Merck Manual

Please confirm that you are not located inside the Russian Federation

Some Causes and Features of Painful Urination

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

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 STD 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 STD

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

STD 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

STD 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

STD 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

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; STD = sexually transmitted disease.