Causes of urethral pain and treatment options.

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The urethra is the tube that runs from the bladder to the outside of the body. Pain in this part of the body can be very unpleasant. People often describe urethral pain as a burning sensation, and urination is sometimes excruciating.

Urethral pain can occur in both genders. Common reasons include:

Also, in people with a prostate, prostatitis can cause pain in the urethra. For those with a vagina, menopause can sometimes lead to vaginal dryness, which contributes to urethral pain.

Diagnostic tests can include:

  • Tests for common sexually transmitted diseases
  • Urine analysis
  • Blood test
  • Visual investigation

Treatment depends on the specific cause. If the cause is an STD, treating the person's partner is also essential.

This article explains the causes, diagnosis, complications, and treatment of urethral pain.

Pain in the urethra in women and men.

Causes

The urethra is the tube that runs from the bladder to the outside of the body. Depending on the human anatomy, there are differences in the structure and function of the urethra. These differences can influence various conditions that cause pain in the urethra.

  • People with a vagina : The urethra carries urine from the bladder to the external urethral sphincter, located between the vagina and the clitoris. The urethra is very short. This, along with the proximity to the anus, makes it much easier for bacteria from the skin to enter the bladder. For this reason, a bladder infection (cystitis) is much more common in those with a vagina.
  • People with a penis . The urethra removes not only urine from the body, but also semen. It is much longer, most of it is outside the pelvis on the penis.

Conditions that irritate the urethra can cause urethral pain. The main reasons are discussed below.

Get Medical Information / Alexandra Gordon

Urethritis

Urethritis is a medical term that means inflammation of the urethra. This inflammation can be due to:

Possible STDs that can cause urethritis include:

  • Gonorrhea : Gonorrhea is caused by the bacteria Neisseria gonorrheae . It was once the most common cause of urethritis. It can cause urethral pain, discharge from the penis, vaginal discharge (often greenish-yellow in color), and pelvic pain, among other symptoms .
  • Chlamydia : Chlamydia and some of the other diseases listed below are often called ' non-gonococcal urethritis ,' meaning any urethritis not caused by gonorrhea. In addition to pain in the urethra, it can cause discharge from the penis and vagina, pain during ejaculation, and pain in the vagina during intercourse. The infection may be asymptomatic, but it can cause harm even when there are no symptoms.
  • Mycoplasma genitalium : This infection can cause pain in the urethra, but it is often asymptomatic. In people with a vagina, this is often associated with bacterial vaginosis , a change in the balance of bacteria in the vagina.
  • Trichomoniasis : Trichomoniasis is a sexually transmitted disease caused by a parasite. This can cause a strong-smelling foamy vaginal discharge and general discomfort to the penis.
  • Ureaplasma : Ureaplasma differs from other STDs in that many people are asymptomatic and have few complications. However, it is often associated with various STDs and can cause urethral pain.
  • Adenovirus : Adenovirus is a relatively rare cause of urethritis. This can cause pain in the urethra, especially in people with a penis.
  • Herpes simplex virus : Herpes infections, especially the initial infection, can cause severe pain in the urethra. Visible sores and ulcers often form on the external genitalia. Lesions may also be present on the urethral mucosa.
  • Syphilis – An open wound called a chancre characterizes the primary stage of syphilis. Unlike herpes, these sores are less painful.

Reactive arthritis

Reactive arthritis ( Reiter's syndrome ) is another possible cause of urethral pain. Eye, urinary tract, and genital infections often accompany this type of joint pain and inflammation. These co-infections can include:

  • Post-infectious arthritis (inflammation of the joints)
  • Non-gonococcal urethritis
  • Conjunctivitis (pink eye) or uveitis (inflammation of the wall of the eyeball )

Reactive arthritis can be associated with:

Urinary tract infection (UTI)

UTIs often cause urethral pain, but they are much more common in people with a vagina (due to the short length of the urethra). Up to 60% of those with a vagina will have a urinary tract infection in their lifetime. In addition to urethral pain, people may experience:

  • Frequent urge to urinate
  • Sudden urge to urinate
  • Blood in the urine

Interstitial cystitis is a little known condition. Severe urethral pain simulates a severe UTI, but the urine culture shows no infection. Some people think it is a systemic (common) disease and not a localized infection. It is often associated with other conditions such as fibromyalgia .

