High prevalence and overlapping conditions of pelvic pain such as interstitial cystitis/bladder pain syndrome (IC/BPS) and lower urinary tract symptoms (LUTS) such as overactive bladder was well known. However, coexisting chronic pain and symptoms of other conditions except IC/BPS are often underestimated in women with LUTS. Urethral discomfort or pain is often observed in women with LUTS. And urethral pain can be a symptom associated with chronic pelvic pain disorders such as IC/BPS and sexual pain. On the other hand, urethral discomfort and pain can be induced by LUTS such as OAB. However, the study is lacking to evaluate the association between LUTS and genital pain including urethral pain even though urethral pain is common findings in women. Therefore, we analyzed the characteristics of LUTS in women showing urethral pain.

A medical record of 39467 women who visited in the health promotion center was reviewed. The 9820 women who completed the questions about sexual function and LUTS from the health questionnaire were included. The questions about LUTS were composed of 6 inquiries about frequency, urgency, urge incontinence, nocturia and stress urinary incontinence (SUI). Of the 9802 women, 1786 (18.2%) women presented to show urethral pain. Urinalysis, lifestyle factor, comorbidities, menopausal conditions were investigated in the 1786 women who showed urethral pain from the questionnaire.

The mean age of the 1786 women who showed urethral pain and LUTS was 43.1±15.9 (18 – 87) years. We included 83.4 (1489/1786) % women showed normal urinalysis. We excluded 16.7  (297/1786) % women with abnormal urinalysis (218 women: pyuria, 79 women: microscopic hematuria). The mean age of 1489 women with urethral pain and LUTS was 42.8 ± 15.9 years and 87.2 (1298/1489) % was between 25 to 54 years. Four (58/1489) % had diabetes and 34.8 (518/1489) % was menopausal women. Thirty four percent (506/1489) % drank more than 2 cups of coffee a day and 2.6 (39/1489)% smoked. Of the 1489 women, frequency, urgency, urge incontinence, nocturia and SUI were observed in 55.8 (831/1489) %, 20.7 (309/1489) %, 21.6 (332/1489) %, 39.6 (590/1489) %, and 37.5 (559/1489)% women, respectively. The women with all of 5 LUTS were 20.8 (309/1489)% and 0.3 (13/1489) %, 16 (239/1489) %, 2.1 (31/1489) %, 16.2 (241/1489) % women showed 4, 3, 2, and 1 LUTS, respectively. The women only had urethral pain was 64.01 (954/1489) %.

In this study, 83.4% women was considered to show urethral pain which was not associated with urinary tract infection. High prevalence of urethral pain was noted in the women from general population. Moreover, half of the women with urethral pain showed frequency, urgency, urge incontinence, nocturia, and SUI. Therefore, LUTS such as OAB and SUI is commonly observed in women with urethral pain. Moreover, urethral pain was more prevalent in the relatively young and sexually active women between 25 to 54 years. Menopausal condition might be cause of urethral pain.

In this study, coexistence of urethral pain and LUTS was commonly observed in women after excluding women with abnormal urinalysis. Moreover, urethral pain may be symptom reflecting chronic pelvic pain disorders such as IC/BPS and sexual pain. In addition, urethral pain can be a symptom of LUTS. However, interest in urethral pain has been not sufficient even though many patients experienced urethral pain and urethral pain could be a factor for low quality of life (QoL).  Therefore, more concern about urethral pain is necessary in women with LUTS. Accurate and timely recognition of coexisting chronic pain conditions such as urethral pain that has been overlooked may help to guide therapeutic recommendations and improve patient’s QoL. Thus, multimodal approach for diagnosis and treatment is needed.

Scand J Urol 2015;49:242-9