Frequently Asked Questions for Women with Paruresis
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.
One major 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 restrooms only has self-catheterization to rely on as a fall-back strategy. (Catheterization refers to inserting a small plastic tube into your urethral opening for purposes of releasing urine). For some women, learning to and feeling comfortable with this process may be enough to provide the security she needs to urinate anywhere. For other women, particularly those who have a moderate to severe case of paruresis and/or those who desire full recovery, it is not.
Female bathroom behavior is very different for women. Unlike men, 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. Some are accompanied by little children who can be disruptive when they share a stall with their mother.
Paruretics, in general, do not like to feel rushed. Women face the possibility of encountering long lines in often crowded bathrooms because there aren’t enough stalls. This may exacerbate the time pressure many report feeling when they enter a restroom. Many paruretic women have heightened concerns about being visible to others when they’re using a stall, unless they’re fortunate to encounter a fully enclosed, ceiling-to-floor one. Some report feeling intimidated by the presence of an attendant in a bathroom, the likelihood of which is greater for women.
Noise affects women in different ways. Some seem ultra-sensitive to it, to the possibility of being “heard” while urinating, or to the presence of external noise in the restroom.
Given anatomical differences, the self-catheterization process is not the same for women as it is for men. It is highly recommended that women be taught by a knowledgeable health care practitioner, preferably a female, before attempting the process. There are different methods, but for practical purposes, it is useful to sit on or stand above a toilet and identify the opening to the urethra by “feel,” then insert a catheter, allowing the urine to drain into the toilet bowl. Assistive devices are also available which can help you identify the correct opening.
Also, all catheters are not created equal, and women may require one whose diameter is less, i.e., a 10 FR vs. a 16 FR. Catheters are available in a number of different styles, sizes, and materials. Anyone who decides to try them will need to experiment to find which kind works best. Click here for specific instructions and tips on catheter use for women.
Women are far more susceptible to urinary tract infections (UTIs or cystitis) than men, and this knowledge may act as a deterrent to the practice of self-catheterization by some. One woman in five develops a UTI during her lifetime, according to statistics from the National Kidney and Urologic Diseases Information Clearinghouse. In fact, in order to reduce the risk of urinary tract infections in the first place, women are advised to drink plenty of liquids, especially water, and to urinate frequently. Therein lies the “Catch 22” – a woman who is suffering from paruresis probably cannot do that. However, antibiotics (e.g., Bactrim, Septra) can be prescribed for use as a preventative or treatment to alleviate the symptoms of a UTI. In addition, phenazopyridine, an over-the-counter medication, can help reduce the burning and frequency of urination that may occur with it.
Besides self-catheterization, women can avail themselves of a few other non-invasive urinary products that may be of some help in bladder emptying. One product provides an alternative to restroom use. It is a urinary pouch which, when attached to one’s inner thigh, is completely hidden beneath loose fitting jeans or pants. A valve at the bottom of the pouch can be opened to allow urine to be emptied into a toilet bowl. Other products are available for paruretic women who find themselves in outdoor situations and may be comfortable peeing there. They are considered assistive devices, such as a funnel or medical-grade tubing, which can enable females to pee through the fly of their clothes while standing. Other such devices include disposable and portable urinal bags and female urinals that can be used in a car, boat, or when camping.
Q: Why does paruresis seem more common among men?
A: Theoretically and statistically speaking, women are just as likely to suffer from paruresis as men. However, the participation rates in IPA workshops and on the IPA Discussion Board are significantly higher for men.
There may be legitimate reasons for the under-representation of women.
Because the media has focused much of its attention on men who have “bashful bladder,” sometimes disparagingly so, perhaps many women are unaware of or minimize its effect on their lives. Some may suffer in silence, rationalizing their condition away with “It’s just something I have to put up with” and therefore do not seek out help.
Perhaps more men than women may seek treatment because they feel their masculinity is being threatened. Some report feeling shame and humiliation if they can’t “pee like a guy.” Female paruretics, on the other hand, do not seem to feel the condition threatens their femininity.
The fact that more men enroll in IPA workshops may also reflect the wage disparity that separates the two sexes. The cost of traveling to and attending a weekend workshop is deemed prohibitive by many women. Some women have expressed concerns about attending co-ed workshops because they fear men will dominate a mixed-discussion group.
The lack of women’s participation on the IPA’s Discussion Board may simply mean they are more inhibited about participating in open forums where they fear violation of their privacy. Some women, finding heavily male-oriented discussions, may think paruresis is a condition that only affects men and not bother to read further. Others are understandably reluctant to talk about personal issues with strangers, especially males; they prefer communicating directly with other women, either in person, by telephone, or by private e-mail exchange.
Q: How can women with paruresis communicate with other female paruretics?
A: A private e-mail forum was established five years ago which provides an opportunity for women who have been suffering from and coping with AP to communicate with each other. Called the AP Women’s Forum and distributed about 3 times a year, this e-zine allows paruretic women to share information, ideas, and resources. For further information about participating, please write to firstname.lastname@example.org and include “AP Women’s Forum” on the subject line. Click here to read more about the Origins of the Women’s Forum.
The typical format of the AP Women’s Forum consists of:
- Latest news section, e.g., relevant newspaper articles, new research developments, drug testing issues, information about the design of women’s toilets.
- A “question of the season,” to which everyone can reply and see each other’s responses
- Roster of participants, including additions/changes/updates to the distribution list.
Some of the discussions have included such topics as:
- How do you deal with someone already in the bathroom when you get there?
- How many of you know how to or practice self-catheterization? If you do, what advice might you have for others?
- What do you do when you’re on a trip and you can’t manage to pee in the public bathroom?
- Do you tell your friends, family? Why or why not? How difficult is this disclosure for you?
- How does having paruresis make you feel about yourself?
- What is your major stumbling block(s) on the road to a complete recovery – to the extent that paruresis no longer seriously affects the quality of your life?
Q: What else can I do?
A: Continue to read the posts on the IPA’s Discussion Forum. Yes, it is heavily male-dominated, but YOU WILL LEARN A LOT!!! And, if nothing else, you will discover you are not the only person in the world who suffers from this condition and also begin to develop empathy for yourself and others. When you are comfortable, either respond to a post or submit one of your own. Remember: you can use an alias – you do not have to use your real name if you have any privacy issues. Continue to be an active participant on the Board, where you will find an immediate connection to fellow paruretic sufferers.
Educate yourself. It is much easier to get started on a recovery program when you have read some of the following materials and understand why certain things are encouraged and others are discouraged.
- Dr. Steve Soifer’s (IPA Co-Founder) book, Shy Bladder Syndrome (considered the bible)
- Dr. Christopher McCullough’s book Free to Pee
- Phobease by Dr. Liebgold. Buy the booklets and tapes
- Self-help books that use cognitive behavioral therapy as the foundation for the book
- A reading list is also available.
- Attend an IPA workshop and support group meetings.
- Practice desensitization on your own.
- Learn how to use a catheter.
- Consider the prudent use of DDAVP, e.g., for long airplane flights.
- Consider taking medications (SSRIs, such as Paxil or Prozac, which work for some but not all towards relieving some anxiety as a way of launching your recovery program.)
Remember, tell people in your life about your experience with paruresis, particularly those you’re close to.
Keep a positive can-do attitude.
START TODAY ON A RECOVERY PROGRAM