"Why do I leak pee during sexual intercourse?"

But what exactly is coital incontinence, and how can it be treated?

So - what is coital incontinence?

Coital incontinence, also known as intercourse-related incontinence or sex-related urinary incontinence, refers to the involuntary leakage of urine during sexual activity, including penetration, orgasm, or both. It can occur in women of all ages, although it tends to become more prevalent in women who are postmenopausal. The severity of coital incontinence can vary widely, ranging from minor leakage to complete loss of bladder control during intercourse and for many women, they feel embarrassed when it occurs which can affect self esteem, intimacy in relationships, and have an impact on mental wellbeing, too.

Okay. So it's mostly related to age?

Yes and no - there are several factors that can contribute to coital incontinence developing but age is an important factor to consider, especially if you are post menopausal.

Jude's GP, Dr Masarat to explains: "Coital incontinence is when women experience urinary leakage during intercourse. They normally have underlying stress incontinence or overactive bladder and the coital activity triggers the incontinence."

As coital incontinence is related to stress incontinence, there are similarities in the causes, too:

Pelvic Floor Weakness

Weakness or dysfunction of the pelvic floor muscles, which support the bladder, uterus, and rectum, can lead to urinary incontinence during sexual activity. These muscles may become weakened due to factors such as childbirth, aging, obesity, or certain medical conditions.

Urethral Sphincter Dysfunction

The urethral sphincter, a ring-like muscle that controls the flow of urine from the bladder, may malfunction, resulting in urinary leakage during intercourse. This dysfunction can be caused by nerve damage, pelvic surgery, or hormonal changes.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, bulge into the vaginal wall due to weakened pelvic floor support. This can put pressure on the bladder and urethra, leading to urinary incontinence during intercourse.

Hormonal Imbalance

Fluctuations in hormone levels, particularly estrogen, can affect the integrity of the pelvic tissues and muscles, increasing the risk of coital incontinence. This is commonly seen in menopausal women or those undergoing hormonal therapy.

Problems with nervous system

Conditions affecting the nervous system, such as multiple sclerosis or spinal cord injury, can disrupt the signals between the brain and bladder, leading to urinary incontinence during sexual activity.

Can it be treated?

The good news is that yes, coital incontinence - like stress incontinence - can be treated. The management of coital incontinence typically involves a combination of conservative measures, lifestyle modifications, and, in some cases, surgical interventions.

Dr Masarat advises: "Vaginal oestrogen can be helpful for women who experience this post-menopause and the supplement may also be helpful for those women who have underlying overactive bladder or stress incontinence."

Other treatments include consistent pelvic floor exercises and where needed, physiotherapy for the pelvic floor; lifestyle modifications such as maintaining a healthy weight and avoiding bladder irritants; and there are also surgical options to consider for severe cases such as pelvic floor repair, midurethral sling placement, or vaginal rejuvenation surgery can help correct anatomical abnormalities and improve bladder control during sexual activity.

The important thing is to speak to your GP in the first instance.

What else should I consider?

Sometimes, coital incontinence can be related to other conditions. These include urinary incontinence including urgency which can sometimes exacerbate coital incontinence.

Chronic pelvic disorders, such an endometriosis, pelvic inflammatory disease (PID), or interstitial cystitis, can coexist with coital incontinence and may require further investigation to understand how they are contributing to leaking during sex.

There are mental health factors too to consider - such as how it's affecting your sex life and whether it's causing you to avoid intimacy or creating feelings of anxiety and embarrassment. The emotional toll of living with coital incontinence should not be underestimated so it's important to know that psychological support such as CBT and talking therapies may also help to manage coital incontinence too.

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