Jun 28 2009

The Bladder During Orgasm

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Differences between men and women

Unlike men, women does not have an inbuilt valve that prevent them from urinating during sex. For those of you that does not know, men can not urinate when they have an erection. Urine kills sperm and mixing urine and sperm when ejaculating will be a bad idea. Women does not have this problem. Unlike men where urine and semen use the exact same tube to exit the penis (urethra), women have a urethra separate from the vagina. Semen and urine will thus never mix in a women.

Anatomy

The urethra is a short tube which leads from the bottom of the bladder, to the external opening known as the urethral orifice or opening.  The urethra contains mucous glands which secrete protective mucous into the urethral canal.  In females, this tube is fairly short, about 4 cm. (or slightly less than 2 inches) long.

The urethral orifice (external opening) is located in the front above the vaginal opening, but can vary a little from person to person, based on anatomical differences.  The urethra in females is designed to carry only urine and mucous secretions.  At the point where the bladder empties into the urethra (the bladder neck) there is an internal urethral sphincter, or a ring of muscular tissue.

The process of voiding (emptying the bladder) is quite complicated, even in normal, non-dysfunctional circumstances.  The important detrusor muscle, the perineal muscles (bottom of the pelvic floor), the muscles of the abdominal wall, the muscles of the urethral sphincters, and even the diaphragm are involved in the process of building pressure within the bladder and then relaxing once the nerves have succeeded in transmitting the urge to void.

Urinary Incontinence

 

Reasons for stress incontinence.  Leakage of urine when you cough, laugh or bend over, or with exercise such as jumping or jogging, is called stress incontinence. It is most common in young women (25–49 years of age). It occurs if the muscles at the neck of the bladder are not strong enough to hold the urine in when the pressure in the abdomen is increased (as happens when you laugh or cough). No one knows exactly why these muscles may become weak; some women notice the problem after childbirth or the menopause. Women with stress incontinence often have leakage of urine during sex, usually at penetration (when the penis enters).

Genes are now thought to be a very important cause of stress incontinence, which explains why this type of incontinence tends to run in families (Obstetrics and Gynecology 2005; 106: 1253–8). Because of their genes, some women are born with a weak pelvic floor. It is probably a weakness of collagen, the tiny strengthening fibres of muscles.

Childbirth is probably an important cause of stress incontinence. The actual birth is mostly responsible, not just the pregnancy – women who have had Caesarean sections do not usually develop incontinence later. It seems that the nerves can be stretched and bruised during the delivery, and they are unable to make the pelvic floor work after the birth. As a result, the muscles become lazy and weak. However, some research suggests that women who have had children are not more likely to have incontinence (Obstetrics and Gynecology 2005; 106: 1253–8), so it seems that more research is necessary.

Hysterectomy. A woman who has had a hysterectomy is more likely to develop incontinence in middle age than a woman who has not had the operation.

Menopause may be another reason, perhaps because the lowering levels of oestrogen make the pelvic floor muscles less efficient. However, recent research shows that although the likelihood of incontinence increases in middle-age, the hormone changes of the menopause may not be the cause. The reason may be that middle-aged women are more likely to be overweight and to have had a gynaecological operation, such as a hysterectomy.

High impact sports, such as jogging on hard pavements, are probably not good for the pelvic floor. Sports such as swimming and cycling are fine. Interestingly, women parachutists in the US Air Force have developed incontinence because the impact of landing has damaged their pelvic floor.

Lifting heavy objects strains the pelvic floor. If you have to lift anything heavy (such as a baby or small child!), get into the habit of doing it in the right way. Place your feet firmly apart in the walking position, and bend at the knees and hip but keep your back straight. Tighten your pelvic floor muscles, hold the heavy object close to you and then lift by straightening your legs.

Obesity. Being overweight is a major cause of incontinence. It puts stress on the pelvic floor muscles.

Smoking 20 cigarettes/day (now or in the past) doubles your likelihood of urinary incontinence – another reason for never smoking.

Drugs can relax the pelvic floor around the ring of muscles at the neck of the bladder, making leakage more likely. The most common culprits are some blood pressure medications (particularly alpha-blockers such as prazosin and doxazosin). If your incontinence problem seems to be related to starting treatment for blood pressure, ask your doctor if you are taking an alpha-blocker. Medications for other conditions, such as fluoxetine (Prozac) and muscle-relaxant drugs, can also promote urine leakage.
Reasons for overactive bladder. The sudden need to pass urine desperately, and maybe not being able to reach the toilet in time, is a slightly different sort of incontinence called overactive bladder. The cause is misbehaviour of the bladder muscle; it starts to contract when it should be stretching to hold more urine. This is called an overactive or irritable bladder (the medical term is detrusor instability, because the bladder muscle is called the detrusor muscle). It means that people with urge incontinence have to pass urine often (probably more than eight times a day and also during the night), but may not pass much each time. Women with urge incontinence often have leakage of urine during sex leakage of urine during sex, usually at orgasm.

Reasons for mixed incontinence. Some people with incontinence have both stress incontinence and an overactive bladder. The ‘stress’ symptoms may be more prominent than the ‘urge’ symptoms, or vice versa.

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