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Also known as
Climacturia, Orgasm-associated urinary incontinence, Orgasmic urinary incontinence, Penetration urinary incontinence, Coital urinary incontinence (CUI), Urinary leakage during sexual intercourse, Intercourse incontinence, Sexual incontinence
Definition
Coital incontinence (CI) is defined as the involuntary leakage of urine during sexual activity, which can occur before, during, or after vaginal intercourse.1 This condition is further classified based on the timing of urine leakage: penetration urinary incontinence refers to urine leakage at penetration (penile or sexual device), while orgasmic urinary incontinence refers to urine leakage at orgasm.1
In men who have undergone radical prostatectomy, this condition is often referred to as climacturia or orgasm-associated urinary incontinence, defined as the involuntary loss of urine specifically at the time of orgasm.2 The pathophysiology involves damage to the urinary sphincter mechanisms during surgery, with several proposed mechanisms including removal of the internal urethral sphincter in conjunction with external sphincter relaxation, and intrinsic sphincter deficiency secondary to injury of the internal urethral sphincter and its supporting structures.2
The condition is frequently underreported despite having a significant impact on quality of life and sexual function.3 The incidence of coital incontinence in women with urinary incontinence has been reported to range between 10% and 27%,3 while in men following radical prostatectomy, prevalence rates range from 20% to 93%, with the average being approximately 30%.2
Current evidence suggests an association between urinary leakage at penetration and urodynamic stress incontinence (USI), as well as between urinary leakage during orgasm and detrusor overactivity (DO).3 The urethral sphincter plays a crucial role in coital incontinence, even in cases with detrusor overactivity and orgasmic incontinence.1
Clinical Context
Coital incontinence is a clinically significant condition that affects both women with urinary incontinence and men who have undergone radical prostatectomy. Understanding the clinical context is essential for proper diagnosis and management.
In Women
In women, coital incontinence is often associated with other forms of urinary incontinence.1 Current evidence suggests a strong association between the timing of urine leakage and the underlying urodynamic diagnosis:
- Urinary leakage at penetration is typically associated with urodynamic stress incontinence (USI)3
- Urinary leakage during orgasm is commonly associated with detrusor overactivity (DO)3
The condition is frequently underreported in clinical settings despite its prevalence ranging between 10% and 27% among women with urinary incontinence.3 This underreporting is likely due to embarrassment and the significant negative impact on women’s sexuality and quality of life.3
In Men After Prostate Surgery
In men who have undergone radical prostatectomy, coital incontinence (commonly referred to as climacturia) is a common side effect that is gaining more attention due to the distress it causes patients.2 The prevalence after prostate surgery ranges from 20% to 93%, with the average being approximately 30%.2 The bothersome nature of this condition has been quantified to be as high as 47%, with many patients avoiding sexual activity altogether due to embarrassment.2
Several mechanisms have been proposed for post-prostatectomy climacturia:
- Removal of the internal urethral sphincter during radical prostatectomy in conjunction with external sphincter relaxation2
- Intrinsic sphincter deficiency secondary to injury of the internal urethral sphincter and its supporting structures2
- Loss of penile length (reflecting loss of prostatic urethral length) as a statistically significant predictor2
Some studies have found an association between climacturia and post-prostatectomy stress urinary incontinence (SUI), though this correlation is not consistent across all research.2
Diagnosis and Assessment
Proper diagnosis requires specific questioning about this symptom, as patients rarely volunteer this information.3 Urodynamic studies are valuable in determining the underlying cause, which guides treatment selection:
- Video-urodynamic studies (VUDS) can help evaluate functional and morphological aspects in patients with climacturia2
- Urodynamic testing can differentiate between stress incontinence and detrusor overactivity as underlying causes3
Given the significant impact on quality of life and sexual function, assessment of coital incontinence should be included in the evaluation of patients with urinary incontinence or those who have undergone radical prostatectomy.1,2,3
Treatment Options
Treatment approaches vary based on the underlying cause and timing of incontinence:
For penetration-related incontinence (associated with USI):
- Pelvic floor muscle training (PFMT)2,3
- Surgical interventions for stress incontinence, with success rates of over 80% in women with urodynamically proven SUI1,3
For orgasm-related incontinence (associated with DO):
- Antimuscarinic medications, with success rates of approximately 60% in women with detrusor overactivity1,3
- Behavioral modifications and bladder training3
For post-prostatectomy climacturia:
- Pelvic floor muscle training (PFMT)2
- Penile variable tension loop2
- Soft silicone occlusion loop2
- Artificial urethral sphincter2
- Male urethral sling2
- Mini-Jupette graft (particularly valuable for patients with concurrent erectile dysfunction)2
Success rates for these interventions range from 48% to 100% depending on the modality used.2 The selection of treatment should be based on urodynamic findings and individualized to each patient’s specific needs and circumstances.3