Urinary tract obstruction

Anything that blocks the urethra can cause urine to pool. This congestion stretches the tissue and causes severe pain in the urethra. There are many potential causes of obstruction, including:

  • Urethral strictures : This narrowing of the urethra can be caused by chronic urinary tract infections, a prolonged catheter, surgery, or irradiation of the urethra.
  • Enlarged prostate gland – can press on the urethra.
  • Tumors : Ovarian cancer , uterine cancer, bladder cancer, or prostate cancer tumors can also compress the urethra. This pressure can block the urethra and, in severe cases, possibly cause damage to both kidneys caused by urine production ( hydronephrosis ).
  • Trauma : For example, a pelvic bone fracture can lead to urethral pain and obstruction.
  • Kidney stones : These can lodge in the urethra, although this is much less common than in the ureter, the tube that runs from each kidney to the bladder. However, when they occur in the ureter, the pain appears to come from the urethra or testicle.

Medicines / food

Some medications, such as Procardia (nifedipine), can irritate the urethra and cause pain. Radiation therapy can also cause chronic pain (radiation cystitis).

There are also bladder irritants that can irritate the urethra and cause pain. Common culprits include:

  • Coffee and tea
  • Acidic fruits and juices such as orange juice.
  • Tomato products
  • Chocolate
  • Carbonated drinks
  • The spicy food
  • Alcohol

Injury

Damage to the urethra can cause pain. Examples of injuries include:

  • Trauma
  • A procedure like cystoscopy
  • Introduction of a foreign body in the urethra.

Skin diseases

Some non-infectious skin conditions that are present near the opening of the urethra can cause pain. Some of these include psoriasis and lichen sclerosis .

Causes associated with the prostate, epididymis, and testicles

As noted, benign prostatic hyperplasia can occur in people with a prostate. This can narrow the urethra and cause pain.

Other conditions that can cause urethral pain in people with a penis include:

  • Prostatitis: inflammation of the prostate that can be bacterial or non-bacterial.
  • Epididymitis : inflammation of the tubes of the testicle that carry sperm.
  • Orchitis: swelling of the testicles.

Vaginal causes

Painful urethral irritation is common in people with a vagina. This irritation can be due to:

  • Spermicide
  • Showers
  • Soaps and lotions
  • Friction from intercourse

Another common cause is yeast infections . These yeast infections can cause great discomfort and itching.

Bacterial vaginosis is another cause associated with the vagina. This infection can be very unpleasant due to its chronic nature. Symptoms include vaginal discharge and a fishy odor.

In menopausal women, vaginal atrophy can cause urethral pain, vaginal pain, and dryness. In severe cases, the urethra may protrude from the opening of the urethra (urethral prolapse). Vaginal atrophy can also increase the risk of UTIs.

Summary

There are many things that can cause urethral pain. These include sexually transmitted diseases, urinary tract infections, obstruction, trauma, and skin conditions. Some causes are specific to the anatomy of the prostate, penis, or vagina.

Diagnostics

The diagnosis of urethritis begins with a complete examination of the medical history. Your healthcare provider will ask about possible risk factors for sexually transmitted diseases, such as a new sexual partner or unprotected sex. They will also ask you about any urological problems you have had in the past.

Then your doctor will do a physical exam. They will pay special attention to the presence of urethral discharge, ulcers, enlarged inguinal lymph nodes (lymph nodes in the groin). They can also gently "milk" the penis by pulling the shaft down to check for discharge.

Your doctor may also examine other areas, such as the scrotum, cervix, anus, and throat, for signs of inflammation. Depending on the results, they may order additional tests or recommend a referral to a urologist .

Laboratories and tests

Laboratory tests to evaluate urethral pain include urinalysis . This test looks for:

  • Leukocytes as signs of infection.
  • Red blood cells and crystals as a key to finding kidney stones or other urological problems.

STD screening recommendations include testing for major sexually transmitted diseases, such as gonorrhea and chlamydia. If your doctor suspects yeast infection, they will also do a KOH preparatory test . STD testing can include:

Your doctor can perform a urine culture to determine if there is an infection. This test can determine the type of bacteria present and its susceptibility to antibiotics. This knowledge helps determine the specific antibiotic that will be most effective in fighting the infection.

Other lab tests may include:

  • Complete blood count if you have a fever or other systemic (whole body) signs of infection.
  • Kidney function tests, including urea nitrogen, creatinine , and electrolytes if there is a concern that your kidneys may be affected.
  • Sedation Rate (ESR) Inflammation Test
  • C-reactive protein, another marker of inflammation
  • HLA B27 for suspected reactive arthritis

Display

Imaging tests are not generally used to evaluate urethritis. However, this may be necessary if your doctor suspects a kidney infection (pyelonephritis) or kidney stones, or if there is a significant amount of blood in the urine.

Most often, imaging tests are used to detect STD complications, such as an ovarian or fallopian tube abscess.

Procedures

Cystoscopy is a test in which a narrow, lighted tube is inserted into the urethra and bladder. This can be done to:

  • Look for stricture (swelling or blockage) in the urethra.
  • Determine the cause of the appearance of red blood cells in the urine.
  • Check people with interstitial cystitis

Sometimes if there are scars and strictures, your doctor may need to widen (open) the urethra to relieve symptoms.

