INCONTINENCE DURING INTERCOURSE
CURRENT DEFINITION in: “The standardisation of terminology in lower urinary tract
function: report from the standardisation sub-committee of the International Continence
Society” Urology 61: 37–49, 2003
Incontinence during intercourse is classified under:
Other types of urinary incontinence
It may be linked to a certain situation, for example, sexual intercourse, or giggling.
1.4 Associated Symptoms
During or after intercourse women may describe symptoms like dyspareunia,(pain during
intercourse), vaginal dryness and incontinence. These symptoms should be described as
fully as possible. It is helpful to define when urine leakage occurs, that is, during
penetration, during intercourse or at orgasm.
When we try to deal with incontinence during intercourse our lack of knowledge about
female sexual dysfunction becomes evident. Since the majority of women do not refer this
symptom to the doctor, it is probably underestimated. On the other hand, when it is
referred, the majority of urogynaecologists are not able to treat it because the
pathophysiology is not clear and the boundary between normal and pathological is blurred.
An in-depth appreciation of similar, but pathophysiologically distinct, phenomena is
essential for distinguishing normal, physiological sexual responses from signs of illness
What is new on this topic in 2013?
Trying to shed light on the topic we find new reports describing:
1) Female ejaculation orgasm (FE)
It can manifest as either female ejaculation of a small quantity of whitish secretions
from the female prostate or squirting of a larger amount of diluted and changed
urine. Both phenomena may occur simultaneously and are two different
physiological components of female sexuality.
The prevalence of FE is 10–54%.
2) Coital Incontinence (CI)
This is divided into when it occurs: during penetration which is more frequent and is
usually caused by stress urinary incontinence (SUI) or during orgasm which is
frequently associated with urodynamic diagnoses of detrusor overactivity and SUI.
The prevalence of CI is 0.2–66%.
CI is a pathological sign of a urethral disorder, detrusor overactivity, or a
combination of both. It requires treatment.
Therapy
Surgery is successful in almost 80% of cases of penetration CI. Adequate
pharmacotherapy may improve 60% of women with orgasmic incontinence. Pelvic floor
muscle training has been observed to provide favorable outcomes. Transvaginal electric
stimulation is another promising new therapy.
Controversies:
 Is this differential diagnosis clear?
Physiological signs of female arousal are sometimes mistaken for CI. Expulsion of
fluid during sexual intercourse may signify a high level of arousal but can also be a
sign of urinary incontinence (UI). The fluid may originate in the vagina, urinary
bladder, female prostate, or a combination of these sources.
 Why are the prevalence rates so divergent?
o Different research methodologies
o Association between types of UI and CI
o Some studies suggest that the penetration form of CI is largely associated
with urodynamic findings of SUI. Orgasmic incontinence may be associated
with both SUI and DOA. 50% of the studies found that DOA is more likely to
be related to orgasmic incontinence, whereas the others did not observe this
association
Although there has been much research on orgasmic expulsions and CI, the exact
pathophysiological mechanisms remain unknown. Future research directions include
determining the real prevalence and mechanisms of their origins. A consensus on
terminology and classification may contribute to more precise diagnoses and provision of
correct information to healthcare professionals and the public.
References
1) Zlatko Pastor Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic
Review JSM 2013
2) Swati Jha & Katherine Strelley & Stephen Radley Incontinence during intercourse:
myths unraveled. Int Urogynecol J (2012) 23:633–637
A PERSONAL VIEW?
Urinary incontinence is well-known in both sexes. Its most frequent clinical situations (SUI,
MUI, UUI) are well addressed by the ICS, physicians and patients.
Coital incontinence is more of a stigma than a taboo.
What is the best way to improve the ICS, physicians
and patients' awareness?
Be ironic and use satire.
A friend of mine, an urologist from Certaldo (Tuscany,
Italy), the same town where Boccaccio, the famous
author of The Decameron, was born centuries ago,
made a great suggestion. He reminded me of an
Italian movie “My Friends”, directed by Mario
Monicelli. The movie is the story of five Italian men
who represent typical characteristics of the average
Italian male: the trickster, the bungler, the passionate.
But one thing links these men to us: their desire to be
close to human beings and to let them live with a
smile on their faces. They do not think of just having a
great time for themselves but they tried to transmit
the satire and irony they represent to us.
Characteristic elements of the 5 friends are teasing
civil authorities or ministers of the church and
especially transforming symphonies into scurrilous,
vulgar songs . Here’s one:
Let’s fuck, fuck, fuck ...zum zum zum zum zum zum zum
Let’s fuck,fuck,fuck .....zum zum zum zum zum zum zum
You bitch, you deceiver
You cry “I’m coming” and you piss over me