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What do people do with a catheter during sex?

Diane M. Rowles, MS, NP

Nurse Practitioner, Spinal Cord Injury Rehabilitation Program, Rehabilitation Institute of Chicago

So, what do you do with a catheter during sex? For people who are on intermittent catheterization, the in-and-out catheterization, I usually recommend to catheterize prior to having sex. Because we talked about those Sacral Arc reflexes, well the bladder has a reflex, and the bowel has a reflex, sex has a reflex. So, remembering that nerves are microscopic and very close together, sometimes when you're trying to stimulate the sex reflex you can hit the bladder reflex, or sometimes when you stimulate the bowel reflex, you can hit the bladder reflex. So in order to prevent incontinence, I recommend that people empty their bladder prior to intercourse, just so that there's no accidents. If they do intermittent catheterization, for a female it's easy just empty the bladder, and its empty and its fine. For men, sometimes catheterization stimulates an erection because it's that reflex erection. The important thing to know is, when you stimulate a reflex erection, you're probably going to want to use that erection for intercourse. Because if you take the catheter out, let the erection go away, it's going to be harder to stimulate a second reflex erection, for most people. So I always tell people kind of foreplay, do a little bit of catheterization, a little more foreplay, and use the erection that comes from the catheterization, if there is one. If a person has an indwelling catheter in, they have two options—they can take it out and have intercourse, the things that they need to remember is that they can't put the same one back in, so they have to have another one to put in, and that can get expensive if they have sex too frequently— depending on their frequency of sex I should say. And if they can't put it in themselves because of limited hand function, they have to have somebody around that can put it back in for them. And it can't stay out too many hours because of one incontinence, and two, again, the autonomic dysreflexia if their bladder overfills, or prevention of a urinary tract infection. So take it out, not a problem, put in a new one when you're done. For people who can't afford to have extra ones, or people who don't want to take it out, people who it's fine in, it's definitely a personal choice, the catheter can be left in. Very simple for women, just tape it out of the way, because sex is a different hole again, and so you just tape it out of the way. For men, what is recommended is leaving a large loop of catheter at the end of the penis, so that if that person does get an erection, there's enough catheter for the penis to climb, and then placing a condom over it. The condoms not necessarily for contraception, it's to prevent urinary tract infections, because you don't want sexual juices to climb up the catheter and cause infections. So what I usually recommend to people is to put a bunch of catheter at the tip of the penis, put a condom over, and then go ahead and have intercourse. The nice thing is is if a person does not get a great reflex erection, so the penis doesn't get real hard, the rigidity of having the catheter run down along the side of the penis actually can help stimulate their partner, so it actually can help with stimulation of their partner, so it can be a good thing. One thing that is very common is people say, "Well Diane, having that urine bag is a real turn off." So clamp the catheter, get rid of that urine bag, put the urine bag in a pillowcase, cover it with a towel, put a long piece of extension tubing on, throw the bag off of the bed—any way to enhance the romance, decrease the focus on the urine bag.