THE ROLE OF SEXUALITY

Sexuality means different things to different people. It involves how you express yourselves sexually including our desires, attractions, preferences, and how you like to be loved and receive love. Your sexuality is influenced by many aspects of your life including your health and wellbeing, cultural background, and life experiences. Sexuality is not about sex.

From the moment we are born, we receive positive and negative messages about our sexuality and these messages can affect the way we see ourselves. It can be expressed in our behaviour, the way we talk, dress and walk. Our sexuality can change depending on the various phases or stages of our life cycle.

Myths and misconceptions about sexuality tend to be passed on from generation to generation, depending on our cultural or religious background. They are beliefs that influence the way we think and shape our values. Examples of the myths about sexuality include:

  • "older people are not attractive"
  • "older people are not interested in sex"
  • "people with disabilities are not sexually active".

These beliefs are often easy to take on because other people believe them to be true. Sometimes it helps to identify and discuss these beliefs with someone and this may reduce the negative impact they can have on our thinking.

Bladder or bowel control issues can have an enormous impact on sexuality and the way you feel about yourselves. Any leakage, fear of leakage, fear of odour, wearing continence pad or need to find at toilet may change how you feel about yourself sexually. It may also affect how you behave including how you dress, socialise and engage in sexual relationships. You may find you restrict your movements outside of the home, avoid intimate relationships and alter your clothes to try to disguise any wetness, staining or sign of a continence pad. Your choice of clothing can be an outward expression of your sexuality.

If your partner needs to assist you with your continence care, including personal care, this may also have an impact on your sexuality and your intimate relationship. If this is impacting on your relationship, you should be talked about with an appropriate health professional, such as your doctor or clinical psychologist.

When you live with incontinence, this can have physical and emotional impacts.  This can include fear of intimacy, concerns over leakage or soiling during sex, concerns over how to manage continence products during sex, painful sex, bladder spasming or catheter bypassing during sex.

These impact or concerns can lead to you avoiding situations of intimacy, withdraw from existing relationships, avoiding new relationships, and suppressing your sexual desires.

You need to know you are not alone in these feelings and that help is available.

The concerns of people living with incontinence can be placed into two categories: emotional and physical.

Emotional concerns

  • embarrassment and shame
  • an overwhelming sense of loss and grief because of their inability to control this bodily function
  • anxiety and depression
  • low self-esteem or confidence
  • feeling lonely and isolated
  • a loss of desire for intimacy.

Physical concerns

  • leaking urinare or bowel motions during sexual intercourse due to position and pressure, or due to a bladder spasm or bypassing a catheter
  • odour from leakage and infection
  • irritation to genital area from allergies or ill-fitting continence aids
  • presence of drainage bag and/or catheter.
  • sexual dysfunction - vaginal dryness, lack of sensation
  • pain or fatigue associated with the underlying cause of incontinence
  • concerns in managing continence aids (for example, catheters) particularly during intercourse
  • the effect of medications
  • hypersensitivity or spasm from an underlying condition (for example multiple sclerosis, motor neurone disease, spinal injuries or cerebral palsy).

These concerns can lead the person experiencing incontinence to avoid situations of intimacy, withdraw from existing or future relationships, and suppress their own desires of sexuality.

You need to know you are not alone in these feelings and that help is available.

This information was extracted from the article Promoting continence and sexual health written by Annie Norrish, Royal Talbot Rehabilitation Centre, for the Continence Foundation of Australia.

COMMON QUESTIONS

There are many questions about sexuality and incontinence. If your question isn't answered below you can call the National Continence Helpline on 1800 33 00 66 for a free, confidential discussion with a Nurse Continence Specialist.

Try to empty your bladder prior to sexual intimacy. Be prepared by protecting the bed such as with a mattress protector and/or a bedpad and have towels and washcloths ready. You could also discuss your fluid intake with your doctor, including the types of fluids you are drinking, and assess your alcohol consumption. Speak to your doctor, pelvic health physiotherapist or nurse continence specialist about what you are experiencing and what treatment is available to help manage it.

A catheter can be removed prior to sexual intimacy and a new one inserted. This may not be possible for many people. For men, a catheter can be taped to the shaft of the penis, allowing for an erection. If friction is a concern, a condom may be worn and water-based lubricant used for lubrication. For a women, a catheter can be taped to the thigh during sex to keep it out of the way.

If your partner is in good health, it is unlikely that they would be susceptible to the organisms associated with a urinary catheter. If there is any doubt, encourage your partner to wash themselves and pass urine after intercourse and drink plenty of fluids.

Having a catheter in place should not affect an erection or ejaculation. An erection is a combination of psychogenic (thinking) and reflexogenic (touching) responses and it is possible that anxiety may affect the 'thinking' responses. If you experience difficulty, it is important to find out the exact cause of the erectile dysfunction or impotence and this may mean a referral to a Urologist. Sometimes, however, a catheter can have the opposite effect and cause spontaneous erections due to the friction.

Certain types of ongoing infections can produce strong or offensive smells. Make sure any symptomatic urinary tract infection (when you have signs and symptoms of an infection) are treated. Drink well to try to avoid having concentrated urine which may have a strong odour.

A leg drainage bag may be covered or put out of the way. It is a good idea to talk to a prospective partner before sexual intimacy about the equipment you use so that they know what to expect. Sometimes a catheter can be temporarily spigotted (sealed off) and the leg bag removed with a catheter valve used instead.

MANAGEMENT

There are ways of managing your bladder and bowel problems so you can still enjoy intimacy with your partner.

By making some small changes you may find you can easily overcome your concerns, but don't forget there is professional help available if you need it.

  • Discuss your concerns with your partner.
  • Empty your bladder and/or bowel (if this is possible) immediately prior to intimacy. 
  • Include hygiene or personal care as part of foreplay.
  • Be prepared by protecting the bed, and have towels and washcloths ready.
  • Use a side-lying sexual position to help manage bladder spasms.
  • Reduce odour by preventing and treating urinary tract infections.
  • Find out about the appropriate treatment for spasms and pain from your doctor. If you experience hypersensitivity try an ice pack on area prior to intimacy.
  • Medications - check with your doctor if any of your medications have side-effects such as reduced libido or sexual function.
  • Seek a referral for professional help for your relationship concerns or sexual issues.

SEEK HELP

It is important for you to have someone to listen to you, and to understand your feelings and worries about sexuality. Contact the National Continence Helpline on 1800 33 00 66. The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and information on local continence services.

Intimacy and Continence: What to do when incontinence joins you in the bedroom

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Last Updated: Mon 27, May 2024
Last Reviewed: Tue 17, Mar 2020