If your doctor suspects that a mass is causing urethral obstruction, he or she may order a pelvic computed tomography (CT) scan to get a better view.

Differential diagnosis

In addition to the conditions listed above, several diseases can lead to pain in the urethra. This includes:

Summary

Diagnoses may include physical exam, lab tests, and imaging. You are less likely to use procedures such as dilation or cystoscopy to open and look inside the urethra.

Complications

Some complications can arise from common causes of urethral pain. These complications require a correct diagnosis. Complications include:

  • Pelvic inflammatory disease (PID) : Untreated STDs, such as chlamydia, can lead to pelvic inflammatory disease , a leading cause of infertility.
  • Pregnancy complications : When pregnancy occurs, there is an increased risk of ectopic pregnancy , which can sometimes be life-threatening. Also, some of these infections can cause problems during pregnancy, like preterm labor and more.
  • Chronic pelvic pain : This can occur due to inflammation or damage caused by these infections. This inflammation can also increase the risk of contracting HIV from contact.
  • Septic Arthritis and Blindness : Gonorrhea can lead to non-reproductive and pelvic complications of STDs.
  • Kidney damage or disease : A blockage in the urethra can trap urine in the kidneys, causing kidney damage (hydroureteronephrosis). Chronic urinary tract infections, especially pyelonephritis, can also lead to kidney disease.

Additionally, even atrophic vaginitis (vaginal dryness associated with menopause) can lead to complications, increasing the risk of urinary tract infections and STDs.

Watch out

Treatment for urethral pain depends on the underlying cause. Common treatments include:

  • Lidocaine, pyridium : To relieve symptoms, topical gel preparations of lidocaine or pyridium (phenazopyridine) may relieve pain (note that pyridium may stain urine red).
  • Antibiotics : Treatment of STDs caused by bacteria depends on the specific bacteria that cause the disease. Unfortunately, resistance to antibiotics is on the rise. Therefore, you should consult a doctor who is aware of the latest recommendations. Also, antibiotics are the standard form of treatment for UTIs.
  • Antiparasitic Medications: Doctors treat protozoan infections such as trichomoniasis with medications for parasites.
  • Antiviral medications: Doctors treat herpes with antiviral medications. Partners must also be treated.
  • Lubricants and hormones : There are several treatment options for atrophic vaginitis, including lubricants and topical estrogen and androgen therapy.
  • Dilation : Treatment for urethral obstruction will depend on the cause and may include dilation if there is scar tissue or stricture.
  • Surgery : If the tumor presses on the urethra, your doctor may need to remove it.

Prophylaxis

Fortunately, there are simple steps you can take to prevent more common causes of urethral pain. Practicing safer sex can help reduce your risk of getting an STD. You can make sex safer by:

Tips for reducing your risk of urinary tract infections include:

  • Keep hydrated
  • Wash before and after sex.
  • Urinate before and after sex
  • Don't hold your urine
  • Clean from front to back
  • Choose a shower instead of a bath (if urinary infections become a problem)
  • Wear loose cotton underwear.
  • Avoid strong lotions
  • Clean the foreskin of your uncircumcised penis regularly.

When to contact a healthcare provider

Urethral pain is never normal. Therefore, a health care provider should always evaluate for this symptom unless it has a clear and reversible cause, such as an injection immediately after using a new personal care product. However, some conditions are more important than others.

When to see a doctor

You should contact your doctor immediately if you have:

  • Hot
  • Shaking chills
  • Severe pain
  • Blood in the urine
  • Inability to urinate

Even if your symptoms are mild or come and go, you should still make an appointment.

Untreated chlamydia and gonorrhea infections can permanently damage the reproductive organs. Even in the absence of symptoms, this can lead to long-term complications.

Summary

Urethral pain can be caused by many causes, including sexually transmitted diseases, trauma, bacterial or fungal infections, and obstruction. Your doctor will do a physical exam to identify the cause of your urethral pain. They can also order lab tests and imaging tests.

Treatment depends on the cause and may include antibiotics, antiparasitic medications, antiviral medications, or treatment of symptoms. Urethral pain is never normal. If your urethra hurts, be sure to see your doctor.

Get the word of drug information

Since some of the causes of urethral pain are related to sexually transmitted diseases, people are sometimes hesitant to talk to their doctor. However, there are many potential causes of urethral pain, and even if you have an STD, they are common and not embarrassing.

In general, pain is your body's way of letting you know something is wrong. In fact, for urethral pain, listening to your body can not only help you eliminate pain, it can also prevent or reduce the risk of complications associated with many causes.

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