Urinary incontinence such as incontinence with coughing or sneezing (stress incontinence) and incontinence with uncontrollable urges (urge incontinence) may be related to impairment in sexual life. All aspects of sexual function can be affected including lubrication, satisfaction and pain with sexual activity. In addition, urinary incontinence often leads to a diminished sense of well-being and quality of life.
Potential mechanisms for alterations in sexual function include interference with spontaneity, incontinence with intercourse, embarrassment of odor and low body image. Coital incontinence is common, and can be seen in both stress and urge incontinent women. When the incontinence occurs with penetration it may be secondary to stress incontinence, while incontinence with orgasm is often associated with urge incontinence. However, it may be very difficult for patients or clinicians to distinguish these two.
Many conservative treatments for urge and stress incontinence such as medications and pelvic floor physical therapy improve sexual function. However, severe stress incontinence is often treated with a surgical approach. These surgeries are highly successful at curing stress incontinence symptoms, and the majority of patients also report subsequent improvements in sexuality. Nevertheless, in a minority of cases, surgery may be associated with alterations in sexual function due to scar tissue, mesh complications, or anatomic disruption. On this basis it is important to for women to discuss potential risks with their surgeon prior to any procedure. Further conversations at subsequent visits when appropriate will establish a need for intervention and mitigate any negative effect on their sexual and general health.