Trujillo’s lack of bladder control parallels his waning grip on control of the Dominican Republic. He maintains outward control over his body—shaving and cleanliness rituals, a strict schedule predictable down to the minute—and his cadre of loyal henchmen. Among the many myths of Trujillo is that he never sweats, and he appears to believe that he can, in fact, allow himself to sweat at will, only when he so chooses.

Trujillo experiences scares of incontinence when events seem out of control in his real life, e.g., when he wonders whether he's lost Sergeant Gittleman's support. At the time of his assassination, although Balaguer is ostensibly his puppet, Trujillo himself no longer holds the presidency. Incontinence reminds him that events outside his control can disrupt that perception of cleanliness, order, and self-discipline, and he can do nothing to stop it, much as he cannot stop death when it comes to find him.

Trujillo associates power and strength with masculinity, in particular his own virility. He prides himself in his ability to bed women, making sure that he makes his trips to Mahogany House weekly as an exercise of power. The impotence that accompanies incontinence vexes him even more; he can take the virginity of girls like Urania by forcefully tearing their hymen, but he can no longer enjoy physical release during the event.