THE ROLE OF SEXUALITY

Sexuality means different things to different people. It involves our desire to express ourselves as human beings, to be loved and receive love. We do this through verbal and non-verbal communication such as talking, looking at someone, hugging, kissing, and other sexual activities such as intercourse. Sexuality involves intimacy and the desire to be close to ourselves or another person.

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 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 we feel about ourselves. Many people report that they feel embarrassed about leaking and wetting their clothes in public. As a result, people restrict their movements outside of the home and alter the clothes they wear to disguise any wetness or staining (for example by wearing dark or patterned clothing). Our choice of clothing is an outward expression of our sexuality.

People report continually washing themselves during the day to stay fresh and avoid the risk of smelling. Others need their partners to undertake this aspect of personal care for them. Partners can experience emotional difficulties providing continence care, which can in turn affect their sexual relationship with the person they are caring for. Cleaning urine (wee) and bowel motions (poo) involves touching the genitalia and is difficult as people are often aware of their partner's discomfort in being helped. Providing intimate personal care can interfere with a couple's sexual relationship. This is an important concern and should be talked about with an appropriate health professional.

For some people, aids and techniques used to manage incontinence can also have an impact on sexuality by preventing relationships, causing embarrassment or evoking memories of their partner.

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 confidential discussion with a Nurse Continence Specialist.

Try to empty your bladder prior to sexual intimacy. Be prepared by protecting the bed 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.

A catheter can be removed prior to sexual intimacy and a new one inserted. This may not be economically viable for some people, but if possible, it should be considered. 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 KY jelly used for lubrication.

If your parter 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 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 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. It is a good idea to wash yourself regularly and even during intimate times as part of foreplay.

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.

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 the bladder and/or bowel immediately prior to intimacy. 
  • Include hygiene care as part of foreplay.
  • Be prepared by protecting the bed, and have towels and washcloths ready.
  • Remove catheter or leave in if preferred. Males can tape the catheter to the shaft of the penis, wear a condom and use lubricant, females can tape the catheter to the thigh or abdomen.
  • Drainage bag - you can cover the bag, place it out of sight, or spigot (seal off) the catheter. 
  • Use a side-lying sexual position to prevent bladder spasm.
  • Reduce odour by preventing and treating urinary tract infections, following adequate hygiene, maintaining a closed drainage system and using appropriate cleaners for bags (if in-dwelling catheter).
  • Talk to your doctor about a sensible reduction of fluids prior to intimacy, including alcohol, caffeine and cola drinks.
  • Find out about the appropriate treatment for spasms and pain. 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, or if medication has incontinence as a side-effect.
  • Seek a referral for professional help for your relationship concerns, sexual issues or depression.

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 referrals to local services.

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Last Updated: Sat 29, Aug 2020
Last Reviewed: Tue 17, Mar 2020