7 Main Causes of Sharp Stabbing Pain in Female Urethra.

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Possible causes of sharp stabbing pain in the female urethra:

Chemical irritation of the urethra due to overwashing with soap or hygienic products.
Infection of the urethra, such as gonorrhea and chlamydia infection.

Urethral diverticulum.
Urinary tract infection.
Passage of a stone through the urethra.

Urethral trauma.
Urethral pain syndrome.
Associated vaginitis or cervicitis.

1. Chemical urethritis (urethral irritation).

Many chemicals may come in contact with the urethra and cause severe irritation and sharp stepping pain. This is especially common among females who over-wash after urination or baths.

Common urethral irritants include:

Soap

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.
Sharp stabbing (needle-like) pain in the urethra sensation in the urethra.

The stepping pain sensation worsens when you pee (Dysuria).
The pain sensation often comes and goes with bathing, overwashing, or using spermicide-coated condoms or diaphragms.
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.

Treatment:

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. Infectious urethritis.

Urethritis is an inflammation limited to the urethra caused by microorganisms such as bacteria. It is more common in males. However, it may also occur in females (often associated with vaginitis or cervicitis).

Infectious urethritis may lead to sharp stabbing urethral pain and urethral discharge in females.

The most common organisms include (reference):

Neisseria gonorrhea: the leading cause of urethritis. It is a sexually-transmitted disease.
Chlamydia Trachomatis: the most common non-gonococcal cause of urethritis.

Tricholoma vaginalis (a protozoal infection).
Herpes simplex virus urethritis.
Adenovirus.

H. influenza bacteria.
Candida species (fungal infection) and others.

Symptoms & diagnosis:

Urethritis can be completely asymptomatic or with only a weird or strange sense of discomfort in the urethra.

Urethral pain (The pain is often sharp, stepping, and continuous). The pain becomes sharper when you pee.
Urethral discharge (the severity and nature of the discharge depending on the causative organism):
- Gonorrhea causes plenty of pus or pus and mucus discharge from the urethra that comes out without urination.
- Chlamydia trachomatics discharge is often scanty and watery. In females, it is often associated with vaginitis and cervicitis.
- Mycoplasma genitalium is often asymptomatic but may cause purulent (pus) discharge from the urethra.
- Herpes simplex urethritis intense dysuria (urethral pain) without significant discharge.

Dysuria (painful urination).
Associated vaginitis and cervicitis, sometimes with associated vaginal discharge, itching, vaginal bleeding, bleeding after sex, etc.
Most types of urethritis are sexually transmitted, So check with your partner if he has similar symptoms.

In females, gonorrhea may spread to the genital system causing pelvic inflammatory disease (infection of the uterus, fallopian tubes, etc.).
The diagnosis of urethritis is based mainly on visualizing the discharge. However, tests may also be needed to detect the cause (urethral swab, urethral culture, etc.).

3. UTI (cystitis).

Urinary tract infections (especially cystitis) are most common in females due to the shorter urethra (which is severe as a route for the bacteria entering the bladder from outside) (reference).

Most cases of UTI have mild symptoms such as painful urination, bladder pain, and urethral discomfort.

Acute cystitis often causes urethral pain (which can be sharp or stabbing), especially during urination.

Symptoms & diagnosis:

Dysuria: stabbing pain in the urethra when you pee.

Urgency: sudden severe urgency to pee.
Frequency: Frequent urge to pee but only a small amount of urine comes out.
Suprapubic (lower abdominal) pain.

Turbid (cloudy) urine may also be present.
The symptoms may be very mild, with a strange feeling in the bladder and urethra.
Also, UTI may become complicated (reaching the kidneys), causing high fever, flank pain, chills, etc.

The diagnosis is often established by urine analysis and culture.

What to do:

UTI is a very common cause of abnormal urinary symptoms in females. Consult your doctor to confirm the diagnosis if you have symptoms consistent with UTI.

UTIs are treated mainly by antibiotics (such as Nitrofurantoin and Trimethoprim-sulfamethoxazole).

An over-the-counter urinary analgesic such as Oral phenazopyridine may help relieve the dysuria and uncomfortable urethral sensations.

4. 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 may become inflamed and cause sharp stabbing pain in the urethra.

Symptoms (reference):

Urethral pain (sharp, stepping, or needle-like pain).
Dripping of urine after peeing.

Tender vaginal mass (felts from inside in the anterior wall).
Painful intercourse.
Dysuria (pain during urination).

Chronic or recurrent UTIs.
Increased frequency of urination with urinary urgency.
Bloody urethral discharge.

Urinary incontinency.
Urine retention.

5. Urethral trauma.

Trauma to the urethra may cause extremely sharp urethral pain. The pain onset is often related to recent trauma to the urethra. 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 sharp, needle-like, or stringing pain in the urethra often starts after an identifiable event and is often constant. Also, bloody discharge or bloody urine may occur.

6. Vaginitis or cervicitis.

Vaginitis (vaginal infection and inflammation) and cervicitis (inflammation of the cervix of the uterus) may lead to urethral pain.

Females with vaginitis or cervicitis often complain of vaginal secretions together with urethral pain. Many females confuse vaginitis for a UTI due to sharp urethral pain. So, It is important to know the differences between both conditions.

The landmark feature of vaginitis is vaginal secretions. The presence of abnormal vaginal secretion, together with sharp stabbing urethral pain, suggests the presence of vaginitis rather than urethral disease.

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.

If you are unsure about the cause of stabbing urethral pain, it is better to consult your doctor. In most cases, the treatment of vaginitis will cause the resolution of the urethral pain.

7. Urethral pain syndrome.

A urethral pain syndrome is a group of symptoms such as painful urination, urinary urgency, frequency, and sharp urethral pain without a UTI. It is more common in females.

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.

Symptoms:

Symptom duration: at least six months of continuous or recurrent symptoms.

Dysuria (sharp or 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.

8. Urethral stone.

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 sharp stabbing pain in the urethra. Stones are unlikely to get stuck in the urethra in females as the urethra is wide and short.

Symptoms:

History of passing a stone with urine.

Severe needle-like stabbing 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 through the ureter.