Dear Queen of Hearts,

I am a 28-year-old female, and I have bladder problems. I am in serious pain and have been so for at least a year. The worst part is, it’s all self-inflicted. Years ago I discovered that during sex I could experience superior pleasure if my bladder was full. I also discovered that when I just plain old needed to relieve myself, I could hold my urine (right at the verge of release) and experience some serious pleasure. I often did this to the point of orgasm, right there in the john. My bladder, stretched to its limit, stimulated me unbelievably. My problem now is that I am in chronic pain and have a bladder that does not work for shit! What kind of reversible/irreversible damage have I done to myself? I have been to two doctors who gave me a urine analysis despite the fact that I told them it wasn’t a bladder infection, and I was sent on my way. I am aware that I need to see a urologist, which will cost a pretty penny. I know that I can do abdominal exercises, which I do. But I need to know straight up, am I bound to be in diapers decades before my time? What can be done for me medically, and what can I do for myself? Is this a common, but unspoken fix people get themselves into? Please help! –Bursting Bladder

Dear BB,

Oww! Your unpleasant situation may be related to your erotic bladder play, but you should also be aware that there is a chance it isn’t–that your bladder stimulation and subsequent chronic pain may be coincidental. The only way to know for sure is to see a specialist, and a sex-positive one at that. I know of a couple of other women who play the way you do, neither of whom has experienced the kinds of problems you are having. There is a chance that your chronic pain results from PID-related adhesions or some other problem, so getting into the office of a doctor who will take you seriously is important. You might consider asking San Francisco Sex Information (415 989-7374) if they have a urology referral, or consult the Kink-Aware Professionals on Race Bannon’s website (www.bannon.com/kap). By all means, when you get to the doctor, tell her or him about the erotic part of your experience. If you are correct and the two things are cause and effect, your doc will need to be able to discuss it with you.

You hold urine with the same muscles that are responsible for the erotically pleasurable contractions of orgasm, and there is a rich supply of nerves to both the bladder and the genitals. Also, when the involuntary sphincter gives up and you release urine in spite of yourself, the pubococcygeal muscles may clench and flutter–it is very likely that this sensation is orgasmic for you. These facts help explain why you, and some others, have sexualized bladder sensations. While the majority doesn’t share this erotic preference, I wouldn’t exactly call it uncommon. However, I do not hear about a lot of cases of chronic pain and incontinence associated with this–ordinarily, you will not be able to voluntarily hold your urine past the point at which the involuntary muscles (that control the urethral sphincter) release. The bladder can’t be made under normal circumstances to stretch beyond its limits; the sphincter will give up first. When I hear of sex-related bladder problems, they are usually in the context of either urethral insertion play (you do not mention doing this) or holding urine during vigorous and/or long-duration intercourse. And the latter usually results in a nasty bladder infection, not the kind of symptoms you describe; I assume that they have not found an infection during the tests you mention.

If you are experiencing leakage or stress incontinence, you should certainly be doing Kegel exercises–is this what you mean when you mention abdominal exercises? They are not actually abdominal, but exercise the muscles of the pelvic floor, the ones you use to hold and release urine (and have orgasms). I would also expect that keeping your urine acidified (with cranberry juice or soluble Vitamin C) would help prevent infection–if the health of your bladder is compromised for any reason, infections can be a problem.

I’d love to hear back from you about what the doctor says. And if you have trouble tracking down a urologist, send me a SASE; I might be able to help. Good luck!

Dear Carol,

I just heard about another new drug that’s coming up for women’s sexual problems. It’s called Arista or something like that. Am I remembering that name correctly? What is it? Is it available yet? –I Want a New Drug

Dear IWAND,

One that won’t make you sick, right? Sorry, readers–I was having an ’80s flashback for a minute there.

You’re probably thinking of Alista, which is going into clinical trials right about now but which won’t be available until after those trials have finished. It is a close relative of the men’s erection-promoting drug Muse, which is a cream that works by being inserted into the man’s urethra. Nice idea but a little kinky for some men–and when Viagra came along, it turns out many men preferred to pop pills instead. So maybe the cream will work on women, and docs conducting the clinical trials aim to find out. It should (if it works) address the situations of women who would like to have sex, but are having difficulty getting turned on. I’ll keep you posted.