Excerpts from The Incontinence Solution: Answers for Women of All Ages, by William H. Parker, MD, Amy E. Rosenman, MD and Rachel Parker (Simon and Schuster, 2002)
Our sex lives are sometimes hard for us to talk about. We struggle to tell our children “the facts of life,” and we struggle to tell our partners what pleases us. Sex is personal, and, at its best, is an intimate treasure savored privately. We each want to please and be pleased, to feel warm, safe, and desired. For many women, perceived problems with their weight, overall appearance and desirability can cause enormous anxiety. When a woman chooses to have sex, oftentimes her worries and insecurities get right into bed with her. Does he like my body? Am I pretty? Are my thighs too big? As you age, those issues may make you more ill at ease. Add prolapse or incontinence to the mix, and things can get pretty complicated. Incontinence may turn that little voice of insecurity into a roar.
Does Incontinence Affect Your Sexuality?
The good news is that a recent study tells us women with incontinence or prolapse report the same amount of sexual activity, comfort, and enjoyment with sex as women without incontinence. There’s more: 80% of the women with either prolapse or incontinence felt their partners were also satisfied with their sexual relationship. Naturally the woman’s feeling about her partner and the relationship has a lot to do with whether she is satisfied sexually or otherwise. But the incontinence and the prolapse turned out to be less important than expected. Incontinent or not, many women stay sexually active well into their seventies and eighties.
However, the same study stated that women with the most severe prolapse or most frequent incontinence did report that their physical condition interfered with their sex lives. As a result, these women were more distressed about their medical situations and were less content. While the women with less severe incontinence did not have a significant problem with sexual satisfaction, those with severe problems found it was a detriment to their sex lives.
Can Young Women Have Incontinence During Sex?
Surprisingly, young women actually have incontinence during intercourse more than older women. A study performed in Israel found that while only 3% of women over age 65 reported incontinence with sexual activity, 29% of women under age 60 had this problem. And, as might be expected, this incontinence caused these women some anxiety. While almost all the women in this study were in stable marriages, 43% of them felt anxiety because of the incontinence during intercourse. Although there is no comparable study for single women, more than likely the absence of a stable relationship only makes things worse.
Can Incontinence Cause a Problem with Sex?
Incontinence makes some women feel unclean and, consequently, undesirable. They may consequently avoid sex or feel less pleasure and freedom when they do have sex. The type of incontinence a woman has can greatly affect how much it troubles her. Women with stress incontinence usually have fewer problems with sex than women with urgency incontinence. Stress incontinence often happens at predictable times, most often right at the beginning of intercourse when penetration alters the angle of the bladder and urethra. Urinating just before having sex will usually prevent this problem.
Urge incontinence, the result of an overactive bladder, causes more distress because it is unpredictable and unavoidable. Women with urge incontinence often lose urine during an orgasm, which may be particularly upsetting. Also, the amount of urine leaked because of an overactive bladder is usually greater than with stress incontinence. One study found that almost 70% of women with urgency or urge incontinence had unsatisfying sexual relations while only 20% of women with stress incontinence had this complaint.
Can Prolapse Cause Problems with Sex?
Prolapse does not usually cause problems with sex. If prolapse results in bulging of the bladder or rectum into the vagina, the bulge can be easily pushed back into place before intercourse, and most women with prolapse say they don’t notice it during intercourse. Also, if you have a prolapse, you should know that intercourse will not cause any harm to whatever is bulging: your bladder, vagina, uterus or rectum.
It is common for women to notice that the prolapse is much less apparent when they are lying down, a likely position during sex, allows the prolapse to move out of the way. However, if the prolapse is severe, the vagina may be exposed to the drying effect of the air and intercourse may be irritating and uncomfortable. In that situation, a lubricant can be very helpful.
Does Incontinence Make You Less Attractive?
Incontinence can undeniably complicate life in an unpleasant way. Many women modify what they wear and how they live as a result. Some tell us they feel less feminine and less independent. Their wardrobe is suddenly limited to only dark clothing in order to hide any possible leaks. They avoid situations where they won’t have easy access to a bathroom. Some women so dread of embarrassing themselves that they only feel comfortable at home. They may also be concerned about odor and may fear that nobody will want to sit next to them at social events. However, as we hope readers will learn from this book, there are now many ways to prevent incontinence. The social and physical isolation that incontinence sometimes brings is unnecessary.
How Can You Talk with Your Partner about Incontinence?
Both women and men with incontinence may suffer from feelings of isolation. Embarrassment and fear of humiliation often keep them from talking to their partners about the subject. Usually the fear is worse than the reality. Unnecessary tension and emotional distancing hurts both people in the relationship. We know that good communication between lovers helps to make sex more joyful, under any circumstance. If you have incontinence, talking to your partner about it may be the most important thing you can do. Good communication will lead to greater affection and trust. Talking about any kind of problem is usually easier in a long-term, intimate relationship, but even in a new relationship, getting things out in the open often brings relief.
If you have incontinence with intercourse, discussing this with your partner before having sex might help you both. Many women, although embarrassed at first, are surprised at how easily the conversation goes. Oftentimes mentioning that there might be a bit of dribbling is all that is needed. Some men worry about getting a bladder infection from an incontinent partner. Although loss of urine may feel unclean, urine is entirely sterile. Your partner can be reassured that no risk of transmitting infection exists. Others worry needlessly about hurting a woman with a prolapse when all that is needed is to push the prolapse back and use a lubricant. The bottom line is very clear. Incontinence does not need to get in the way of sexuality.
