Some Causes and Features of Painful Urination
Cause | Common Features* | Tests |
|---|---|---|
Infections† | ||
Cystitis (bladder infection) | Usually in women and girls A frequent and urgent need to urinate Getting up at night to urinate Sometimes blood in the urine or foul-smelling urine | A doctor's examination Usually urinalysis and urine culture |
Epididymo-orchitis (infection of an epididymis and a testis) | Tenderness and swelling in a testis Possibly frequent urination or a discharge from the urethra Sometimes fever or nausea | A doctor's examination Sometimes urinalysis Sometimes STI testing |
Prostatitis (infection of the prostate) | A tender prostate detected during a digital rectal examination Often fever, difficulty starting urination, frequent urination, the need to urinate during the night, and burning or pain during urination Sometimes blood in the urine Often symptoms of a long-standing blockage in the urinary tract (including a weak urine stream, difficulty passing urine, or dribbling at the end of urination) | Urinalysis and urine culture |
Urethritis (infection of the urethra), typically due to an STI | Usually a visible discharge from the urethra in men Sometimes a discharge from the vagina in women In people who have recently had unprotected intercourse | STI testing |
Vulvovaginitis (infection of the vulva and vagina) | A discharge from the vagina Often redness in the genital area | A doctor's examination, including examination of a sample of the discharge under a microscope |
Cervicitis (infection of the cervix) | Often a cervical discharge History of unprotected intercourse | STI testing |
Disorders that cause inflammation | ||
Connective tissue disorders that cause inflammation (such as reactive arthritis or Behçet syndrome)‡ | General or bodywide symptoms (including body pain and joint pain) that develop before urination becomes painful Sometimes sores on the skin, mouth, eyes, or genital area, including inside the vagina | STI testing Sometimes blood tests to check for these connective tissue disorders |
Contact with a substance that irritates the area or causes an allergic reaction (such as a spermicide, lubricant, or latex condom) | Sometimes redness in the genital area In people who have been exposed to a substance that could cause irritation or an allergic reaction | Only a doctor's examination |
Interstitial cystitis (inflammation of the bladder without infection) | More common among women A frequent and urgent need to urinate Long-standing symptoms | Urinalysis and urine culture Examination of the interior of the bladder using a flexible viewing tube inserted through the urethra (cystoscopy), usually including removal of a sample of tissue for examination (biopsy of the bladder) |
Other disorders | ||
Atrophic vaginitis or urethritis (thinning of tissues in the vagina or urethra) | In postmenopausal women Vaginal dryness Often pain during intercourse A discharge from the vagina Changes in the interior of the vagina (it becomes smooth and pale) | Only a doctor's examination |
Tumors (usually bladder, prostate, or urethral cancer) | Long-standing symptoms, such as a weak urine stream or difficulty starting urination Usually blood in the urine | If bladder cancer is suspected, cystoscopy If prostate cancer is suspected, a blood test to measure PSA levels If the PSA level is elevated, biopsy of the prostate |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Infectious organisms that commonly cause painful urination include sexually transmitted organisms (such as those that cause gonorrhea, chlamydial infection, and trichomoniasis) and bacteria that are not sexually transmitted, mostly Escherichia (E.) coli. | ||
‡ This cause is rare. | ||
PSA = prostate-specific antigen; STI = sexually transmitted infection. | ||