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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 ways of communication, such as talking, looking at someone, hugging, kissing, and other sexual activities, through to the act of 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 on our roles in life and the various phases or stages of our life cycle.

incontinence and sexuality

Myths and misconceptions

Myths or 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" or "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.

How does incontinence affect sexuality?

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. Dealing with urine 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 to 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.
  • Feeling dirty as they are reminded of their own early experience in toilet training.
  • 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 - impotence, premature ejaculation, 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.

The topic of sexuality is an important one, yet is often difficult to discuss and many people feel uncomfortable talking about this area, especially when they have concerns about bladder or bowel control. Many health professionals do not broach the topic with their patients despite the clear relationship between incontinence and sexuality.

It is important for you to have someone to listen to you, and to understand your feelings and worries about sexuality. The Continence Nurse Advisors on the National Continence Helpline 1800 33 00 66 are able to listen to your concerns, give you information and, if necessary, refer you to an appropriate health professional for further support and advice.

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.