Let’s Talk About Leaks: Urinary Incontinence During Intimacy
Sex is meant to be intimate and enjoyable, but when urinary leakage happens, the moment can lose its magic.
Urinary incontinence affects a significant number of men to varying degrees, particularly those who’ve had prostate cancer treatment. While potentially awkward, it’s also common and treatable.
Defining the Disruption
Sexual incontinence is a form of urinary leakage that happens during, you guessed it, sexual activity. It can happen at different stages:
- Foreplay incontinence – urine leaks during arousal or physical stimulation.
- Coital incontinence – leakage during intercourse.
- Climacturia – leakage during or immediately after orgasm.
This can happen in men with known urinary incontinence, but also in men who have no other leakage issues. That’s right – for some people, it only happens with intimacy.
According to research, climacturia is reported by up to 28.6% of men after prostate surgery, even among those who are otherwise continent and sexually active.¹ While the reason why it happens continues to elude researchers, two main culprits tend to emerge.
Pelvic Floor and Urethral Changes
After prostate surgery or due to age-related changes, the structures that help keep urine in, like the external urinary sphincter and bladder neck, may not function as well. Some studies suggest that men with climacturia tend to have a shorter functional urethral length that contributes to leakage.1
Pudendal Nerve Injury
The pudendal nerve controls both sexual and urinary function. It helps maintain continence during orgasm by signaling the bladder neck to close. But it also carries signals related to orgasmic sensation and erectile function. If this nerve is damaged – say, during prostate surgery or due to pelvic floor strain – leakage and other sexual side effects like decreased orgasm intensity or delayed climax can follow.
It’s More Than Physical
A 75-year Harvard study on well-being found that the strongest predictor of long-term health and happiness wasn’t necessarily cholesterol levels or career success – it was the quality of a person’s relationships. Emotional connection, physical closeness, and feeling supported all play a significant role in how we age, heal, and thrive.¹
For many, a fulfilling sex life is part of that equation. So when urinary leakage interferes with intimacy, it can shake confidence, dampen desire, and place stress on even the strongest partnerships. Sexual incontinence can lead to embarrassment, avoidance of intimacy, and a strain on communication between partners.
In one study, 5 out of 9 men with climacturia said the leakage was enough to avoid sexual contact with their partner altogether. Even men who only experienced leakage during foreplay, and not during climax, reported significant emotional distress – two-thirds avoided intimacy due to shame.¹
The overlap between sexual function, emotional connection, and overall happiness is real, and ignoring this issue means ignoring a vital part of what makes life feel whole.
Shift From Shame to Solutions
Urinary leakage during sex isn’t something you just have to “put up with.” It’s common, it’s treatable, and you don’t have to let it hijack your confidence or your relationships. There are several ways to manage sexual incontinence, many of which are effective, non-invasive, and allow you to regain confidence and control.
Behavioral Adjustments
Simple strategies can go a long way. Many patients see improvement by emptying the bladder before intimacy, reducing fluid and caffeine intake beforehand, or using barrier methods like condoms or dental dams to contain leakage. One study found that 84% of men who emptied their bladders beforehand reported fewer accidents.¹ These minor adjustments can reduce anxiety and make intimacy feel more manageable.
Pelvic Floor Physical Therapy (PFPT)
Kegels aren’t just for women. For men, especially those recovering from prostate surgery, early PFPT has been shown to significantly improve climacturia, with one study showing improvement in two-thirds of patients who received therapy, compared to none in the control group.1 These exercises strengthen the muscles that support urinary control, helping reduce leakage during arousal and orgasm.
Supportive Devices
Innovative tools, such as variable tension loops worn at the base of the penis, help many men reduce leakage during sex without affecting erectile function. In one study, nearly half of patients experienced complete resolution of leakage using these devices, and both patients and partners reported less distress.¹
Medical Management
While research into medications for sexual incontinence is limited, drugs used to treat overactive bladder may help some individuals. Women in particular have seen improvement in both leakage and sexual satisfaction after treatment, though more studies are needed to confirm benefits for men.¹
Surgical Solutions
For persistent or severe cases, especially after prostate surgery, surgical treatments like urethral slings or artificial urinary sphincters can be a real game-changer. A study of men with post-prostatectomy incontinence found that those who received sling procedures for climacturia experienced almost total resolution of symptoms.¹
If you’re experiencing distress in the bedroom due to urologic issues, it’s worth exploring. The men’s health team at Georgia Urology specializes in diagnosing and treating male urinary incontinence, and can help you understand your options. That conversation could be the turning point that brings comfort and confidence back to your intimate life.
Reference:
- Mendez, M. H., Sexton, S. J., & Lentz, A. C. (2018). Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities. Sexual Medicine Reviews, 6(1), 16–28. https://doi.org/10.1016/j.sxmr.2017.07.012.
