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Intimacy and Incontinence: A Frank Discussion with Dr. Babs

Intimacy and Incontinence: A Frank Discussion with Dr. Babs

We’re going to start this week’s long read by reminding us all that you can absolutely have bladder leaks and still have a fulfilling sex life, however you define it. But sometimes that might be easier said than done, and we wanted to know why. So we sat down with Dr. Barbara Frank, a Harvard-Affiliated OB-GYN and one of our Attn: Grace Medical Advisors – the perfect person to give us frank answers to our big questions. So settle in and buckle up, because we’re not holding back as we dive into this conversation.

AG: Dr. Frank, what worries women most about incontinence and their romantic life?

BF: Many women are not excited about a so-called “golden shower” in the middle of being intimate, and therefore abstain from sex altogether if they are worried about peeing a little. They might be too embarrassed to talk about their bladder leaks with their partners, they might worry about odor, feeling unsexy, or making a mess on the sheets …

AG: So there are quite a few things about bladder leaks that can prevent women from getting in the mood. How do you respond to their concerns? 

BF: I always recommend they be open with their partner. The more open you can be with your partner the more fulfilling your sex life will be in any aspect. Not just around incontinence. Our partners can often surprise us and be more accepting of things than we might expect. Experiencing a bladder leak during sex might be painfully embarrassing for you but not faze your partner in the least. 

I also suggest that women try to discover when they are more likely to have leaks – certain positions, penetration, orgasm – so that they feel more in control.

AG: What are some other practical things women can do? How do we keep the romance alive?

BF: I think it is important to prepare for the moment. If you pee before sex, you will enjoy intercourse more because you aren’t as worried about leaking. If you’re worried that your partner might detect the smell of urine, take a shower beforehand so you feel fresh and clean. 

I also always encourage women to work towards healing the underlying cause of the bladder leaks when possible and to talk openly about these issues with their healthcare provider. For instance, your doctor might refer you for pelvic floor PT, where you’d work on tightening up the muscles in your pelvic floor and learn about how you can strengthen them. Increased awareness will lead to a stronger connection with your body and in turn, support greater intimacy.

AG: Tell us: Peeing during orgasm. What’s going on there?

BF: This is very common – it happens a lot. Even if you don’t normally have incontinence you might leak a little during sex or while masturbating. This can be caused by a loss of control of the muscles during orgasm that pushes out a little bit of urine. Or, in certain positions during penetrative sex (with a partner or a toy), there could be pressure on the bladder that causes a leak. 

AG: Is this a situation that calls for Kegels?

BF: Pelvic floor exercises can help everything with sex. If you are in touch with your pelvic floor then you are in touch with your body and that is the first step. Working hard to exercise the pelvic floor can also lessen incontinence and help with bladder control, which in turn will have a positive effect on your feelings about intimacy. 

AG: Outside the bedroom, what can women in this situation do?

BF: There are also resources in the form of sex therapists and books like Hold Me Tight (Sue Johnson) and Come As You Are (Emily Nagoski). These might be worth exploring if you think the underlying nervousness or embarrassment could benefit from doing some intimacy work with your partner.

AG: Any final words?

BF: I’m a big advocate of talking about what’s going on – with your partner, with your girlfriends, so you feel less alone. Talking about sex and all of these related issues is all a part of intimacy. There are also so many other women out there who have these same experiences. Women should know that they’re not alone. 

AG: Thanks, Dr. Frank!

Whether you’re partnered or not, we hope this open conversation serves as a reminder that bladder leaks don’t mean you have to leave intimacy, sexual exploration, or orgasm behind. Having honest discussions with your partner may be the best way to eliminate any shame or embarrassment you’re feeling and rediscover your sexual side.

Want to hear more from Dr. Frank? 
Read Dr. Barbara Frank on the Importance of Lube
Read Normalize This: Menopause
Read Urinary Incontinence 101

Disclaimer: This content is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This content is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.