Hypothesis / aims of study
Sexual pleasure is the physical and/or psychological satisfaction and enjoyment derived from solitary or shared erotic experiences, including thoughts, dreams and autoeroticism (1). Coital incontinence is one of the least studied forms of urinary incontinence and can have a negative impact on all aspects of sexuality. However, there is no evidence about the possibility that this symptom generates pleasure. On the other hand, coital incontinence, as it has been defined, involves penetrative intercourse, which reduces the wide diversity of sexual practices of people with vulva. The aim of this research is to determine the frequency of people with vulva experiencing sexual satisfaction associated with Urinary Incontinence During Sexual Activity (UIDSA).
Study design, materials and methods
Cross-sectional population-based study. A self-administered online survey was developed and administered between December 2020 and January 2021. The Incontinence Severy Index and ICIQ-7 instruments validated in Spanish were used to assess urinary incontinence, as well as a sociodemographic survey and questions on UIDSA, validated by Delphi group. UIDSA was defined as involuntary leakage of urine during any type of sexual activity, including masturbation, sexual ideation, foreplay, vaginal or anal penetration. To determine sexual pleasure, questions were asked about sexual satisfaction, negative impact and suspension of sexual activity. Inclusion criteria: persons with vulva, (women, trans men, non-binary people), over 18 years-old from the province of Concepción, Chile. Analysis of absolute and relative frequencies with SPSS software.
Results
1114 persons participated, mean age 28.8 years (range 18-71). 18.6% reported urinary incontinence during sexual activity (UIDSA). 90.8% recognized their gender identity as female, 5.8% non-binary, 1.9% as male. In relation to sexual orientation, 1.4% recognized themselves as asexual, 17.9% bisexual, 69.6% heterosexual, 4.3% lesbian, 4.8% pansexual, 2% other. 38.6% answer that the symptom is an obstacle to full enjoyment, while 39.1% reported that they fully enjoyed sexual activity despite urine leakage. Moreover, 25.1% said they felt satisfaction with urine incontinence during sexual activity, 52.2% did not feel satisfaction and 22.7% preferred not to answer the question. 67.6% of people maintain their sexual activity and only 10.6% have suspended sexual activity due to incontinence.
Interpretation of results
The physical and psychological stimuli that can provoke pleasure are very varied and may also be conditioned by certain social, moral and cultural convictions. Incontinence of urine during sexual activity has been defined as a symptom that reflects an alteration of the pelvic floor; however, the pathophysiological phenomenon that leads to its appearance is unknown. From the data obtained, it is concluded that the concurrence of the aforementioned factors admits the existence of pleasure and/or sexual satisfaction with the leakage of urine during sexual activity without the need, in many cases, to interrupt or avoid the sexual act as a consequence of its occurrence.
Concluding message
These results give evidence on the magnitude of the symptom and also invite us to rethink on whether UIDSA should always be considered pathological, or be considered as a phenomenon that does not require medical intervention, since it does not produce egodystonia and, on the contrary, is capable of generating sexual pleasure. It is therefore very important to determine in every consultation the impact on each person, to incorporate sexual pleasure in the conversation and to inform in a safe and non-judgmental environment. Even so, urinary incontinence during sexual activity, in many cases generates discomfort in people, so each intervention must be individualized.