Coital incontinence (CI) is defined as the involuntary leakage of urine during or after penetrative sexual activity and is common in women with stress or urge incontinence (24-66%). Coital incontinence associated with penetration and/or orgasm has been described and has been linked to stress urinary incontinence and overactive bladder, respectively. However, the term "coital" reduces this phenomenon to the association of penetrative sexual activity, there being multiple other practices in which sexuality manifests itself. There is a lack of population-based studies that determine the real frequency of this phenomenon and that include the various manifestations of sexuality, as well as the inclusion of a diverse population. The aim of this study is to determine the prevalence of urinary incontinence during sexual activity (UIDSA) in a population of persons with vulva.

Population-based, cross-sectional study. An online, self-administered survey was developed, applied between December 2020 and January 2021, and promoted through social networks. We used the Incontinence Severity Index and ICIQ-7 instruments validated in Spanish to assess urinary incontinence, a sociodemographic survey and questions regarding incontinence during sexual activity validated in a Delphi group. UIDSA was defined as involuntary leakage of urine during any type of sexual activity. Inclusion criteria: persons with vulva (women, trans men and non-binary persons), over 18 years-old from the province of Concepción, Chile. Analysis of absolute and relative frequencies with SPSS software.

1114 persons with vulva agreed to participate. Mean age 28.8 years-old (Range 18-71). Mean weight 66.3 kg (Range 42-140). 93.7% recognize their gender identity as female, 4% recognize themselves as male (trans), 1.7% non-binary and 0.3 non conforming/undefined. 80.9% define themselves as heterosexual, 11.8% as bisexual, 2.7% as pansexual, 2.1% as lesbian. 27.6% have had a pregnancy. 8.2% have some chronic disease and 39.3% frequently use some medication. 9.7% reported pelvic surgery. 23% have stress urinary incontinence, urgency or other, more than once a month. 18.6% have had an episode of urinary incontinence associated with sexual activity. Of these, 37.2% have stress, urge or mixed incontinence more than once a month and 21.3% have no other type of urinary incontinence (exclusive UIDSA). Among people with UIDSA, incontinence associated with orgasm is the most frequent (62.3%), then during penetration (54.1%), during masturbation (30.9%), during “foreplay” with a partner (28%), during sexual ideation or erotic fantasies (10.6%) and during anal penetration (4.8%). 32.4% have presented this phenomenon for more than one year.

Urinary incontinence during sexual activity is a frequent phenomenon and can occur during any type of sexual practice, not only during coitus. Therefore, the term "coital incontinence" is inadequate to describe the wide variety of this symptom. It is important that related studies include the sexual diversity of our populations. Traditionally, UIDSA has been associated with stress or urge incontinence, however, we now know that an isolated form of this symptom exists in 21% of the population presenting with UIDSA. Therefore, it is important that the interview of any persons with vulva include questions associated with involuntary urine leakage during sexual activity. At the same time, it is necessary to further investigate in the pathophysiology of this phenomenon, since theories of association with stress or urge incontinence are not enough to explain the multiplicity of expressions of the symptom.

Urinary incontinence during sexual activity is a common phenomenon among persons with vulva and may occur during different sexual practices.