Coital urinary incontinence is a common symptom affecting sexually active women with pelvic floor dysfunctions. Although frequently under reported, it can have a devastating impact on female sexuality and quality of life. CI, particularly incontinence at orgasm, can be the cause of loss of libido, anorgasmia, absolute cessation of sexual activity, and in general a worsening in sexual satisfaction.
It is traditionally divided into two forms: (1) incontinence at penetration and (2) incontinence during orgasm. Of women who experience CI, 60 percent experience it with penetration and 40 percent experience CI with orgasm. Typically women with preexisting stress urinary incontinence (leaking with cough, activity, laugh, etc) are more likely to experience CI compared to women with over active bladders. This is surprising as it is assumed that spasms of the bladder would be more likely to be associated with orgasmic incontinence, but this has not been proven to be true. This may explain why women who experience coital incontinence with orgasm may not respond well to medication that decreases bladder spasms.
The first step in treating your symptoms would be to make sure you have a proper diagnosis. As mentioned earlier, fluid expulsion during female sexual arousal is not uncommon. Distinguishing FE from CI is an important step in treatment. A bladder test, called a urodynamic test, will be normal in a patient with FE and will be abnormal in women with CI. Women who experience FE should not be embarrassed, as this is a normal physiologic process.
Depending on the abnormality noted on the test, treatment can include physical therapy, medication, nerve therapy and surgery. It is important to discuss your symptoms with a physician who is knowledgeable about FE and CI to obtain proper diagnosis and treatment.