Women, Sex and Incontinence

It’s the health problem that we don’t want to talk about. Many women, particularly post-menopause, may experience urinary incontinence during sex. Instead of unleashing a flood of pleasure, having an orgasm suddenly releases a flood of shame.

But the experts want you to know that leaking urine need not be a death blow to your sex life.

The image of removing a wet pad as part of foreplay, or laying a felt-covered plastic sheet over your satin ones, may not exactly pulse with eroticism, but incontinence will be a fact of life for some women—and a part of their sexual lives, as well. Because of the proximity of pelvic organs, a weekend or overactive bladder may be activated during sexual activity. “The neurophysiology of orgasm is closely related nerve-wise to the neurophysiology of urination,” says Dr. Lauri Romanzi, a urogynecologist and assistant clinical professor at Cornell Weill Medical College in New York. “The pelvis is Grand Central Station for bodily function,” she added, “there’s a lot going on in a small space.”

An estimated 20 million or more women more than twice the number of men—have some degree of incontinence, according to the National Association of Incontinence. This can range from the temporary leaking after childbirth (when sex is less of a concern) to a more chronic condition. The most common form of urinary incontinence, stress incontinence, is leakage during physical stress such as sneezing or running for a bus—or having sex.

The bad news is that many women suffer in silence. Too embarrassed to bring this up with their partners or doctors, they begin to avoid sex. Nor is the problem limited to elderly women. For younger women, the subject has been even more taboo.

But the good news is that the silence is breaking. In what may have been a first in the consciousness-raising department, last year Carol Levin, founding chair of Women’s Own, a volunteer organization dedicated to women’s health issues based at the New York University School of Medicine, addressed the Task Force on the Jewish Woman at the New York-UJA Federation about incontinence. Levin said that most of the time incontinence is treatable, if not curable. A urogynecologist, a specialist who focuses on female pelvic health, can evaluate and recommend treatments, from biofeedback to surgery.

“I am more than a breast,” Levin told LIILTH. “We have to be focused on the whole person.”

Experts say that a woman shouldn’t wait until she begins having trouble holding her urine to start paying attention to her pelvis. There is something all women can do even if incontinence is not yet a problem—Kegels. No, this is not another word for pudding, but a simple exercise of contracting and strengthening the pelvic muscles (named for its inventor, Arnold Kegel). You could be building up your pelvic muscles while you’re reading this. “I call pelvic floor exercises the dental floss of our specialty,” says Dn Romanzi.

Even when not curable, incontinence need not be the end of sex. The experts suggest: Try to void completely before having sex. Limit fluid intake, particularly coffee, tea and alcohol before sex. Talk openly with your sexual partner. A sex therapist can work with couples to overcome discomfort. It’s better to explain the situation than to try and hide it.

“It’s so uncommon that coital incontinence wouldn’t at least be significantly reduced in frequency with treatment,” Romanzi says. “I just tell patients that even though it’s still happening, it’s not something they need to be mortified about.”