback technology such as Intone can also help.
- Other treatments – Sometimes surgery or certain medications can help the condition.
You are not alone and there are many options that can help improve the condition. Please talk to your doctor or gynecologist to communicate your concerns.
I previously did an interview with Marilyn Suttle of Poise regarding Light Bladder Leakage (LBL) and Intimacy for their podcast series. You can click on the audio file below to listen to that interview for a more detailed discussion on coital incontinence.
Audio Credit: Poise
Photo Credit: Stock Photo