The big O.

Orgasm.

An explosion of genital muscle contractions that makes your whole body shiver and quiver. Ecstasy at its finest. But what really defines an orgasm? It seems like there's an ongoing fetish with having a "gushing" orgasm, especially in the porn industry. But some women "squirt" and some don't. So what gives? Does the female ejaculate really exist? In a recent study, authors concluded that "squirting" during orgasm was an involuntary loss of urine during sex.⁵ Urine?! Yikes! There are tiny glands next to the urethra (tube that empties your bladder) that help lubricate the urethra with fluids from the bladder. Most female ejaculate has some urine mixed with other sexual fluids creating a milky white discharge. These glands are very small and in no way capable of creating bucket amounts of cum like they want you to believe in porn. So could it actually be urine leakage and not some fantasy flowing love potion that the porn industry advertises? 

What are women are saying?

Up to 66% of women experience coital incontinence, urinary leakage with penetration and/or orgasm.⁶  Whoa! Major anxiety reaction with sexual dissatisfaction! 86% of women with urinary incontinence feel that sexual health is an important issue, but they're just aren't talking to their doctors about their sex lives. So many of these symptoms go under-reported.⁴ When was the last time your doctor asked you about your sex life? More than 50% of women think that their gynecologists should ask them about their sexual health during routine visits.³ As a healthcare provider, I believe improving sexual health first starts with asking the right questions. If we don't know a problem exists how can we fix it? 

Here's the skinny

There are two categories of coital incontinence: 1) incontinence during penetration and 2) incontinence during orgasm. Both with different mechanisms causing symptoms of leakage. 

Incontinence during penetration is most commonly associated with stress urinary incontinence (SUI), loss of urine during an effortful activity. Women who have SUI are more prone to experience incontinence during sex and is usually associated with weak pelvic floor muscle activation or weakness. In one study, researchers found that out of 228 women who participated in the study >80% experienced SUI with penetration.²

Incontinence during orgasm is more associated with an overactive bladder, although less common than loss of urine during penetration. Researchers suggest that in some women orgasm triggers bladder muscle contractions which, at the same time, causes involuntary relaxation of the muscles around the urethra leading to, well, an embarrassing moment in the bedroom. 

So "gushing" and "squirting" orgasms aren't a real part of the female orgasm. The female ejaculate and "squirting" are two different physiological responses that take place. Sometimes both can happen at the same time but very rarely does the female ejaculate occur let alone expel at larger quantities. When it does, it's usually diluted and chemically changed urine.⁶

What's the best way to diagnose SUI?

The best way to spot SUI is with a urodynamic test. A urodynamic test looks at how well your bladder and urethra are working at storing and releasing urine both at rest and under stress such as with coughing and sneezing. This test improves the outcome of treatment for SUI. 

How do you know if it's urine or ejaculate?

Well for one, the smell of urine is just plain obvious. But if that's not enough, place a towel underneath your bum and notice the color. If it's yellow and smells like urine, you've got your answer. There's also an over-the-counter medication, Azo, used to treat UTI (urinary tract infection) symptoms. Azo changes the color of your urine to dark orange or red making urine leakage easier to recognize but I don't recommend taking pills without consulting with your doctor first.

So what's a girl to do?

Seri et al. referenced two specific studies analyzing the effects of pelvic floor muscle training on female function and coital incontinence. Want to know what the authors said? Of course, you do! In both articles, there was a clinically significant improvement in sexual satisfaction and reduction in leakage during intercourse.¹ Yay!!!!! The women in those studies reported improved desire, arousal, lubrication, orgasm, satisfaction, and pain. Pelvic floor training is the first line of treatment for any incontinence. So there you have it. The female ejaculate, although rare, does exist but not like in the movies. If you're experiencing incontinence that's keeping you away from the bedroom, see your local pelvic health specialist because we can help!

1. Serati M, et. al. Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's Sexuality. J Sex Med.2009;6:40-48

2. Moran PA, Dwyer PL, Ziccone SP. Urinary leakage during coitus in women. J Obstet Gynecol.1999;19: 286–8

3. Bachmann GA, Leiblum SR, Grill J. Brief sexual inquiry in gynecologic practice.Obstet Gynecol.1989;73:425–7

4. Chu CM, Arya LA, Andy UU. Impact of urinary incontience on female sexual health in women during midlife. Women's Midlife Health.2015.1:6

5. Salama, S., Boitrelle, F., Gauquelin, A., Malagrida, L., Thiounn, N. and Desvaux, P. Nature and Origin of “Squirting” in Female Sexuality. J Sex Med.2015.12: 661–666. dos: 10.1111/jsm.12799

6. Pastor Z. Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review.J Sex Med. 2013;10:1682-1691

This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.