Painful Urination

Pain during or immediately after urination is a common reason for women to seek medical attention. Frequent causes for this symptom include:
  • Cystitis (bladder infection)
  • Urethritis (infection of the urethra)
  • Herpes vulvitis
  • Endometriosis
  • Contact dermatitis
  • Trauma

 

Evaluation
  • Document the onset and severity of symptoms, whether the pain lasts throughout urination or just at the end (terminal dysuria), and whether the pain is on the outside (vulva) or behind the pubic bone (bladder)..
  • Inspect the vulva, looking for signs of trauma, or the open sores of herpes.
  • Palpate the urethra and bladder, looking for the tenderness of urethritis or cystitis.
  • Lab tests may include urine dipstick screening, urine sediment microscopic analysis, urine culture, gonorrhea, chlamydia, or herpes testing, depending on the severity and type of symptoms.
  • With classical symptoms, lab testing is sometimes omitted.
  • Some providers test the urine after completing therapy, while others do not.
Treatment

Treatment is based on the presumed cause of the pain. Cystitis may be treated with such antibiotics as:

Urethritis is treated with antibiotics effective against chlamydia and gonorrhea, following CDC Guidelines.

Herpes is treated with acyclovir.

Endometriosis is treated surgically or hormonally.

Contact dermatitis is treated by removal of the offending organism, anti-inflammatory medications, and soothing baths.


OB-GYN 101: Introductory Obstetrics & Gynecology
© 2003, 2004, 2005 Medical Education Division, Brookside Associates, Ltd.
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