Aims of study

Urinary incontinence during sexual intercourse occurs in 1% of women in the community (1) and in 24% of women attending urogynaecology clinics (2). Coital incontinence might adversely affect sexual life and cause personal distress (1, 3). This study reviews the urogynaecology database of sexually active women.

Methods
The data of all 1072 consecutively referred sexually active women since April 1996 were analysed. A standardised questionnaire had been applied at the first clinical visit containing questions on bladder, bowel and sexual function. Urinary leakage during intercourse was noted to occur during penetration and/or during orgasm. The data were analysed regarding symptoms, urodynamic diagnosis and pelvic organ prolapse.

 

Results

Coital incontinence was present in 261 women (24%). Of those, 119 (46%) experienced urinary leakage during penetration only, 37 (14%) during orgasm only and 105 (40%) with both, penetration and orgasm. No woman related coital incontinence to sexual arousal only. Seven women (3%) reported coital incontinence to be the primary symptom. Urodynamic studies were performed in 200 women. Neither symptoms of stress and urge incontinence nor urodynamic diagnoses nor the stage of anterior, posterior or middle compartment prolapse were related to coital incontinence during penetration, orgasm or both (chi-square-test). Among 742 stress and/or urge incontinent women, 16% reported urinary leakage during penetration, 4% during orgasm and 11% during both.

 

Table: Coital incontinence and urodynamic diagnosis in 200 women who underwent urodynamic studies.

 

Urodynamic diagnosis	Coital incontinence penetration (n=109)	Coital incontinence orgasm (n=26)	Coital incontinence both (n=65)
Normal	13 (12%)	3 (11%)	6 (9%)
Genuine stress incontinence	47 (43%)	6 (23%)	24 (37%)
Detrusor instability	25 (23%)	7 (27%)	8 (12%)
Mixed (GSI+DI)	21 (19%)	9 (35%)	25 (38%)
Sensory urgency	1 (1%)	1 (4%)	0
Low compliance	1 (1%)	0	2 (3%)
Voiding disorder	1 (1%)	0	0

 

Conclusions

Our data show that coital incontinence is common among urogynaecology patients. Our results do not support the theories that women who are incontinent during penetration are more likely to have urethral sphincter incompetence and those who are incontinent during orgasm are more likely to have detrusor instability. Stage and site of pelvic organ prolapse was not associated with the presence of coital incontinence.

 

 

References

1.       Social context, social abstention, and problem recognition correlated with adult female urinary incontinence. Dan Med Bull 1992; 39: 565-570.

2.       Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom. Br J Obstet Gynaecol 1988; 95: 377-381.

3.      Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol 1995; 85: 483-487.