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From Billy Baldwin (verified user, 109 RTs, 805 likes, Wikipedia biography), referring to Jenna Jameson, who used to be a porn star:

Curious to know what might've caused that sneeze-pee condition of yours... anybody care to venture a guess?

You might wanna get that checked out. P.S. Love @Alyssa_Milano!!
#TrumpRussia
#MuellerTime
#InBobWeTrust

One reply indicated too much sex:

I can guess what caused the sneeze pee. A worn out hooha from all the porn she's done.

While a few others suggested STDs: 1, 2

Gonn
Ghonn
Gonearr

The clap🤔😲😲

Jameson disputed this, saying that childbirth caused it:

Probably the baby I had a few months ago you [expletives deleted]

Does too much sex, and/or STDs, cause urination after sneezing, apparently called urinary incontinence?

Does frequent sex cause vaginas to become permanently stretched? talks about frequent sex, but not about urination.

  • What does "109 RTs" mean? Verified user of what? – PoloHoleSet Dec 7 '17 at 15:58
  • @PoloHoleSet retweets, verified by Twitter to be a genuine account of someone notable. – Andrew Grimm Dec 7 '17 at 19:34
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    Thank you. Clearly, I'm not a big Twitter user/fan. :D – PoloHoleSet Dec 7 '17 at 19:41
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TL;DR version: Of the potential risk factors listed, pregnacy is the only one for which there is some systematic evidence linking it to this type of "sneeze pee" incontinence, called stress incontinence in medical terms. The other putative risk factors, "too much sex" or STDs aren't backed by evidence (or even discussed) in the reviews of stress incontinence that I've looked at.

It's possible that some Twitter commenters have confused frequent urination (which is a symptom of gonorrhea) with incontinence (loss of control). Frequent urination is linked to urge incontinence in people with overactive bladder, but that's a different story.


The Wikipedia page about urinary incontinence (UI) you link to has a link to another about stress incontinence (SUI), which has this pathophysiology/definition:

the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thus increase pressure on the bladder.

That Wikipedia page doesn't say much about risk factors though, except for obesity... However there are several review papers in pubmed which discuss these.

A 2004 review said in its abstract:

Aging, obesity, and smoking appear to have consistent causal relationships with the condition, whereas the roles of pregnancy and childbirth remain controversial.

A 2011 review's abstract lists the following as common risk factors; i've added some snippets from the review itself where relevant:

  • obesity, diabetes: "Incidence of new-onset SUI was related to obesity in longitudinal cohort studies [...], supporting a causal relationship." For diabetes, the association with SUI rather than with UI in general is less clear, studies had contradictory findings.
  • age: "The relative contribution of each type of incontinence changes with age, with SUI being predominant in young and middle-aged women. Urge (UUI) and mixed incontinence are predominant in older wom. [...] As women advanced in age, they were more likely to have SUI and UUI in combination."

  • pregnancy, delivery, and pelvic floor surgery: "Several studies have reported a high prevalence of female SUI during pregnancy, ranging between 20% and 60%; in particular, de novo occurrence is more frequent in nulliparous women. [...] Incontinence during pregnancy has been shown to be a good predictor of postpartum persistent incontinence or of SUI recurrence 5 years after delivery [...]. Nevertheless, the most important factor associated with the occurrence of SUI in young women is undoubtedly childbirth. In particular, some risk factors associated with vaginal delivery have been described as strongly related with the development of UI." (Emphasis mine)

  • genetic: huge variance in reported results for genetic factors of SUI from just 1.5% (2011 study) to 40% (2008 study).
  • hormonal changes (unclear evidence)

So, Jameson's own explanation points to one of the more common risk factors (pregnancy)... even though not all reviews agree that the link is convincing. The other Twitter explanations point out to even less discussed causes (STDs, "too much sex"), but that doesn't necessarily mean they are false. It's impossible to diagnose someone post-hoc and say "this caused that in subject X" unless you can remove "this" and obtain a cure/reduction for "that".

Neither of the reviews I mentioned above discuss STDs (or too much sex, or even sex work) as a possible cause... which doesn't mean it can't be one, just that probably it isn't a common one nowadays in the general population. I tried to find some studies/data on SUI in sex workers, but insofar, no luck with that.


