A sneeze has you heading for the loo, and the thought of intimacy has you heading for the exit. Sound familiar?
One in three women in the UK (that’s 10 million of us) will experience bladder leaks at some point, and any of them will be able to tell you the impact it can have on your day-to-day life. Yep, that means your sex life, too.
Leaking during sex might not be the sexiest topic, but it’s a lot more common than you’d think.
Incontinence doesn’t have to stop you from having a fulfilling sex life, so we spoke to experts about how to deal with bladder issues and intimacy.
Leaking during penetration and orgasm are by far the most common problems, according to GP Dr Masarat Jilani.
Weak muscles might be the cause, but it could also be caused by your womb, bowel or bladder slipping down from their normal position and pressing on your vagina (aka ‘prolapse’).
Or the bladder itself might bulge into the space occupied by the vagina (aka ‘cystocele’).
As for leaking during orgasm, this is often the result of an overactive bladder.
Leaks reduce the quality of life for many of us. A study published by the American Journal of Obstetrics & Gynecology found that among women participants aged 40 to 80 who had urinary incontinence, 25% may also experience leakage during sex.
The National Center for Biotechnology Information’s research went further. It found that women of 30 to 70 years of age with incontinence issues were not only less likely to engage in sexual activity, but they also experienced less sexual desire.
These findings were echoed in the ways the Jude community described their experiences:
“It makes me scared and nervous.”
“I don’t feel clean.”
“It robs me of confidence during intimacy.”
“It makes me feel less desirable.”
“It causes me to turn away from spontaneous sex.”
“We haven’t made love for some time because I wear a pad and feel self-conscious.”
And you know what? Many of them didn’t realise that there are practical steps you can take to increase self-confidence and lessen the impact on your love life. That’s something society should feel ashamed about.
There are many practical steps you can take, from lifestyle changes to physiotherapy and even surgery.
But, says Lauren Rosher, psychosexual therapy can be of enormous value.
As a psychosexual and relationship therapist registered with the College of Sexual & Relationship Therapists (CORST), she sees many women who experience leaks.
“Unsurprisingly, there’s so much embarrassment that it doesn’t usually come in as a presenting issue. It’s mentioned later, almost as an add-on.”
Rosher goes on to explain how women often hide the problem from their partners, and this silence can lead to a decline in desire and arousal that their partner doesn’t understand.
“I work with women to address feelings of shame, which in turn can have a positive effect on including partners, increasing communication, and finding ways to accept, overcome and enjoy their bodies.”
The therapeutic model she works with recognises three ‘break points’ in sexual arousal: body, brain and emotion.
The first occurs when there’s inappropriate pain or stimulation, such as pressure on the bladder.
The second happens when the mind is distracted — worrying about leaking, for example.
The third is when negative feelings, such as fear of failure, paralyse sexual response.
Essentially, any inhibition makes it difficult to reach a level of contented pleasure.
With urinary incontinence, says Rosher, “…a person may experience a range of emotions that impact their intimate relationships: feelings of anger (“Why me?”); fear that they are no longer attractive, or that they might have a serious medical condition; sadness related to body identity; and grieving for a body that is no longer what it was; as well as self-directed emotions such as disgust and shame.”
But there truly is another way to frame this.
Urinary incontinence can make women feel anxious about getting intimate, but there are several things you can do to make sex easier and less stressful.
These top tips from Rosher get right to the point. Designed to be practical, candid and fearless, they could transform your sex life.
Empty your bladder. Try to avoid drinking for an hour before you get down to business and have a pee just beforehand if you have the urge.
Change positions. If you’re on top, you can control your pelvic muscles better and reduce the stress caused by penetration. Put a pillow on their thighs and rest your bum on it. Or try spooning, which is less strenuous.
Talk to your partner (this one is huge). Imagine they have the problem, would you leave them, or would you offer support?
Be open. Intimacy is sexy.
Embrace the funny side. Funny is also sexy!
Kick the ‘ick’ factor. Remind them, and yourself, that urine is quite sterile.
Remember that great sex is wet and sticky. It’s unlikely that small leaks will be noticed, anyway.
Be prepared. There isn’t a Girl Scout badge for this one, but there should be. Keep towels and pads nearby so that leaks can be dealt with quickly.
Choose your moment. Does your bladder behave better at certain times of the day?
Get some comfy, discreet mattress protection.
Use massage oils and water-based lubes, then no one will know what caused the wet patch.
Scented candles don’t just set a mood, they mask odours, too.
Have sex in the shower.
Rosher believes we need to do more to normalise bodily functions and recognise that our bodies are untidy and unpredictable. Farting, bleeding, peeing — it happens!
“Why is it that only sweat is acceptable during sex?” she asks. “How would you feel if it were female ejaculate? Female ejaculate has a much better reputation than urine, yet we still don’t know what it is. So, why should urine be any different?” Her message is: “It’s OK to be messy.”
Many of Rosher’s clients are also new mums, and she’s concerned at how little information about the pelvic floor is offered to them: “There’s a need to fill the gaps with sex and vulvar education — I regularly refer women to a physiotherapist.”
Dr Jilani, who has made it her mission to fight medical taboos and misinformation, agrees and adds that reluctance to discuss it with a clinician is another issue.
“There are many treatment options available to women, but the biggest hindrance is their embarrassment about speaking to their doctor in the first place,” she says.
“Also, they may think it’s normal or incurable, which is not the case. It can affect mental health, self-esteem and body confidence. It can also lead to relationship problems and rob a woman from having a satisfying sex life.”
Improving sexual health is Dr Jilani’s priority, and she believes there isn’t enough research in this area of women’s health: “When it comes to the terminology used in studies, often what we call ‘coital incontinence’ gets lumped in as ‘sexual dysfunction’.
You’d expect women’s sexual function to be taken seriously, but the facts support these views.
One study found that 74% of the women attending a urology clinic had never been asked about their sex life. When you consider that in another study a third said they leaked during sex, while half said sex was spoiled by worrying about odours and leaks, we must get the conversation going in a clinical setting, as well as among ourselves.
No woman should have to suffer in silence. There’s so much we can do to improve urinary incontinence, sexual satisfaction and relationships.
Speaking up is not just necessary — it’s a matter of urgency. Let’s get it out of the closet!
Poor bladder health shouldn’t be a “normal” part of ageing or childbirth — that’s why we created the Bladder Care Handbook: our guide to life’s trickly moments. Download your free copy here for expert tips on how to look after your bladder.