It's no secret that discussing sex and urinary incontinence can make even the most confident among us squirm a little. And let's face it, urinary incontinence during sex (formally termed coital urinary incontinence) -- that's a whole new level of discomfort. But here's the thing: discomfort often stems from unfamiliarity and embarrassment. Yet, the very topics that we're conditioned to avoid are the ones that need our attention the most.

If you're eager to gain insights that can truly make a difference in your life, then keep reading. In this blog we discuss six key things that every woman should know about peeing during sex It's a path to understanding, reclaiming confidence, and embracing your ability to make positive change.

1. The female reproductive and urinary systems have an interconnected relationship

The close connection between the female reproductive system and the urinary system is highlighted by their shared anatomical structures. The muscles, nerves, and connective tissues responsible for maintaining bladder control and facilitating urine flow also play a pivotal role in sexual function. Similarly, the nerves that coordinate sensations during sexual arousal are intertwined with those that regulate bladder sensation and control. Due to this intricate overlap, disturbances in either system can cascade to impact the other. Acknowledging and understanding this interplay can guide medical intervention and management strategies, promote comprehensive well-being, and improve quality of life.

2. You are not alone in your experience with sexual incontinence

Have you ever found yourself wondering, "Is it normal to pee during sex?" If so, you're far from alone. While we know it is not normal, coital incontinence is surprisingly common. In a study involving 324 sexually active women who were referred to a urology clinic due to bladder leakage, 24% experienced some type of urinary incontinence during intercourse. That’s almost 1 in 4 women with this same complaint!

3. Urinating during sex can occur at two distinct moments.

First, to be clear, sex is different for each person and intimacy varies across the board. We fully acknowledge that “common” does not equate to “only” and “sex” does not equate to “penetration.”

However, from a pure clinical research perspective, two moments have been recognized as frequent culprits for peeing during sex.

• Moment #1: Vaginal Penetration

Peeing during vaginal penetration has been shown to be associated with stress urinary incontinence (SUI), which is the involuntary loss of urine that occurs with a change in pressure in the abdominal area. Think of instances like coughing, sneezing, or jumping, which generate increased pressure in the abdomen (ever felt your abs ache after a bout of coughing during a cold?). If this pressure isn't properly managed, it can lead to bladder leaks.

Similarly, vaginal penetration can also trigger bladder leaks. This happens because the pelvic floor muscles play a role in supporting and coordinating the function of the urethra (the tube that carries urine out of the body). When there's an underlying issue with weak pelvic floor muscles, the pelvic floor may not be able to counteract the increased abdominal pressure caused by vaginal penetration and different positions during intimate moments – resulting in leaks.

• Moment #2: Orgasm

Urinating during an orgasm can be linked to a condition known as detrusor (the bladder muscle) overactivity: spontaneous contractions of the bladder muscle when the bladder is not emptying.

Detrusor overactivity is often associated with an overactive bladder or urinary urgency, which is that sensation of needing to rush to the bathroom frequently throughout the day, and possibly even at night. It's crucial to address this urgency in everyday life to ensure the bladder functions properly and doesn't disrupt sexual experiences.

To be very clear, bladder leakage during sex is very different from female ejaculation, also known as “squirting”. This term can be misleading because it indicates that a lot of fluid is produced during orgasm. In fact, female ejaculation is generally just a small amount and usually a combination of diluted urine and milky white fluid, produced by glands on either side of the urethra. And it’s perfectly normal.

So how do you know if it's true urine incontinence during sex or female ejaculate? Well, if it’s a lot of fluid, there’s a higher likelihood it’s urine. The other test? Check the smell. If it smells like urine, it probably is.

4. You don’t have to be leaking urine in the bedroom to have a problem

Maybe you aren’t experiencing issues with urinating during sex. But you’re still worried that the symptoms you experience during the day will show up in the bedroom. Maybe you are nervous about the possibility of unpredictable urine loss during sex or concerned about the odor associated with urine leaking if it were to occur. This can lead to lack of fulfillment with sexual activity or even to avoidance of sexual intercourse.

