‘I think sex is here to stay’, said the beloved comedian Groucho Marx (1890-1977). Even though you may really want to be intimate with your partner, your worries might hold you back. There are a few extra precautions to make when you have bladder issues – both to avoid disturbing leaks and to prevent urinary tract infection as an unwanted morning gift.

The confidence to enjoy an active sex life

Intermittent catheterisation in itself rarely interferes with sexual activity. Make sure to catheterise yourself and empty your bladder completely before having sex to prevent leakage. Women are more likely to get a urinary tract infection and sexual activity can increase the risk because of the female anatomy, but men can also get it – so the following advice is relevant for both:

Precautions when you have sex

During intercourse your genital area will always be introduced to bacteria – either from yourself or from your partner. Follow these rules before, during and after sex to limit the amount of bacteria:

Before sex:

Empty your bladder as a full bladder gives better conditions for bacteria to settle down and grow.

During sex:

If you or your partner feel dry during intercourse use a water-soluble gel (lubricant) to help decrease friction and stress on tissue, which can lead to infection. The use of diaphragms and spermicides can also cause irritation, which promote infections. If you have frequent UTI’s talk to your doctor about another form of birth control.

After sex:

Empty your bladder immediately after having sex, even if there is only a small amount of urine in your bladder to flush potential bacteria out. Drink 2–3 glasses of water and urinate when you have the urge to do so. The goal is to have a good steady stream of urine to wash any bacteria from the bladder.

It hurts when we have sex. What can I do?

Some women with bladder problems may have pain during intercourse. If this happens, contact your doctor or nurse for advice.

My vagina feels dry

This can be a common difficulty for some women. Try some water-based lubricant. If you have sore skin, you should see your doctor about it.

I often suffer from urinary tract infections (UTIs)

• Be careful to clean your genital area before and after sex.
• Drink lots of water afterwards and empty your bladder when you feel the urge to.
• This will flush out bacteria. If this does not prevent UTIs talk to your doctor.

I am pregnant. Can ISC harm my baby?

Intermittent catheterisation will not harm the baby at any stage of your pregnancy.

I worry about leakage

If you use intermittent catheterisation just before the act, you should not need to worry. If you still have concerns, try wearing a condom.

I sometimes get an erection when I catheterise

Sometimes catheterisation stimulates an erection. When you stimulate a reflex erection, you may want to use that erection for intercourse. If you take the catheter out and let the erection go away, it will for most men be harder to stimulate a second reflex erection. Try to do a little foreplay, then catheterise, and then quickly continue with more foreplay using the erection that comes from the catheterisation.

I have a headache, I’m too tired, I don’t have time…

You may have used one of these once in while.

It’s okay to not be in the mood – all women (and men) experience that sometimes. But for some it becomes an actual problem. A UK national survey showed that 54% of sexually active women suffered from at least one sexual problem lasting at least one month in the preceding year.

Women who see a doctor about bladder problems are not always checked for sexual problems as well. But as you may have experienced, bladder problems can have a negative effect on all parts of your sex life. This includes effects on sexual desire, arousal, lubrication and orgasm. It can also be a cause of pain during sexual activity.

Different types of incontinence can have different effects on sexual function:

Stress incontinence

If you have stress incontinence, you may have reduced sexual desire, because the fear of having a leak episode during intimacy can result in sexual anxiety.

Urge incontinence

If you have urge incontinence, you may be uninterested in sex because of a strong increase in the desire to urinate during intercourse, with subsequent frequent leakage of urine during such. Moreover, urge incontinence has been associated with pain and anxiety related to intercourse and fear of reaching an orgasm due to the risk of having an urge incontinence episode at this time.

Coital incontinence

It can occur at any point during sexual activity, but the mechanism seems to be divided into ‘mechanical’ (introduction of the penis, deep penetration, pressure on the abdomen) and ‘non-mechanical’ factors (clitoral stimulation, arousal and orgasm).

Coital incontinence does not affect sexual enjoyment in all women.

Fewer than one in five women suffering from sexual problems look for help for their sexual concerns.

Many people find it embarrassing to talk to their doctor about bladder problems and sex. It may be due to the age and gender of the doctor or the perceived attitude of the doctor – especially if you are an older person seeking help for a sexual problem. Sexual problems are often not perceived as a ‘severe’ health problem.

However, it is important to seek advice if you have sexual problems. Doctors treat patients with intimate healthcare issues every day, so there is no need to be embarrassed. If you prefer, you can always request a doctor of the same gender as you. 

Sex begins in your mind. A positive self-image is the first step to be able to enjoy sex. To feel that you are desirable even if your body has changed or the way you can have sex is different. Another important factor is openness towards your partner. Talking about your worries and allowing your partner to share his or her thoughts as well can help you relax when you’re together. Show or tell him or her what you like and don’t like.

The willingness to experiment makes you think less about what you can’t do and might even spice up your sex life.

People cope with their bladder issues when it comes to sex in different ways including:

• Laughing about it
• Having sex in the shower 
• Connecting intimately in other ways like massage
• Padding the bed with sheets
• Avoiding sex

Did you know?

In the general population, sexual response is different for men and women:

Women’s motivations for having sex are usually related to attraction, pleasure, affection, love, emotional closeness and reproduction.

Men more often have sexual fantasies and thoughts about sex. Men also feel the urge to have sex more often than women. With ageing, the difference in sexual response between women and men becomes less obvious.