Coital Urinary Incontinence

Editor: Elisabetta Constantini

Last updated April 2018

Current definitions (1)

Coital urinary incontinence (CI): urinary incontinence occurring before, during or after vaginal intercourse

Orgasmic urinary incontinence: urinary incontinence at orgasm

Penetration urinary incontinence: urinary incontinence at penetration (penile or sexual device)

History

In the past several types of urinary incontinence (UI) where combined under other.
Other types of urinary incontinence may be situational, for example the report of incontinence during sexual intercourse, or giggle incontinence (2).

Controversy:

It is important to differentiate Coital incontinence from Female ejaculation orgasm (FE)
It can manifest as either female ejaculation of a small quantity of whitish secretions from the female prostate or squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously and are two different physiological components of female sexuality. The prevalence of FE is 10–54%. (3,4)

Physiological signs of female arousal are sometimes mistaken for CI. Expulsion of fluid during sexual intercourse may signify a high level of arousal but can also be a sign of UI. The fluid may originate in the vagina, urinary bladder, female prostate, or a combination of these sources.

Our lack of knowledge about female sexual dysfunction becomes evident when we encounter incontinence during intercourse. Since the majority of women do not report this symptom to the doctor, it is probably underestimated. On the other hand, when it is reported, the majority of urogynaecologists are not able to treat it because the pathophysiology is not clear and the boundary between normal and pathological are blurred. An in-depth appreciation of similar, but pathophysiologically distinct, phenomena is essential for distinguishing normal, physiological sexual responses from signs of illness.

The physio-pathological mechanisms involved have been widely debated, with bladder overactivity conventionally being implicated in orgasmic incontinence and SUI in penetration incontinence. In the past 5 years (5), studies however, have underlined the role of the urethral sphincter in coital incontinence, which is thought to be crucial even in women with detrusor overactivity and orgasmic incontinence. Coital incontinence on penetration can be cured by surgery in 80% of women with urodynamically proven SUI. Similarly, orgasmic incontinence can respond to treatment with anticholinergics in 59% of women with detrusor overactivity. (6,7)

References

1. Rogers, R. Pauls, R. Thakar, et al. An international urogynecological association (IUGA) / international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with female pelvic floor dysfunction Neurourol Urodyn. 2018 Feb 14.
2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.Urology. 2003
   Jan;61(1):37-49
3. Rubio-Casillas A, Jannini EA. New insights from one case of female ejaculation. J Sex Med 2011;8:3500–4.
4. Goldberg DC, Whipple B, Fishkin RE, Waxman H, Fink PJ, Weisberg M. The Grafenberg spot and female ejaculation—A review of initial hypotheses. J Sex Marital Ther 1983;9:27–37
5. Bohm-Starke N, Hilliges M, Blomgren B, Falconer C, Rylander E (2001) Increased blood flow and erythema in the posterior vestibular mucosa in vulvar vestibulitis(1). Obstetrics and Gynecology 98(6):1067-74.
6. Maravilla KR, Cao Y, Heiman JR, Yang CC, Garland PA, Peterson BT et al. (2005) Noncontrast dynamic magnetic resonance imaging for quantitative assessment of female sexual arousal. The Journal of Urology 173:162-6. 27.
7. Sommer F, Caspers HP, Esders K, Klotz T, Engelmann U (2001) Measurement of vaginal and minor labial oxygen tension for the evaluation of female sexual function. J Urol 165(4):1181-4.