Not many studies have been done on this subject as this is a very intimate and private affair, and it is difficult to get subjects for such studies. Over the years, the physiology of orgasm has changed from it coming from the clitoris alone to involving many other organs, including the uterus, bladder, urethra (the opening of the bladder) and contractions of the pubococcygeus muscle (the muscle surrounding the vagina and supporting the pelvic floor, going into spasm during an orgasm). Orgasm can include many full-body experiences such as tingling in the fingers and toes, spasm of arms, legs, face and lower abdomen, emotional outburst and feelings of relief and ecstasy.

*INCONTINENCE* is any leakage of urine, of which the 2 most common reasons are stress incontinence and urge incontinence. Stress incontinence is leakage of urine from exertions such as coughing, sneezing, jumping and laughing. This is due to a weakness of the support of the door of the bladder, such that it does not close tight on exertion, leading to leakage. Urge incontinence is due to the bladder wall muscles contracting, involuntarily, squeezing urine out before one can reach the toilet.

Orgasm is pleasurable but when associated with urinary incontinence, many may be frightened or turned off by sexual intercourse. Urinary incontinence during sexual intercourse is a poorly understood and infrequently volunteered problem.

This is different from female ejaculations which can occur at orgasm. Urinary incontinence may be from mechanical reasons such as the penis striking on a prolapsed (dropped) bladder, pushing urine out of a weakly supported urethra, or bladder contractions/spasm occurring at the same time as orgasm, or both of these reasons. Some women lose muscle control throughout their bodies during an orgasm, including the muscle keeping the urethra closed, causing incontinence. A study done some years back in the United Kingdom on 324 women found that 79 (24%) experienced urinary incontinence during intercourse, two-thirds of whom had incontinence on penetration (70% of them had stress incontinence) and one-third from orgasm (42% had stress incontinence and 35% had urge incontinence from an overactive bladder). There is another school of thought that Since contractions occur during orgasm and these contractions cause the bladder to contract as well (overactive bladder), it thus leads to incontinence.

A person with urinary incontinence should seek medical advice from her gynae, urogynae or her doctor, otherwise the condition may worsen, reducing the success rate from treatment, and affecting her sex life and relationship with her partner. The reason certainly Should be sought after as there may be many factors involved. For incontinence occurring just once or twice when it had never happened before could be simply due to a urinary tract infection, which can usually be easily cured with antibiotics.

Other than a physical examination, I will offer my patients a urodynamic study (computerised assessment of the bladder). This will help us with the diagnosis of stress and urge incontinence. In simple terms, stress incontinence is treated with pelvic floor (Kegel’s) exercise (mild cases) or surgery (moderate or severe cases), and urge incontinence is treated with medication and not surgery. Hence, making the correct diagnosis is of utmost importance as the treatment is totally different.

Kegel’s exercise is useful not only in helping people with stress incontinence but also in strengthening the pubococcygeus muscles. If the pubococcygeus muscle is weak, it may be difficult to go into spasm (orgasm) when there is an object in the vagina. It has also been found by another study that females with a stronger pubococcygeus muscle ejaculate (just like the males) better (not urinary incontinence) and have stronger orgasm.

Certain simple measures may be useful. One can visit the toilet before intercourse as an empty bladder will not leak. Medication known as minirin can be taken a couple of hours before intercourse to reduce urine formation. For people with an overactive bladder, medication such as detrusitol can reduce contractions of the bladder. A person should be properly assessed before starting medication.

Urinary incontinence may be more common than we think. Help is certainly at hand and can be easily assessed and the problem can be treated in most cases. Sufferers must not do so in silence, or their sex life and relationship may be affected.