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Q I’ve had a prolapsed uterus since having a baby last year. I wet myself every time I laugh, cough or sneeze and can’t imagine having sex again

DR THOMAS STUTTAFORD

A You have been very unlucky. Incontinence, with or without a prolapse, can blight a woman’s life. It is bad enough for a woman if she leaks a bit with stress urinary incontinence, which can happen after lifting heavy weights, laughing excessively, coughing, sneezing, becoming excited or even hitting a tennis ball a mighty swipe. One recent research survey showed that nearly a third of female hard-hitters on the tennis court leaked a drop or two, and another study found that one American female student in five suffered minor stress incontinence daily.

All forms of incontinence, in men and women, are likely to become more common with advancing age. Stress incontinence often results in nothing more than damp underclothes, but many women suffer from far more severe signs and symptoms that require special clothing and may affect their lifestyle.

You tell us that incontinence has destroyed your sex life, but I am sure that it is also affecting other aspects of your life. Many women have to consider incontinence when choosing clothes, accepting social invitations and when they will be able to return to work, if ever, after a pregnancy. Incontinence and the embarrassment it causes keep many women at home.

It is appalling that the excitement you and your partner must have felt after having a baby should be overshadowed by this complication. Incontinence after vaginal delivery is often the result of damage to the pudendal nerve causing faulty control of the bladder and a weakening of the pelvic floor. If more damage has been done, a prolapse is the result. In a study of 278 randomly selected women 30 per cent were suffering urinary problems five years after childbirth.

Fifty years ago, when midwifery was relatively primitive, prolapses were even more common. One young mother whispered in my ear that she wanted to talk to me about an embarrassing and shaming problem. Apparently a year or two earlier she had had a child and since then she had, seemingly, changed sex. She told me that she now had a scrotum. An examination revealed, however, that her uterus was hanging between her legs.

There are three types of urinary incontinence that trouble men and women, but women far more often than men: stress urinary incontinence; urge urinary incontinence; and mixed urinary incontinence. Stress incontinence, as I have already discussed, is the leaking of urine during physical activity. Urge urinary incontinence is the technical name for getting caught short. Those with mixed urinary incontinence, have both stress and urge incontinency. Incontinence during sex is a complex problem, with many possible explanations. Often it is a manifestation of stress incontinence but it can occur without other evidence of stress incontinence.

Some cases of incontinence can be treated successfully by pelvic-floor exercises, the use of vaginal weights to tighten muscles and/or with minor lifestyle changes and drugs to reduce bladder sensitivity. In my opinion the effect of incontinence on morale, self-esteem, professional and domestic life, let alone sex life, is so disruptive that surgery shouldn’t always be postponed, as is sometimes recommended, until after a proposed family is complete.

Dr Thomas Stuttaford, The Times doctor, spent many years working in a genitourinary clinic

SUZI GODSON

A There are several surgical procedures to hoick up the uterus and glue the pelvic floor back together and I would urge you to explore these options. But forgive me if I use your question as an opportunity to have a rant about something that has bugged me for years.

Half of all mothers experience a prolapse at some point and one woman in three suffers from postnatal incontinence after her first child. These statistics are outrageous.

If becoming a father meant that 50 per cent of men would find their internal organs hanging out of their anuses or one man in three would experience incontinence, the medical profession would not be so blasé about pelvic-floor exercises. They wouldn’t be so enthusiastic about vaginal birth either. Incontinence and prolapse are much much more common in women who have had complicated vaginal deliveries. Research has proved that an elective Caesarean with an epidural is as safe as an uncomplicated vaginal delivery and is far superior to secondary interventions such as vacuum delivery or forceps. It just happens to be more expensive.

When it comes to prolapse and incontinence, prevention is obviously better than cure, but although the National Institute for Health and Clinical Excellence (NICE) recommends that all women should be offered “supervised” pelvic-floor exercises during their first pregnancies, a lack of consistency in the antenatal care means it isn’t happening. When I had a baby two years ago, I never saw the same doctor or midwife twice, and pelvic-floor exercises were never mentioned. While NCT classes do address them, there were 669,601 babies born in Britain last year and only 25,000 women attended the classes. For the other 644,601 mums-to-be, the NHS offers trivialised guidelines on how to do pelvic-floor exercises. Women are told they can lift-hold and squeeze while they are “waiting for the kettle to boil” or “standing at the bus stop”, but the only way of checking whether you are doing pelvic-floor exercises correctly is to put a finger inside yourself or to hold a mirror to your genitals and watch whether your anus shifts away from the mirror when you clench. Try doing that at a bus stop.

Doing pelvic-floor exercises properly requires time and concentration, and most pregnant women are too preoccupied with the health of their baby to give them the attention that they require. And, of course, the real tragedy for the 50 per cent of the population who wear skirts is that although pelvic-floor exercises have a critical role during pregnancy, they have another, arguably even more important, function. A woman who has a strong pelvic floor is more likely to experience stronger, longer orgasms. She is also more likely to reach orgasm during penetrative sex. It seems strange that this enormous upside could be so overlooked, but female sexual pleasure has never been high on the scientific agenda. The full extent of the clitoris was discovered only ten years ago and we still don’t know whether the G-spot or female ejaculation exist.

As for the fact that 75 per cent of men always reach orgasm when the have sex compared with 26 per cent of women... well, don’t get me started on that particular inequity.

Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

E-mail your sexual dilemmas to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT

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