Q: I’m a woman, is there anything different about paruresis for women to know?

A: In general, the similarities between women and men in terms of etiology, triggers, privacy issues, and treatment methods far outweigh the differences between the genders.

Your urologist, gynecologist, or urogynecologist will often be the person to talk with about your paruresis.  This can be a positive thing. Many men report that urologists have limited or no experience outside of treating prostate trouble, bladder infections, and sexually transmitted disease, so the doctor is not very interested in something they are not familiar with. Gynecological practice is more general in nature and your doctor may be more accepting and helpful.

Both men and women find discussing paruresis with their doctors extremely difficult and embarrassing. Young people are generally shy about their bodies and typically have not experienced intimate medical exams (especially the men). They should try to pick a doctor with whom they are likely to feel most comfortable. Consider both the age and gender in selecting your doctor. For a variety of reasons, women are often more comfortable with a male physician, whereas some men are more comfortable with a woman. Some young people are more comfortable with a doctor who is elderly. Choose someone you will be comfortable with.

The main distinction is that while private stalls may be the back-up option for some men, they are the only option available for women, unless they have learned to pee in the wilds! A woman who cannot urinate in private stalls in public restrooms only has self-catheterization as the last resort. This will need to be your reliable fallback strategy, which is essential to developing a successful recovery plan.

Also, women face the possibility of encountering long lines in crowded bathrooms. This may exacerbate time pressure, which many report already feeling when they enter a restroom. Some women have heightened concerns about easily being visible to others when they’re using a stall, unless they’re fortunate to encounter a fully enclosed, ceiling-to-floor one; others seem ultra-sensitive to noise.

Other noticeable differences between the sexes pertain to bathroom behavior. Women often enter public restrooms in packs, enjoying the social aspect when they congregate. Some talk between stalls; others linger in restrooms while they apply make-up or perhaps change a baby’s diaper. Little children, who can be disruptive, more frequently accompany their mother to the restroom than their father.

Given anatomical differences, the self-catheterization process is not the same for women as it is for men.  It is highly recommended that a knowledgeable female health care practitioner teach women before attempting the process. There are different methods, but for practical purposes, it is useful to learn to sit on a toilet, identify the opening to the urethra by “feel”, insert a short catheter, and allow the urine to drain into the toilet bowl.

Also, all catheters are not created equal, and women may require one whose diameter is smaller, e.g.., a 10 FR vs. a 14 FR. Catheters are available in a number of different styles, sizes, and materials. Anyone who decides to try them will need to do some experimenting to find which kind works best. Follow this link to specific instructions and tips on catheter use for women: www.umm.edu/ency/article/003972.htm. The IPA web site also maintains a page with women’s catheter tips.

Women are more susceptible to urinary tract infections (UTIs or cystitis) following catheterization. Antibiotics (e.g., Bactrim, Septra) can be prescribed for use as a preventative or treatment to alleviate the symptoms. There are other things that can be done to reduce the risk of infection, such as drinking plenty of fluids—especially cranberry juice—at the first opportunity after using a catheter.

Besides self-catheterization, women can avail themselves of a few other tools that may be of some help. One is the use of a female urinary pouch that connects to a leg bag system (worn on the inner calf) and can be completely hidden beneath loose fitting jeans or pants and allows users to enjoy events. The other is a device, like a funnel or medical-grade tubing, which facilitates urinating while standing up and could be beneficial in outdoor situations.

Lastly, while it may appear that paruresis affects men in greater proportion than women, no hard-core evidence actually supports that theory. Some women may simply be more inhibited about participating in open forums where they fear violation of their privacy.  Others prefer communicating directly with other women, either in person, by telephone, or private e-mail exchange. 

In the meantime, until the IPA membership base expands to include more of them, women will have to expend extra energy to reach out to other women. They can plan on traveling further to attend an all-women’s IPA workshop, participate in a regular IPA workshop in which the presence of at least one other female (though not necessarily one who has paruresis) is guaranteed, join a support group which may consist largely of men, start a female-only support group in their area, or consider asking a non-paruretic female friend for help with the practice of desensitization exercises. If you know another woman with paruresis, please encourage her to join IPA!