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CURRENT DEFINITION in: “The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society” [1]
Incontinence during intercourse is classified under:
Other types of urinary incontinence
It may be linked to a certain situation, for example, sexual intercourse, or giggling.
1.4 Associated Symptoms
During or after intercourse women may describe symptoms like dyspareunia (pain during intercourse), vaginal dryness and incontinence. These symptoms should be described as fully as possible. It is helpful to define when urine leakage occurs, that is, during penetration, during intercourse or at orgasm.

When we try to deal with incontinence during intercourse our lack of knowledge about female sexual dysfunction becomes evident. Since the majority of women do not refer this symptom to the doctor, it is probably underestimated. On the other hand, when it is referred, the majority of urogynaecologists or urologists are not able to treat it because the pathophysiology is not clear and the boundary between normal and pathological is blurred. An in-depth appreciation of similar, but pathophysiologically distinct, phenomena is essential for distinguishing normal, physiological sexual responses from signs of illness.

What is new on this topic in 2013?

Trying to shed light on the topic we find new reports [2,3] describing:
1)Female ejaculation orgasm (FE)
It can manifest as either female ejaculation of a small quantity of whitish secretions from the purported “female prostate” or squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously and are two different physiological components of female sexuality. The prevalence of FE is 10–54% [4,5]
2)Coital Incontinence (CI)
This isclassified according to when it occurs: a) during penetration. This is more frequent and is usually caused by stress urinary incontinence (SUI), or; b) during orgasm. This is frequently associated with urodynamic diagnoses of detrusor overactivity and SUI. The prevalence of CI is 0.2–66% [2]. CI is a pathological sign of a urethral disorder, detrusor overactivity, or a combination of both. It requires development of effective treatments.

Therapy
Improvement in a high proportion of cases of penetration CI has been claimed (Pastor), but most experts feel that caution is needed in counselling women about outcomes as the evidence base is weak. Adequate pharmacotherapy may improve 60% of women with orgasmic incontinence [6]. Pelvic floor muscle training has been observed to provide favorable outcomes [7]. Transvaginal electric stimulation is another proposed therapy [8].
Controversies:
  • Is this differential diagnosis clear?
Physiological signs of female arousal are sometimes mistaken for CI. Expulsion of fluid during sexual intercourse may signify a high level of arousal but can also be a sign of urinary incontinence (UI). The fluid may originate in the vagina, urinary bladder, female prostate, or a combination of these sources.
  • Why are the prevalence rates so divergent?
    • Different research methodologies
    • Association between types of UI and CI; Some studies suggest that the penetration form of CI is largely associated with urodynamic findings of SUI. Orgasmic incontinence may be associated with both SUI and detrusor overactivity (DOA). 50% of the studies [2] found that DOA is more likely to be related to orgasmic incontinence, whereas the others did not observe this association
Although there has been much research on orgasmic expulsions and CI, the exact pathophysiological mechanisms remain unknown. Future research directions include determining the real prevalence and mechanisms of their origins. A consensus on terminology and classification may contribute to more precise diagnoses and provision of correct information to healthcare professionals and the public.
A PERSONAL VIEW (Elisabetta Costantini)
Urinary incontinence is well-known in both sexes. Its most frequent clinical situations (SUI, MUI, UUI) are well addressed by the ICS, physicians and patients.
Coital incontinence is more of a stigma than a taboo.
What is the one way to improve the ICS, physicians and patients' awareness?
Be ironic and use satire.
A friend of mine, a urologist from Certaldo (Tuscany, Italy), the same town where Boccaccio, the famous author of The Decameron, was born centuries ago, made a great suggestion. He reminded me of an Italian movie “Amici Miei” (My Friends), directed by Mario Monicelli. The movie is the story of five Italian men who represent typical characteristics of the average Italian male: the trickster, the bungler, the passionate. But one thing links these men to us: their desire to be close to human beings and to let them live with a smile on their faces. They do not think of just having a great time for themselves but they tried to transmit the satire and irony they represent to us. Characteristic elements of the 5 friends are teasing civil authorities or ministers of the church and especially transforming symphonies into scurrilous, vulgar songs.
Amici Miei beter.png
Here’s one from Amici Miei:
Let’s f.., f…, f...zum zum zum zum zum zum zum
Let’s f.., f…, f...zum zum zum zum zum zum zum
You bitch, you deceiver
You cry “I’m coming” and you piss over me”

References
1)Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; Standardisation Sub-Committee of the International Continence Society. Urology. 2003 Jan;61(1):37-49
2)Pastor Z. Pastor Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review. J Sex Med. 2013 Jul;10(7):1682-91
3)Swati Jha & Katherine Strelley & Stephen Radley Incontinence during intercourse: myths unravelled. Int Urogynecol J (2012) 23:633–637
4)Rubio-Casillas A, Jannini EA. New insights from one case of female ejaculation. J Sex Med 2011;8:3500–4.
5)Goldberg DC, Whipple B, Fishkin RE, Waxman H, Fink PJ, Weisberg M. The Grafenberg spot and female ejaculation—A review of initial hypotheses. J Sex Marital Ther 1983;9:27–37
6)Serati M, Salvatore S, Uccella S, Cromi A, Khullar V, Cardozo L, Bolis. Urinary incontinence at orgasm: relation to detrusor overactivity and treatment efficacy. Eur Urol 2008;54:911-5.
7) Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogynecol J 2008;19:401–6.
8)Giuseppe PG, Pace G, Vicentini C. Sexual function in women with urinary incontinence treated by pelvic floor transvaginal electrical stimulation. J Sex Med 2007;4:702–7.

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