Bladder leaks can have effects that reach far beyond your sex life. Leakage can insidiously impact a woman’s self-esteem and body image, regardless of age. For those dealing with incontinence during sex, common ways to cope include urinating before intercourse, restricting physical activity during intercourse, and reducing the frequency and duration of intercourse. For some, this may lead to completely avoiding intercourse, and unfortunately, studies show that more than 60% of women avoid sexual activity to avoid peeing during sex. We are parts of a whole, and the way bladder leaks sway our mental self-image can cast ripples on our sexual arousal. If you are avoiding intimacy due to fear of leaks, please continue reading.

5. You can strengthen intimacy by communicating with your partner

When the challenges of  sexual incontinence  start affecting your relationship, it's crucial not to let them cast a shadow on your connection. One powerful tool at your disposal is simple yet transformative: communication. Talk about your concerns with your partner. Initiating an open conversation with your partner can be a pivotal step towards enhancing your sexual experience. This can help you navigate how to make the experience of sexual intimacy more pleasurable for both of you. You can also try talking about it with a close friend. Sometimes, the tendency to keep worries bottled up can lead to feelings of shame and isolation. Instead, find your support system in your partner, friends, family, and healthcare providers.

6. You don’t have to live with it. Really. You really, really don’t

If you're seeking solutions for how to stop leaking during sex, it's important to consult with a specialized healthcare provider who focuses on pelvic health. This may be a pelvic floor physical therapist, a urogynecologist, or your OB/GYN. These doctors can listen to your unique story and determine what lifestyle changes and treatments you need to make long-term improvement in your quality of life.

But what can you do right now?

• Validate your feelings and recognize that feelings of embarrassment and frustration are natural when dealing with urine leakage during While these emotions are valid, remind yourself that you're deserving of love and fulfilling intimate experiences.
• Try Flyte, a female incontinence device clinically proven to treat bladder leaks from the comfort of your home. Flyte is the only treatment of its kind, using a treatment modality called mechanotherapy to treat leaks and strengthen the pelvic floor muscles. Flyte comes with a money-back guarantee, so you can try it with Flyte also offers complimentary access to pelvic health Doctors of Physical Therapy to answer questions about leaking and pelvic floor health.
• Empty your bladder before sex and pay attention to any dietary irritants that may contribute to your urine leaking. This could be coffee, cocktails, or something Keep a bladder log to track your intake of fluids and food for a week, noting any times you are experiencing leaking and what you may have been doing beforehand. A pelvic health specialist can help you with this too.
• Try different sex positions. This may help you reduce the pressure being placed on your bladder and reduce leaks.

Embark on your journey to intimate wellness

In taking away these six key insights about peeing during sex, remember that you're not alone on this journey. The path to understanding, regaining confidence, and fostering fulfilling intimate connections is within your reach. Empower yourself with knowledge, seek support, and explore available solutions. Your well-being is worth prioritizing, and you have the ability to reclaim control over your sexual experiences.

Sources:

Hilton P. (1988). Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom. Br J Obstet Gynaecol; 95(4): 377-81. Doi: 10.1111/j.1471-0528.1988.tb06609.x.

Renato L. M. (2017). Female urinary incontinence and sexuality. International Braz J Urol; 43(1): 20-28. Doi: 10.1590/S1677-5548.IBJU.2016.0102.

Moalem, S. & Reidenberg, J. S. (2009). Does female ejaculation serve an antimicrobial purpose? Med Hypotheses; 73(6): 1069-71. Doi: 10.1016/j.mehy.2009.07.024

Burzyński B, Kwiatkowska K, Sołtysiak-Gibała Z, Bryniarski P, Przymuszała P, Wlaźlak E, Rzymski P. Impact of stress urinary incontinence on female sexual activity. Eur Rev Med Pharmacol Sci. 2021 Jan;25(2):643-653. doi: 10.26355/eurrev_202101_24622. PMID: 33577017.