What are the causes of dysuria (painful urination)?

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Causes of Dysuria

Dysuria (painful urination) is most commonly caused by urinary tract infections, but can also result from sexually transmitted infections, bladder irritants, skin conditions, and chronic pain syndromes. 1

Infectious Causes

Urinary Tract Infections

  • Cystitis (bladder infection)
    • Most common cause of dysuria
    • Presents with dysuria, frequency, urgency, and suprapubic pain 2
    • Escherichia coli is the predominant pathogen (>90% in young women) 2
    • Absence of vaginal discharge increases likelihood of UTI 1

Upper Urinary Tract Infection

  • Pyelonephritis (kidney infection)
    • Presents with systemic symptoms (fever, chills, fatigue) along with dysuria 2
    • Often includes flank pain/costovertebral angle tenderness 2
    • Can lead to renal scarring if untreated 2

Sexually Transmitted Infections

  • Urethritis
    • Caused by Chlamydia trachomatis, Neisseria gonorrhoeae
    • Consider Mycoplasma genitalium testing if initial testing is negative 1
  • Cervicitis (in women)
    • More likely when vaginal discharge is present 1

Other Infectious Causes

  • Vaginitis (in women)
    • Candida, bacterial vaginosis, Trichomonas
    • Usually presents with vaginal discharge and/or odor 3
  • Prostatitis (in men)
    • More common in older men 4

Non-Infectious Inflammatory Causes

Chemical/Irritant Causes

  • Bladder irritants
    • Spermicides
    • Soaps, bubble baths
    • Feminine hygiene products
    • Certain foods and beverages (caffeine, alcohol, spicy foods) 1, 3

Dermatologic Conditions

  • Contact dermatitis
  • Lichen sclerosus
  • Lichen planus
  • These can affect the urethral meatus and cause pain during urination 3

Foreign Bodies

  • Urinary tract foreign bodies
    • Can cause inflammation and secondary infection 3

Non-Inflammatory Causes

Anatomical/Structural Issues

  • Urethral stricture or diverticulum
  • Bladder or kidney stones
    • May present with hematuria and severe pain 3
  • Prostatic hyperplasia (in men)
    • More common in older men 4

Chronic Pain Conditions

  • Interstitial cystitis/bladder pain syndrome
    • Chronic pelvic pain with urinary symptoms
    • Diagnosis of exclusion after ruling out other causes 3

Medication-Related

  • Certain medications
    • Chemotherapeutic agents (cyclophosphamide)
    • Some antibiotics
    • Spermicides 3

Hormonal Factors

  • Atrophic vaginitis/urethritis
    • Due to hypoestrogenism in postmenopausal women 4

Trauma

  • Local trauma to urethra or genitalia
    • Can be related to sexual activity or instrumentation 3

Neoplasms

  • Bladder cancer
  • Urethral cancer
    • Usually present with hematuria and other symptoms 4

Common Pitfalls in Diagnosis

  • Overdiagnosis of UTI based solely on urinalysis without symptoms 5
  • Treating asymptomatic bacteriuria (except in pregnancy) 5
  • Missing non-infectious causes by focusing only on infection 1
  • Inadequate specimen collection leading to contaminated samples 5
  • Relying on virtual encounters without laboratory testing, which may increase recurrent symptoms and unnecessary antibiotic use 1

Special Considerations

  • In women with typical symptoms of uncomplicated cystitis and no complicating features, empiric treatment may be appropriate 3
  • In men, dysuria warrants more thorough evaluation as UTIs are less common and often complicated 4
  • Persistent symptoms after initial treatment require further workup for both infectious and non-infectious causes 1
  • Recurrent UTIs (≥3 in 1 year or ≥2 in 6 months) affect 20-30% of women and require documentation of positive cultures 2, 6

Understanding the diverse causes of dysuria is essential for accurate diagnosis and appropriate management, ultimately improving patient outcomes and reducing unnecessary antibiotic use.

References

1
Research

Dysuria: Evaluation and Differential Diagnosis in Adults.

American family physician, 2025

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Dysuria: Evaluation and Differential Diagnosis in Adults.

American family physician, 2015

4
Research

Evaluation of dysuria in adults.

American family physician, 2002

5
Guideline

Urinary Tract Infections

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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