Female Urethral Syndrome Urethral syndrome is present in one quarter of patients presenting with lower urinary tract symptoms.
Urethral syndrome, or frequency-dysuria syndrome, is characterized by frequency, dysuria and suprapubic discomfort without any objective finding of urological abnormalities or infection. Dysuria or constant suprapubic discomfort is partially relieved by voiding. Patients also may report of difficulty in starting urination, slow stream, and a feeling of incomplete emptying of the bladder. Most patients are women aged 30-50 years. Vaginal discharge and vaginal lesions must be excluded. History is important, and diagnosis is by exclusion.
In urethral syndrome, the etiology is unknown. Historically, urethral stenosis (narrowing) was thought to be the cause of urethral syndrome. Currently theorized etiologies include hormonal imbalances, inflammation of the "female prostate" (Skene glands and the paraurethral glands), a reaction to certain foods, environmental chemicals (eg, douches, bubble bath, soaps, contraceptive gels, condoms), hypersensitivity following urinary tract infection, and traumatic sexual intercourse. Regardless of the initial pain-causing event, the patient has both involuntary spasms and voluntary tightening of the pelvic musculature during the painful episode, which, in addition to any residual irritant or reinjury, starts a vicious circle of worsening dysfunction of the pelvic floor musculature. Often, the original cause of the pain has healed, but the pelvic floor dysfunction persists and is worsened by patient anxiety and frustration with the condition.
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