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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 olmert@aol.com
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:
1. Latest news section, e.g., relevant newspaper articles, new
research developments, drug testing issues, information about the
design of women’s toilets.
2. A "question of the season," to which everyone can reply
and see each other’s responses.
3. 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?
Examples of previous issues can be found on our Newsletters
page.
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.
a) Dr. Steve Soifer's (IPA Co-Founder) book, Shy
Bladder Syndrome (considered the bible)
b) Dr. Christopher McCullough's book Free to Pee
c) Phobease by Dr. Liebgold. Buy the booklets and tapes
d) 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.)
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!
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