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I feel like I'm about to wet myself when I have sex. Why might this be happening?

by Peter Greenhouse on 15 April 2010

"When I have sex with my partner I always feel like I'm about to wet myself. I have had an STI check which has come back fine. It's only been happening for the last 2 years. I go to the toilet before so I can't understand why this is happening. Do you have any suggestions?" (Female aged 21, no previous pregnancies)

 

It has taken a while to answer your question because this problem is rarely talked about or researched in younger women. You've been sensible enough to exclude infections, although I can't think of any which could cause this particular symptom - except, perhaps candida (Thrush) or Trichomonas, which would show up in the tests, be easy to treat and shouldn't have occurred continuously for 2 years.

 

Actual urine leaking during sex occurs much more commonly in women who've had children (especially after one or two difficult births) and is a major problem in older women after menopause when lack of the female hormone oestrogen causes the bladder muscles to be more irritable - thus more easily triggered into contracting when stimulated (in other words, prodded around). Lack of hormones also causes inflammation of the urethra (urine tube) and bladder lining known as "interstitial cystitis", which further increases discomfort, irritability and feeling of an urge to pass urine much more frequently.

In young women there are several possible reasons why the feeling of being about to leak urine during sex could occur, and your problem may be due to an unfortunate combination of all of them.

Firstly, you should think about simple mechanics:

The larger - in this case I mean wider rather than longer - your partner is, and the more vigorous he is, then the more the base of the bladder (known as the trigone) will be pushed into and stretched and the more the urethra will become irritated. This mechanism usually causes what used to be called "honeymoon cystitis", which most women have experienced at some time when starting with a new partner or in long-distance relationships where periods of separation increase desire. However, it doesn't usually cause leaking or your particular feeling of an urge to leak.

Also, on the mechanical front, position during sex could be important. If the man is behind you - as in "spoons" or "doggy-style" positions - the penis pushes directly into the front wall of the vagina and thus the bladder trigone. This is great for G-spot stimulation but is even more certain to trigger bladder contraction if this has been a problem. The position least likely to cause this is so-called "male astride", a variant of the missionary position where the man's legs are outside the woman's hips. This causes shallower penetration and greater clitoral stimulation, and almost no bladder pressure - great for women who get pain on deep thrusting and worth trying.

Secondly, think hormones.

If you're using methods of contraception which contain only progesterone and no oestrogen - i.e. the injection (Depoprovera), the implant (Implanon) or a progesterone-only pill (usually Cerazette) - then the amount of oestrogen you need to keep the vagina well lubricated, the bladder muscle correctly toned and the bladder & urethra lining completely healthy might have reduced in your particular case to a level where symptoms - similar to those found in older women - can occur. Although the majority of women taking these methods will be OK, the problems of reduced bladder capacity and poor lubrication are well-recognised (especially after long-term use of the injection) by contraception specialists in continental Europe, where most of the research on this has been done, but seemingly not so much in Britain.

If you are using one of these methods, you might benefit from using a little natural oestrogen supplement by way of a small pellet or cream put into the vagina on a regular basis. You'd expect to notice some improvement around 2-4 weeks after starting treatment. This is safe to use even if you aren't allowed to take the combined pill containing artifical oestrogen (for instance because of severe migraine with neurological symptoms). Alternatively, if you were originally put on a long-acting method (injection or implant) because you had difficulty remembering to take the combined pill, you could take the pill at the same time as the injection or implant to use as an oestrogen supplement (this is often done to help control abnormal bleeding patterns). Better still, set up a system which ensure you take the pill reliably (for example, plan to take it when you wake up, but set your mobile phone alarm for tea-time every day to remind you) and think about switching from the long-acting method - but only when you haven't missed a pill for over three months or so.

Finally a possible, temporary fix might be the use of tablets to reduce bladder irritability. These are normally offered to much older women with this problem, but might provide some relief of your symptoms - for instance if taken an hour or two before intercourse. However, they won't tackle the underlying cause, which is by no means obvious in your case.

Yours is a rare, specialized problem which needs a specialist assessment either by an expert in gynaecological hormones or gynaecological urology. I suggest you start by going to your nearest main contraception/sexual health clinic and asking to see a senior doctor there, if possible. A list of these clinics can be found at: www.fpa.org.uk or by phoning the fpa helpline on 0845 122 8687

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Bish Training said on 24 April 2010

One explanation for the feeling which the questioner is experiencing has been completely overlooked: female ejaculation.

Female ejaculation has been reported for many years but since this report www.jstor.org/.../3812357 in 1981 there has been increased agreement that female ejaculation is *not* the same as female incontinence.

Furthermore many studies have now shown that the fluid which many women 'leak' during sex is not urine but more like 'semen'. www3.interscience.wiley.com/.../abstract

Because ejaculatory fluid comes from the urethra it can be confused with the feeling of urination.

Studies suggest that as many as 69% of women can experience female ejaculation during sex or through masturbation. It seems pretty likely to me that this is what the questioner is experiencing, and that furthermore it is not problematic but entirely 'normal'.

So my advice to the question would be to try to accept this as a cause of the feeling which you are experiencing and to try to overcome your anxieties by exploring your body.

Dr Beverley Whipple, co-author of the 1981 report, gives the following advice to Dr Sharon Moalem in 'How Sex Works'

"Begin with clitoral stimulation, and at least initially this may be the best way to start getting aroused. One should never feel rushed or pressured in any way. When she is ready it's best to move on to stimulating the anterior wall of the vagina [which, if a woman is lying on her back, would be closest to her stomach], stimulating the area with one or two fingers making a "come here" motion. It's perfectly normal if she feels as if she needs to urinate, because this area surrounds the urethra, the tube you urinate through. With time and practice and help of a partner a woman may experience female ejaculation." Page 130, How Sex Works.

The amount which women can ejaculate can vary, but it can be a lot so you may want to put a towel on the bed if you are concerned.

The more you practice the more likely it is that you will accept this as normal. Try to focus on what gives you pleasure and let go.

For more

mackiller.tripod.com/femaleejaculationlp.pdf  

www.fiawol.demon.co.uk/.../femejac.htm

bishtraining.wordpress.com/.../the-clitoris-orgasms-and-other-stuff

 
Helenahardwick said on 2 June 2010

It sounds like the problem is experienced only during sex and is the sensation of being about to urinate, rather than actual incontinence.  You don't say whether it comes on immediately or whether it happens after prolonged contact, and whether if you continue it goes away. From what I have read a lot of women experience this sensation particularly when approaching orgasm, and it usually goes away quickly even if they don't experience any ejaculation, and does not cause any urination or leakage.  I would suggest reading up on female ejaculation and orgasms to see if this matches what you experience, and if not, experiment with different positions and different types of stimulation to discover whether it is pressure on the bladder during penetration, stimulation/irritation of the urethra from outside or front wall of vagina, or whether it is a sensation which passes quickly. You could experiment on your own if you are concerned about being incontinent.  If it's mechanical you could try different moves or if this is too restrictive try the irritable bladder treatment.

 
husna said on 6 September 2010

i have the same symptons, i feel during vigorous sex, that i need to wee, but once he stops i'm fine. the doctor told me this is normal, nothing to worry about. he also said that feeling like you're gonna wee is actually the G spot!!! this means he is doing the right thing!!!

 
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