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Urinating
during sex
Passing
urine during intercourse, and being unable to control
it, happens to many women. No one seems to talk about
this, so a sufferer thinks she is the only one with the
problem.
Is
it common?
A
doctor did a survey of women attending his urogynaecology
clinic (many of whom of course already had an incontinence
problem) and found that 24% had incontinence during intercourse
(British Journal of Obstetrics and Gynaecology 1988;95:377–81).
Most had felt too embarrassed to mention it to their
doctor.
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In
about two-thirds, the leakage occurs when
the penis enters the vagina (penetration).
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In
about one-third, the leakage occurs only
at orgasm.
What
causes it?
The
reason is not understood, but it is likely to
be partly due to an irritable bladder or a weakness
at the neck of the bladder. If you have
difficulty holding urine during the day, you
may experience leakage during intercourse. However,
many women have
leakage of urine during intercourse but not at
any other time.
Could
it be ‘female ejaculation’?
In
1950, a Dr Grafenberg described what he called “female
ejaculation ... the expulsion of large quantities of
clear transparent fluid at the height of orgasm”. Some
sex manuals still talk about this ‘female ejaculation’ as
if it were some kind of discharge of sexual glands. They
claim it comes from Skene’s glands, which are supposed
to be similar to the prostate gland in men.
People
who believe in ‘female ejaculation’ say that analysis
of this fluid reveals high levels of an enzyme called
acid phosphatase that is made by prostate-type gland
tissue. In fact:
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a
study in six women showed that their ‘female ejaculate’ fluid
contained the same amount of acid phosphatase as their
urine
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a
study of just one woman did find high levels
of acid phosphatase in the fluid she released at orgasm,
but
the method used to analyse it was unreliable.
The
facts have been reviewed in an American medical journal
(American Journal of Obstetrics and Gynecology 2001;185:359–62),
and it now seems clear that this fluid is just urine.
What
can be done
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Empty
your bladder before sex.
Cut
down on caffeine-containing drinks and alcohol.
Do
not drink excessive amounts of fluid – not more than
1.5 litres (2.5 pints) over 24 hours.
Discuss
the problem with your doctor, especially if you have
leakage at other times.
Your
doctor may prescribe oxybutynin
or a similar drug for you. You should
take this about 1 hour before sex (if you
can plan that well ahead!).
Alternatively,
your doctor can prescribe imipramine, to be taken in
the evening. This is normally given as an antidepressant,
but it also has effects on the bladder (which is why
a similar drug is used to treat bed-wetting in children).
If your doctor suggests it, it is because of its bladder
effects, not because he or she thinks you are depressed.
The dose will be lower than given for depression.
If
none of these deals with the problem, it
would be worth asking for a referral to a gynaecologist,
preferably
one who specializes in urogynaecology. If
you have leakage at other times, as well as during
sex, an operation to
strengthen the bladder neck is sometimes recommended.
Unfortunately
this operation is successful in controlling
leakage during intercourse in only two-thirds of people.
In
the end, you and your partner may simply have to come
to terms with the problem, and enjoy your sex life in
spite of it. If it is causing a real problem in your
relationship, or affecting your feelings about yourself,
a few sessions with a psychosexual counsellor can be
very helpful.
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You
can also contact a number of organisations for help and advice
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