When I was recently reviewing the literature on sex during pregnancy, it surprised me to learn that one of the biggest impediments to having sex for pregnant women is incontinence. The problem can last for up to six months after pregnancy.

So I was already sensitive to the matter when this month's Journal of Sexual Medicine arrived and there was an article titled "Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's Sexuality" J Sex Med 2009;6:40-48.

According to the authors, coital urinary incontinence is usually divided into two categories: that which occurs during penetration and that which occurs during orgasm. It's been shown that women who experience the first type of urinary leakage--incontinence at penetration--often have urodynamic stress incontinence, while women with incontinence during orgasm often experience detrusor overactivity.

Urodynamic stress incontinence is when your urinary sphincter doesn't stay closed when you'd normally expect it to. It is often associated with weak or otherwise compromised pelvic muscles.

Detrusor overactivity is when the muscle that surrounds the bladder contracts while the bladder isn't full enough to justify a trip to the loo. The detrusor is a muscle that’s part of the bladder wall. It usually stays relaxed except when the bladder fills up and you need to pee. The detrusor then contracts and helps squeeze out the liquid that’s in the bladder.

A common treatment for urodynamic stress incontinence includes pelvic floor exercises. Unfortunately, people often assume this means to simply squeeze your pelvic muscles in a misguided attempt at doing Kegel Exercises.

To learn more about pelvic floor exercises, I recommend that you read a Medscape article** on the subject and that you read everything you can on Talli Rosenbaum's website. (I am far from alone in considering Talli to be one of world's top experts in pelvic floor rehabilitation.)

As for treatment of detrusor overactivity, this article on bladder retraining might be of help.

And please, before formulating any kind of treatment strategy for urinary leakage or any other physical concern, I highly recommend you discuss it first with your healthcare provider. I am not a physician, and even if I were, I would tell you that nothing you will read on the Internet takes the place of a face-to-face or face-to-crotch meeting with a licensed healthcare provider.

**I apologize if Medscape requires you to register to see this article. I believe you can register for free. If you need, the full citation is "Pelvic Floor Exercises Reduce Female Urinary Incontinence" by Laurie Barclay, MD and Désirée Lie, MD, MSEd., October 31, 2008.

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