Urinary problems and sex in women

There are several problems that are common to both urinary tract and sex. Here are what experts have to say on the urinary problems and sex in women, at a recent conference on lifespan and sexuality held in Hyderabad.

Women commonly suffer from all sorts of bladder problems. One condition that frequently affects women is a urinary tract infection (UTI), which can occur when bacteria enter the bladder and cause symptoms of frequent and often painful urination, difficulty urinating, and bladder discomfort.

A UTI may or may not be triggered by sexual activity, but certainly having sex when an infection is present can be very uncomfortable. Fortunately, UTIs are fairly quickly and easily treated with antibiotics, natural remedies such as cranberry juice or tablets and by increasing fluid intake, such that an occasional UTI does not generally affect one's sex life or partner relationship.

However, some women suffer from chronic bladder symptoms even when no bacterial infection has been determined. In many cases, these symptoms, which can include painful and frequent urination and bladder pain, are constant and intractable. This condition is referred to as interstitial cystitis (IC).

IC is a chronic condition which frequently goes undiagnosed. Women are more prone than men to this syndrome, and one of its main features is a sensitive and sometimes painful bladder. Because the bladder may be displaced slightly by sexual intercourse, having penetrative sex can be very uncomfortable. IC is similar to vulvar pain syndromes in that the vaginal muscles are often in a state of hypertonus (tightness).

Women with IC may not necessarily have pain upon initial penetration but may suffer from pain with deep penetration or upon orgasm. As with chronic vulvar pain conditions, women with IC need not give up on having a sex life. However, when these conditions exist, it is very important to communicate openly with one's partner. Sometimes simple modifications such as modifying positions may be helpful, and often, openness to non-penetrative sexual activity and emphasis on sensual pleasures that don't hurt can facilitate a healthy sexual life.

Even more common than chronic painful conditions of the bladder are those bothersome urogenital problems such as urinary frequency, urgency and incontinence. In fact, it is estimated that one out of four women will suffer from incontinence at some point in her life.

Leaking urine with activities such as coughing, laughing or sneezing is known as stress incontinence. This occurs when the pressure on the bladder that occurs during activities such as these, exceeds the pressure provided by the urethral sphincter, which keeps the urethra, the tube that carries urine from the bladder out of the body, closed.

This occurs due to insufficient strength of the pelvic floor, which may be weakened by pregnancies, births, and hormonal changes, particularly menopause.

Urge incontinence describes a situation where one has a strong urgent desire to urinate, to the extent that urine is lost involuntarily before making it in time to the toilet. This occurs because of unwanted contractions of the bladder.

This can be stimulated by drinking coffee, cold weather, running water, or upon arriving close to the bathroom destination (also know as "key in the door" incontinence).

While these are distressing conditions in themselves, patients rarely volunteer (and all too often doctors don't ask) information about how their sex lives are negatively affected by it.

Women with incontinence are often afraid of leakage during sex, and as a result, they avoid intimate situations. Women with stress incontinence are more likely to leak with penetration due to pressure on the bladder and women with urge incontinence may leak during orgasm, which may or may not occur with intercourse.

Both urge and stress incontinence can be treated. Pelvic floor strengthening exercises have demonstrated success in curing incontinence in several controlled studies.

Urgency can be managed as well, with behavioural techniques such as bladder training, timed voiding, and dietary restrictions. In severe conditions, medications that control bladder contractions, known as anti-cholinergic medications, may be helpful as well. In more severe cases, when pelvic floor rehabilitation is not effective enough, surgical repair may be the appropriate intervention.

If urinary problems are affecting your sex life, you should consider the following suggestions:
1. Speak to your doctor about your symptoms. Something as simple as an anti-cholinergic medication to prevent bladder contractions a half hour before sex may prevent orgasm related leakage.
2. Speak openly with your partner about your fears and discomforts. If intimacy has been greatly affected by urinary or vulvar discomforts, consider consultation with a couples counsellor or sex therapist.
3. Request a referral by your physician to a pelvic floor physical therapist in your area who can address your symptoms and help improve the quality of your life, particularly your sex life.

Simple tips to over come light glare

A five-year-old girl has a pathetic tale to tell. Like her two elder sisters, she can't tolerate light.

Bright light makes her virtually blind. The three girls were diagnosed by doctors at LV Prasad Eye Institute in Hyderabad as suffering from a strange eye problem called cone dystrophy.

Their father, a daily labourer, deserted the girls after he noticed that the eye defect could not be rectified. The girls' mother took care of them and admitted in a local government school. But soon the problems began for the girls as they could not see the black board or move freely in the open.

The mother then took the girls to LV Prasad Eye Institute where doctors prescribed some simple techniques to reduce the problem. The girls now have an improved vision and play with other children. The doctors helped the girls overcome the defect by advising sunglasses. The girls were given absorptive or tinted lenses that reduce glare.

They were also advised to wear hat for shade from sunlight.

"There is no permanent treatment or cure to photophobia but better eye management and eye care techniques will reduce the trouble. Lubricant eye drops will also help. Patients find it difficult to drive during night because of headlights glare. Even during the day time they feel uncomfortable in the sunlight," says senior ophthalmologist Dr Sreekumar Reddy.

The problem with these three girls was that they are extremely sensitive to light and lower their gaze while walking.

They squint and blink at the slightest glare. Cone dystrophy in their eyes has led to this rare condition called photophobia or hyper sensitivity to light.

Andhra Pradesh has thousands of children and adults with photophobia and the number is increasing with the each passing year. Neglect of ophthalmic care by parents in case of young children is said to be one of the causes for low vision coupled with sensitivity of light. As many as five crore people suffer from the low vision problem in the country and quite a considerable number of them complains of photophobia.

Though there are no official statistics on the number of photophobia patients in the country, the problem is quite common in albinos or "moon-children" and those with low vision. People who suffer from various eye diseases like ocular albinism, cataract, retinitis pigmentosa and diabetic retinopathy also complain of sensitivity to light like these girls. "For a clear image to appear on the retina a clear medium is needed. In case of opacity in the eye the intraocular light gets scattered bringing down the vision levels. Such eyes become extremely sensitive to light and glare. People with photophobia see glare in light that appears normal for healthy people," says ophthalmologist Dr Altaf Akbar.

Eyecare specialists suggest that coloured lenses with specific tints to restrict different wavelengths of light will do wonders. The patient may choose from a wide range of colours that suit his or her eyes.

Filters, that come in different tints at various levels of absorption and different cut-off points, provide contrast enhancement and help in light adaptation. Corning photochromic filters are also useful since short wavelength light has been shown to cause hazy vision, reduced contrast and discomfort. The photochromic filters filtering out blue light in the visible portion of the spectrum, at the wavelengths that create problems for the photophobic patients.

They are specially designed to filter short wavelength light.

Some ophthalmologists are of the view that ultra violet shields (of blue spectrum) provide protection for 100 per cent UV and visible light. The filter in the shields eliminates near infrared 100 per cent UV and provides visible light protection.

For those who find it a problem while reading because of reflection from white pages may go in for typoscope (a black, non-reflective plastic card with a rectangle cut out of it).

A hat with a wide brim or a sun visor can help cut down glare and facilitate mobility outdoors.

When photophobic patients move between places of different lighting levels (say from sunlight to a closed room or vice versa), doctors suggest that they pause a while, take off or put on the sunglasses depending whether they are moving in or out of sunlight. This allows their eyes to adjust without causing any visual discomfort.