Women experiencing a burning sensation in their urethra coupled with the frequent urge to pee but with low urinary output, along with an uncomfortable pressure within the bladder will probably have a diagnosis in mind well before they get to the doctor. Urinary Tract Infections are, after all, incredibly common. One in three women will have had at least one UTI before age 24, while over half will go through a minimum of one during their lifetime and UTIs are considered the single most common bacterial infection out there.
What if you present with all the tell-tale symptoms of a Urinary Tract Infection, but no pathogens are found in your urine culture? It could be Female Urethral Syndrome. FUS comes with all the same signs, but does not appear to be caused by any bacteria or viruses.
What Is Female Urethral Syndrome?
What exactly is Female Urethral Syndrome? That's a hard question to answer because FUS is, in many ways, defined by what it is not. FUS is not your ordinary UTI, caused by known pathogens that are detected in a urine culture, most frequently bacteria. It does come with the same symptoms, however: an uncomfortable pressure in the bladder, increased frequency of urination, pain while urinating, pain during sex, and a generalized burning sensation in the urethra. Women with FUS can also suffer from a more general pelvic pain, and can have swelling and tenderness throughout the groin area.
The symptoms are all too real, however, and can be chronic or acute. The lack of a detectable infection leaves medical professionals to speculate about the possible causes of Female Urethral Syndrome. FUS could be the result of an infection after all, just one that we don't have the means to detect as of yet. It may also be the cause of a wide range of external factors, and not necessarily the same ones in all cases. Exposure to radiation, chemotherapy, or other chemicals could be responsible for FUS. Products such as soaps, perfumes, sanitary products, or contraceptive products including condoms could also be to blame. Physical injuries to the groin area, rough sex, and even dietary irritants such as caffeine are other possibilities.
See Also: Urinary Tract Infection: Causes, Symptoms, And Treatment
These glands are called the Skene glands and the paraurethral glands, and they are present on both sides of the urethra in women. While problems with these glands are thought to be rare, they happen. FUS could fall into this category, and Gittes and Nakamura (see link in links box below) have gone so far as to describe the syndrome as a "female prostatitis".
Female Urethral Syndrome: Risk Factors, Diagnosis, Treatment And Prevention
FUS: The Risk Factors
While there is no consensus about the cause or causes of Female Urethral Syndrome, the condition is associated with certain risk factors. One study into the gynecological risk factors associated with FUS found that women who had delivered more than five babies, those who didn't have an episiotomy (vaginal cut) during birth, had undergone two or more abortions, or had pelvic relaxation were more at risk. The study also determined "hospital birth" to be a risk factor.
In addition, a physical narrowing of the urethra, other physical abnormalities including as the result of injury, and medications that weaken the immune system can be factors that lead to symptoms that warrant a diagnosis of FUS.
Diagnosis
Female Urethral Syndrome is diagnosed on the basis of:
- The patient's medical history
- Abdominal examination and gynecological examination
- Negative results to urine cultures, dynamic cystourethroscopy and urodynamic studies — other infections and conditions that could lead to the same symptoms are ruled out
- Causes such as allergies, inflammatory reactions to underwear, and physical injury should also be ruled out.
Women who have been diagnosed with FUS, or those who have not been diagnosed by do have the same symptoms without a known cause, may consider seeking a second opinion.
Treatment
Since the cause remains unknown, treatment is as much of a problem as the diagnosis of FUS — how do you go about treating something that doesn't have a known cause? Since Urinary Tract Infections come with the same symptoms, antibiotics have frequently been offered to women suffering from FUS. These will not help in the absence of an infection however, and may well be counterproductive. You've heard the news: antibiotics may be completely useless in the near future if we continue using them for things they don't actually help for.
See Also: Urinary Tract Infections in Women: Why they occur and how to treat them?
Urethral massage, therapy (yes, that does suggest it's all in your head, something that can be insulting and frustrating when you have physical symptoms!), vaginal estrogen cream, and even surgery to dilate the urethra have all been used as well, with varying degrees of success.
Prevention
What preventative measures can you take when you have no idea what causes these symptoms? The best we can do is offer common-sense suggestions that work towards the general prevention of problems in the genital region and the urinary tract:
- Stay sufficiently hydrated: always have a glass of water on the go.
- Avoid using chemical or perfumed products in the genital area. This is particularly true for women who noticed symptoms after they started to use a new product. Products you may want to avoid include douches, soaps, tampons and sanitary pads (look into reusable menstrual cups instead), bath oils, contraceptive gels, lubricants and condoms.
- Avoid consuming too much caffeine, alcohol and spicy foods. Get tested for food allergies.