Incontinence during sexual intercourse

Urinary incontinence, the involuntary leakage of urine, is a distressing symptom causing embarrassment and impairing quality of life. When occurring during intercourse, it can lead to the disruption of relationships. Studies have shown that up to 43% of women attending gynaecology clinics complain of a degree of sexual dysfunction when specifically asked. One of the causes is intercourse incontinence, which has been shown to affect up to 25% of women presenting with incontinence. Due to the embarrassing nature of the symptom, patients rarely volunteer it as a symptom, hence stressing the importance of doctors incorporating questions into their history taking. Leakage of urine can occur at different stages of sexual intercourse, namely on arousal, on penetration of the vagina and on achievement of orgasm. Studies have shown that there is a correlation between the urodynamic diagnosis and the stage of intercourse when this occurs. Women with detrusor overactivity tend to leak at orgasm whereas women with urodynamic stress incontinence tend to leak on vaginal penetration. There is, however, no underlying proven theory and despite these associations, laboratory studies have failed to show any cystometric differences.

Management of these patients would include a careful history, physical examination and a set of investigations trying to find out the underlying cause. Treatment is difficult as these specific symptoms often do not response to conventional methods of treatment.