Burning Urethra in Females (without UTI): 5 Main causes.
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The burning urethra in females is a common symptom. The main cause is urinary tract infections (UTIs) and urethral infections (mainly gonorrhea and chlamydia).
In this article, you will learn about the main causes of the burning urethra in females other than UTI (when the urine culture is negative).
The most common cause of burning urethra in females (other than UTI include:
- Chemical irritants: such as soap, bubble baths, feminine hygiene products, etc.
- Vaginitis or cervicitis.
- Passage of a stone through the urethra.
- Urethral pain syndrome
- Painful bladder syndrome.
- Psychogenic (low threshold to pain).
- Labial adhesion (in prepubertal girls).
- Viginal vaginal ulcers (in prepubertal girls).
- Lichen sclerosis (in older females).
- False-negative (or culture-negative) UTI.
- Allergic conditions
1. Local irritation by chemicals (overwashing).
Chemicals may irritate the urethra in females. This is especially common among females who over-wash after urination or baths.
Common irritants include:
- Bubble baths
- Feminine hygiene products
- Spermicide-coated condoms and diaphragms.
- Synthetic fibers in the underwear.
Symptoms & diagnosis
- History of overwashing or switching to a new soap type or hygiene product.
- Continuous burning sensation in the urethra.
- The burning sensation worsens when you pee (Dysuria).
- The burning sensation often goes with bathing, overwashing, or using spermicide-coated condoms or diaphragm.
- Also, there may be redness or itching around the urethral opening.
- Chemical urethritis doesn’t lead to fever, lower abdominal pain, or urethral discharge.
- The urine analysis is often free and doesn’t reveal UTI.
- Eliminate the irritant: the only definitive treatment of chemical urethritis is to avoid the offending soap or hygienic product.
- Petroleum jelly: studies show that applying petroleum jelly around the urethral area improves the burning sensation dramatically and prevents further irritation.
- Use 100% cotton fabric underwear.
- Don’t over-wash or under-wash; limit the unnecessary use of soap or hygienic products.
- If the burning pain is severe, your doctor may prescribe phenazopyridine (Pyridium) to ease the pain.
2. Vaginitis and/or cervicitis.
Vaginitis (vaginal infection and inflammation) and cervicitis (inflammation of the cervix of the uterus) may cause burning urethral pain without UTI.
Females with vaginitis or cervicitis often complain of vaginal secretions with urethral pain. The three most common causes of vaginitis according to the type of secretion (reference):
- Scanty secretions: nonspecific vaginitis (the most common type).
- White & cheesy: candida infection (a famous fungal infection).
- Thick & green: gonorrheal infection.
A burning sensation in your urethra may occur secondary to vaginitis. Consult your doctor if you suspect abnormal vaginal secretions.
Severe infections such as gonorrhea and candida need medical consultation and antibiotic or anti-fungal therapy.
3. Passage of a stone with urine.
Passing a stone with urine may lead to minor trauma (injury to the inner wall of the urethra.
These minor abrasions secondary to the passage of the stone may cause urethral pain or a burning sensation that lasts for days after the stone passage.
- History of passing a stone with urine.
- Severe burning pain in the urethra, especially with urination (dysuria).
- Bloody urine may occur due to the injury to the urethra.
- Prior history of flank or bladder pain during the passage of the stone in the ureter.
- The stone may also appear in the toilet.
4. Urethral Pain Syndrome (UPS).
A urethral pain syndrome is a group of symptoms such as painful urination, urine urgency, frequency, and persistent urethral pain without UTI.
The disease is diagnosed based on chronic symptoms after excluding organic diseases such as UTI and urethritis.
Several theories tried to explain the syndrome, such as (reference):
- Undiagnosed infections.
- Chemical urethritis.
- Psychogenic factors such as stress, anxiety, and depression.
- Decreased estrogen levels.
- Inflammation of the female prostate (skene glands and the paraurethral glands.
- Symptom duration: at least six months of continuous or recurrent symptoms.
- Dysuria (Burning urethral pain during urination).
- Frequent urination (every 30-60 minutes during daytime, less during nighttime).
- Sudden urge to urinate.
- Bladder pain.
- Urethral irritation.
- Painful menses and painful intercourse.
5. Painful bladder syndrome (previously called interstitial cystitis).
Facts and statistics:
- It affects more women than men.
- It is relatively uncommon, affecting about 0.85% in women (850 per 100,000 case) and 0.06% (60 per 100,000 case) in men (reference).
- It is more common in the 4th decade of life (in the thirties or forties).
- Potential genetic causes are proposed based on the fact that it affects identical twins more than non-identical twins.
- Bladder discomfort, pressure, or spasms, especially when the bladder is full.
- Symptoms are chronic and present almost all days for several months. But they may range in severity from one day to the other.
- The symptoms usually start after an event such as UTI, Bladder procedure, or bladder trauma.
- Frequent urination.
- Prolonged sitting on the toilet to let the urine drip.
- Sudden severe urge to urinate.
- Frequent urination at night (nocturia).
- Burning in the urethra after urination (without UTI or urethritis).
- Painful intercourse.
- Associated conditions: depression, irritable bowel syndrome, and fibromyalgia.
6. Urethral trauma.
Trauma to the urethra may cause urethral pain without UTI. Common causes of urethral trauma include:
- Direct, blunt trauma to the urethra.
- Violent sexual acts or sexual abuse.
- Recent insertion of urine catheter.
- Major trauma to the pelvis, as with car accidents.
- Pelvic radiation.
- Pelvic surgery.
The burning sensation in the urethra often starts after an identifiable event and is often present with and without urination. Also, bloody discharge or bloody urine may occur.
7. Urethral diverticulum.
The urethral diverticulum is a localized dilatation or pouch in the female urethra (common in the middle portion of the urethra).
Urethral diverticulum is a common condition affecting up to 5% of women (reference).
The diverticulum can cause pain or discomfort in the female urethra without UTI.
- Urethral pain.
- Dripping of urine after peeing.
- Tender vaginal mass.
- Painful intercourse.
- Dysuria (pain during urination).
- Chronic or recurrent UTIs.
- Increased frequency of urination with urinary urgency.
- Bloody urethral discharge.
- Urinary incontinency.
- Urine retention.
- Labial adhesions (in prepubertal females).
- Urethral pain syndrome.
- Lichen sclerosis (more in older females).
- Virginal vaginal ulcers.
- Psychogenic (with anxiety and depression).
- False-negative UTI.
- Eosinophilic cystitis.
- Bladder cancer.
- STDs of the urethra, such as gonorrhea, chlamydia, and viral urethritis.
- Written by a doctor.
MD, Internal Medicine and Nephrology specialist.
Dr. Esraa A. MagidAuthor