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Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity?

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Abstract

Introduction and hypothesis

Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO).

Methods

To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses ‘CIAP is associated with USI’ and ‘CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage.

Results

Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not.

Conclusions

CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.

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Authors and Affiliations

  1. University of Sydney, Penrith, Australia

    Hans Peter Dietz & Nishamini Subramaniam

  2. 193 Burns Rd, Springwood, NSW 2777, Australia

    Hans Peter Dietz

Authors
  1. Hans Peter Dietz
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  2. Nishamini Subramaniam
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Contributions

Hans Peter Dietz: Project conception, design and development; data acquisition; analysis and interpretation; drafting the manuscript, revising it critically for important intellectual content and final approval of the version to be published. Nishamini Subramaniam: Data acquisition; analysis and interpretation; drafting the manuscript, revising it critically for important intellectual content and final approval of the version to be published.

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Correspondence to Hans Peter Dietz.

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HP Dietz has received unrestricted educational grants, lecture honoraria and consulting fees from GE Medical and Mindray. The other author has no conflict of interest to declare.

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Dietz, H.P., Subramaniam, N. Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity?. Int Urogynecol J 33, 1175–1178 (2022). https://doi.org/10.1007/s00192-021-04809-8

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  • DOI: https://doi.org/10.1007/s00192-021-04809-8

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