FAQs about Pelvic & Sexual Health
Incontinence can happen at all ages - young girls, adolescents, during adulthood, and with aging and menopause.
Leakage is not normal; it's very embarrassing and corrosive to self-esteem and body image.
If not treated, leakage can lead to a variety of chronic health issues; it is often the first domino to fall in the chain of leakage, less exercise, weight gain, diabetes, heart disease and depression. Incontinence is linked to all these conditions, so it's important to find strategies to manage your plumbing so you can stay healthy and avoid chronic health conditions.
Leakage also impacts your relationships - from something as simple as picking up your cat, to playing a sport, to intimacy and sharing your body with your lover. You may feel inhibited about doing any of these things since you're concerned about leaking, while those around you don't realize why you are holding back.
How much counts as 'leakage'?
Any unwanted and unplanned leakage can be an issue - if it's a bother to you then it's something you should address.
What causes leakage?
Urinary leakage can happen with a variety of causes.
It can happen for temporary reasons, such as a bad cold with a lot of coughing or a bladder infection. Your leakage will improve after your cold or UTI is resolved.
Urine leakage can also be caused by pregnancy, vaginal deliveries, gravity, aging, time or a change in hormones...it's a long list!
What kinds of treatments are available?
Treatments for bladder leakage may include:
- A Kegel program and a visit with a pelvic health physical therapist to teach you how to do them properly (most of us have a hard time easily localizing the pelvic/vaginal muscles)
- A "pessary" which is a plastic ring you can place in your vagina to provide support
- Surgical procedures that can bulk or lift to get you completely dry.
Would treatments be covered by most insurances?
This is the reason many women defer treatment - thinking it's not covered by insurance. Incontinence treatments are always covered by insurance.
Is this something I can bring up during my yearly checkup, or do I need to specifically talk to a GYN or other specialist?
You can do either...your gynecologist or a pelvic health specialist can counsel you about your options - and depending on your primary provider you may get some counseling about first steps for treatment or a referral to a specialist.
I'm having lots of UTIs and leakage around them; should I be treating the leakage or the UTIs?
UTIs are a little problem that can create a big hassle. With an infection in your bladder, the tissues get inflamed and nothing works down there until the infection is cleared up!
Often it takes more than antibiotics to get the tissues completely healed and during this interval, you are at risk of another infection and more inflammation that can drive leakage, pain and irritation.
UTIs and bladder leakage are linked and one can cause the other. It’s best to be seen by a specialist to help sort out which is the chicken and which is the egg.
What kind of specialist should I see? Do I need a referral, or can I make an appointment myself?
Specialists who treat urinary incontinence are either in gynecology, urology or a combined specialty called "urogynecology." At our urogynecology practice, we specialize in treating women with pelvic health problems such as bladder, bowel or sexual problems.
Most women will get a referral from their primary care provider to see a urogynecologist, but check with your insurance to see if a referral is needed or if you can self-refer.
Self-referral is often easier for women who aren’t comfortable bring up pelvic health or sexual health issues during their annual exam.
Can drinking too much water cause leakage?
Drinking too much water can definitely drive urinary frequency, urgency and leakage.
A normal amount to drink is enough to keep you urine light yellow to clear, usually about 40-60 ounces a day - and that amount depends on your activity.
Does it make a different in the type of fluid? Like caffeinated drinks vs just water?
Water is the best drink. The more dilute urine it produces the larger volume you're able to hold.
Acidic drinks such as coffee, black tea, anything with bubbles and citric juices will be more irritating to your bladder and cause you to feel like you need to urinate before your bladder is at full capacity.
I'm 55 and as I've gotten older, I've noticed that I have to pee a lot more frequently than I used to. Can menopause cause incontinence?
The pelvic tissues that line and support your vagina and bladder are all hormone sensitive, so dryness and irritative bladder symptoms like frequency, urgency, burning and leakage can all occur with menopause.
Sometimes a little hormone cream applied to your vaginal area is all that's needed for significant improvement, sometimes menopause is the tipping point that unveils an underlying issue with poor support that leads to incontinence.
Where did my libido go? And how can I get it back?
A woman’s sexuality changes throughout her life. It seems like you can’t turn on the TV at night and not see an advertisement for erectile dysfunction, so women are rightfully wondering when they might have a pill to increase their sex drive.
There have been several attempts to get FDA approval for drugs treating women’s low sex drive, but none made the grade for approval.
Hormone replacement after menopause can be helpful in restoring sexual vitality, but there are pros and cons based on your risks of other conditions such as bone loss, breast cancer and heart disease.
Women’s sexual desire is an emotional state that is dependent on being in a healthy relationship, so open communication, and creating time for intimacy are all key in having a gratifying sexual relationship.
Keep an open mind to what constitutes intimacy and a gratifying sexual experience, and until we have our own version of a little blue pill, it will take creativity, communication, and a lot of lube to keep up with the men!
Which lube is right for me?
A National American Menopause Society study looked at which vaginal lubricants posed the lowest risk for vaginal infections such as yeast or bacterial overgrowth. Surprisingly, some of the safest lubes can be found right in your own kitchen!
- Coconut oil or olive oil is perfectly safe to use as a vaginal moisturizer – both inside and out.
- For intercourse, the silicone based lubricants have the lowest risk of vaginal infections. These are more expensive than the olive oil in your cupboard, but will give you long-lasting, low friction lubrication during intimacy.
- Water-based lubricants tend to have more preservatives to promote shelf life, but these preservatives may be toxic to the normal healthy vaginal flora.
- Glycerin or oil-based lubes have a smooth, low-friction texture, but may have components that promote yeast growth.