Pee During Sex? It Could Be a Pelvic Floor Disorder

Of all the less-than-desirable things that can happen during sex — realizing your zipper is stuck, losing your character during role-play, getting a hamstring cramp — accidentally peeing on your partner is pretty high on the list. What's surprising is how common it is; up to 56% of people who are sexually active report peeing a little or a lot during sex. Nonetheless, it can be extremely distressing when it happens to you.

The worry that at any moment you could accidentally leak pee can entirely consume your sexy headspace, to the point where it makes you want to avoid sex altogether. Ultimately, it can place significant strain on your romantic relationships and quality of life.

Known as coital incontinence (CI), peeing during sex is often related to pelvic floor weakness. The good news is that if a weak pelvic floor is the reason you're leaking, pelvic floor physical therapy can help. Keep reading to better understand this frustrating sexual symptom and learn how you can stop worrying and enjoy sex even more.

Is peeing during sex normal?

It may be common, but accidentally peeing during sex is not normal from a health perspective. Coital incontinence is part of a broader spectrum of urinary incontinence issues faced by many women and people born with vaginal anatomy.

Peeing during sex most often happens during vaginally penetrative sex or during orgasm, but some women report leakage during clitorial stimulation as well.

Unfortunately, because there is a significant lack of awareness about coital incontinence — and because it can be understandably difficult to talk about with your friends, partner, and/or healthcare provider — the true prevalence of CI is not well known. Some studies report that coital incontinence impacts about 1 in 4 sexual active women and people with vaginal anatomy. Another study reports that more than 1 in 2 people report peeing during sex.

Is it pee or female ejaculation?

During the throws of an orgasm, it can be tricky to know what exactly is going on when you feel a gush of fluid. It’s common to wonder if the wetness you feel is pee or the result of female ejaculation. Current research indicates that these are two different things that can occur during sex, and that can also happen at the same time.

Female ejaculation is the expulsion of a small amount of thick, milky fluid during orgasm. This fluid comes from the Skene’s glands, which are two small glands on either side of the urethra (these are also referred to as the female prostate) that may provide lubrication and antimicrobial protection during sex. Female ejaculation only happens during orgasm and is considered part of a normal and pleasurable sexual response.

Peeing during orgasm or coital incontinence involves the leakage of urine from the urethra. This is considered a symptom of incontinence, and not part of the normal sexual response.

When female ejaculation and urination happen at the same time, you have a combination of different types of fluid and the amount of fluid can vary, depending on how much urine is being released.

How does coital incontinence impact quality of life?

Not surprisingly, peeing during sex or coital incontinence is well known to contribute to sexual dysfunction and it can have a significant impact on your quality of life. During sex, CI may contribute to:

• Worry over the possibility of leakage during sex
• Decreased libido, or desire for sex
• Vulvar irritation from persistent urine leakage
• Less self lubrication
• Dyspareunia, or pain during sex

Coital incontinence may also contribute to difficulties with orgasm and it can put a significant strain on your romantic relationships.

What causes peeing during sex?

Unfortunately, there is a lot we don’t know about female sexual dysfunction. Bladder leakage during sex is no exception. While the causes of coital incontinence are still being researched, some believe peeing during sex is linked to:

• Weakened pelvic floor muscles
• Scar tissue in the abdomen or pelvis
• Overactivity in the muscle that surrounds that bladder (detrusor overactivity)
• Urethral dysfunction
• Pelvic organ prolapse

Newer research finds that coital incontinence is most commonly associated with stress urinary incontinence and urethral incompetence. Urethral incompetence is when the muscles that surround the urethra are not able to close as tightly as they need to, to prevent urinary leakage.

There are also some personal and clinical factors that have been found to increase your chances of peeing during sex. One study notes that coital incontinence was more common in those who had more significant stress incontinence, were younger in age, and who smoked.

As coital incontinence is a symptom of urinary incontinence, the following will also increase your risk of peeing during sex:

• Sex assigned female at birth
• Pelvic organ prolapse
• Multiparity (having had more than one baby)
• Having a larger body size

Is a weak pelvic floor making you pee during sex?

Like with stress urinary incontinence, weak and under active pelvic floor muscles are likely to contribute to coital incointnence. When weak, your pelvic floor muscles don’t have the strength or endurance to protect against the increases in intra-abdominal pressure that occur during times of physical exertion — like sex. Plus with penetrative sex, physical pressure from a penis or dildo can provoke leakage if your muscles aren’t strong enough to manage the extra pressure.

This is particularly true if you have pelvic organ prolapse, which is when your pelvic organs can drop down into the vaginal walls. If your urethra or bladder are dropping down lower than before (which is common after a vaginal delivery), then physical pressure from penetration may make leakage even more likely.

Another way that your pelvic floor muscles can contribute to coital incontinence is through poor muscle coordination. Normally during sex, your pelvic floor muscles should contract to enhance arousal and orgasm. These contractions should help to support the bladder and close the urethra during orgasm. However, if your muscle coordination is disrupted — this can happen for a variety of reasons, including bad habits, or in response to injury — then your muscles may relax and lengthen during sex, which will allow your urethra to open. You may even inadvertently strain during the effort of sex, which places more stress on your bladder and can worsen leakage.

Pelvic floor PT can help you stop peeing during sex

If you've been peeing during sex, check in with a gynecologist, or urogynecologist so they can assess your symptoms and rule out any causes due to illness or injury. Once ruled out, pelvic physical therapy is the next best step to help treat your symptoms.

Research has shown that the most common causes of coital incontinence are stress incontinence and urethral incompetence, both of which can be successfully treated with pelvic floor physical therapy. Your pelvic floor PT can work with you to address underlying pelvic floor muscle dysfunction. This typically involves using a variety of strategies like the ones listed below.

Pelvic floor muscle exercises

Kegel exercises are “old reliable” when it comes to strengthening weak and underused pelvic floor muscles, and easing symptoms of urinary incontinence. They are genuinely helpful in improving pelvic floor muscle strength and endurance so that your muscles are effective and protective. And years of research backs up this exercise’s ability to improve symptoms of underactive pelvic floor muscle dysfunction such as stress incontinence, and symptoms related to pelvic organ prolapse.

Manual therapy and coordination training

If muscle tightness or poor coordination are to blame, then a combination of coordination exercises, biofeedback training, and manual therapy can be very effective in normalizing muscle function.

Manual therapy and coordination exercises can improve the coordination of signals between the brain and the pelvic floor, and will help make sure the muscles are working precisely when needed, such as during sex to prevent urinary leakage.

Lifestyle and behavioral modifications

When it comes to coital incontinence, there are usually some adjustments that can be made in your diet, and sexy-time routine that can help to improve your symptoms. A pelvic physical therapist can help you to identify any not-so-helpful habits that can immediately ease your symptoms. For example, it can be helpful to eliminate bladder irritants from your diet (or at least find a good time to cut yourself off for the day, so that you feel better by sex time). They can also help you find different sex positions that work for your body, and minimize the pressure that is placed on your bladder and urethra during penetration.

At Origin, we understand that peeing during sex can be a distressing and isolating issue. It's important to remember that you're not alone and there are effective treatments available. Our compassionate and skilled pelvic physical therapists are dedicated to helping you regain confidence and enjoy intimacy and sex without the fear of leakage. By addressing the underlying pelvic floor muscle dysfunction with personalized exercises, manual therapy, and lifestyle modifications, we can help you manage or even eliminate this symptom. Take the first step towards more comfortable and confident sex by scheduling an examination with one of our PTs today.