There isn't a whole lot of systematic epidemiological data about STDs in the US porn industry, but what is there is pretty daming. From a 2015 review:

A study conducted by the renamed Los Angeles County Department of Public Health (LACDPH) [ref9] found that between 2004 and 2007, there were a total of 2,633 chlamydia and/or gonorrhea cases reported among 1,849 adult film performers in Los Angeles County, of which 72 percent of the cases were among females. This study also found a 26 percent rate of reinfection within one year among performers. In a 2012 UCLA study, nearly one-third of performers tested positive for chlamydia and/or gonorrhea despite the adult film industry’s testing standards. [ref10]

In (my) comparison, looking at the 2016 CDC data for incidence among the general population, chlamydia and/or gonorrhea account for 497+146 = 643 cases per 100,000 people, so a prevalence of (new cases) of only 0.64% in the general population. So the incidence in the porn industry appears way over the average for the general population.

And finally emedicinehealth.com notes that some STDs (AIDS, neurosyphilis, and genital herpes affecting the perineal area (perineal neurosyphilis)) as a cause for overflow incontinence (which "occurs because the bladder is too full and urine passively leaks or overflows through the urinary sphincter"), but it doesn't say anything about the link between stress incontince [which it does discuss] and STDs.

So, despite the fact that STDs seem much more prevalent among the US porn industry workers (than in the general population), it's still not clear that porn work is a risk factor for SUI... because while some forms of incontinence are caused by some STDs, I couldn't find a source discussing the association of STDs with SUI.

My guess is that the Twitter comments pointing to "the clap" did so because ghonorrea symptoms include frequent urination, but the latter is not the same thing as SUI.


As for the hypothesis that (too much) sex is causing SUI, coital incontinence (CI) probably deserves a mention in this context, although "too much" (sex) means something else here, namely that in women predisposed to penetrative CI, deep penetration may trigger it. Penetrative CI is associated with (other forms of) SUI more than the orgasmic CI variant is; the etiology and pathophysiology of orgasmic CI are more controversial. The (previously linked) review I in which I found this info, doesn't mention the frequency of sexual encounters as a factor for either form of CI (or for SUI). So it's probably fair to assume there's no known link.

  • This is a great answer. It’d definitely not fit in 140 characters! – Andrew Grimm Dec 6 '17 at 7:22
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According to URETHRAL DIVERTICULA by Eric S. Rovner:

Peters and Vaughn [reference 30] found a strong association between concurrent or previous infection with Neisseria gonorrhea and urethral diverticula.

This and other sources explain that stress incontinence is one of the symptoms of urethral diverticulum.

"Peters and Vaughn" is Urethral diverticulum in the female. Etiologic factors and postoperative results. Obstet Gynecol 1976;47(5):549–552.

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    While they may have found "a strong association", it's by far not the only cause. WebMD says of Stress Incontinence [SI] that it "is the most common type of incontinence suffered by women, especially older women" (Jenna is 43) and "In addition, women who have given birth are more likely to have stress incontinence". It also notes that smoking can also lead to SI (a quick Googling suggests she does). – TripeHound Dec 5 '17 at 15:35
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    I kept wondering why those reviews of stress incontinence don't mention urethral diverticulum. I suspect that's because it's very rarely diagnosed in living people "The reported prevalence of urethral diverticula in adult females from studies of autopsy specimens or urethrography series ranges from 1 to 5 percent [...]. A population-based study estimated the incidence to be less than 20 per 1,000,000 (<0.02 percent) per year" – Fizz Dec 6 '17 at 7:07
  • @Fizz Is it not also the case that UD can sometimes be the route by which other (more well known triggers) cause SI? I.e. the first link in this answer says while childbirth isn't considered as much a cause of UD as it once was, it can still play a part (especially in a forceps delivery). So (more recognised risk) --> (usually undiagnosed) urethral diverticulum --> stress incontinence. – TripeHound Dec 6 '17 at 8:40
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    It should also be noted that the quote in this answer about the strong association between gonorrhea and UD is a partial one. It continues: "However, the initial infection and especially subsequent reinfections may be caused by a variety of organisms, including E. coli, other coliform bacteria, and vaginal flora." So "normal" urinary infections can play as much a part as STDs. – TripeHound Dec 6 '17 at 8:43
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It can, but indirectly. Note - this assumes that someone with urinary incontinence issues, in general, might have issues when sneezing as well.

Urinary incontinence may also be caused by an easily treatable medical condition, such as: Urinary tract infection...

Urinary incontinence - Symptoms and causes - Mayo Clinic

Sex is a common cause of UTIs in women because sexual intercourse introduces bacteria into a woman's urinary tract.

The Link between UTIs & Sex - Causes & Prevention - Everyday Health

So, possibly Baldwin was saying she had to involuntarily pee from constant UTIs from having constant sex, because.... porn star.

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