Pain with Urination (Dysuria)

What it is

Pain or burning during urination (dysuria) is a symptom, not a diagnosis. It can occur with urinary tract infections (UTIs), urethritis, kidney stones, prostatitis in men, vaginitis/vulvovaginitis in women, sexually transmitted infections (STIs), mucosal irritation, and other conditions.

Common causes & risk factors

• Urinary tract infection (UTI): acute cystitis, urethritis

• STIs: chlamydia, gonorrhea, trichomoniasis, genital herpes, etc.

• Prostatitis (acute/chronic) in men; benign prostatic hyperplasia (obstruction)

• Vaginitis/vulvovaginitis in women (bacterial, candidiasis, atrophic)

• Urolithiasis (stone/“gravel”)

• Chemical/allergic irritation: harsh soaps, gels, sprays, spermicides; tight synthetic underwear

• Urethral trauma, catheter, recent procedures

• Low fluid intake, infrequent voiding, hypothermia

• Pregnancy, diabetes, immunodeficiency (raise UTI risk)

Symptoms (what may accompany the pain)

• Burning/stinging with urination, frequency, urgency, sense of incomplete emptying

• Suprapubic pain (lower abdomen); in men — perineal discomfort

• Cloudy urine, strong odor; blood in urine

• Fever, chills, flank/loin pain (possible kidney involvement)

When to seek urgent care

• Fever ≥38 °C, chills, flank/loin pain, nausea/vomiting

• Visible blood in urine, urinary retention, rapid deterioration

• Pain and dysuria in pregnancy, children, or men with severe symptoms

• Recurrences (≥2 episodes in 6 months or ≥3 in a year), significant comorbidities

Diagnosis

• Examination by a urologist (women may also need a gynecologist; if STI risk — a dermatologist-venereologist)

• Urinalysis (leukocytes, nitrites, erythrocytes); if needed — urine culture with antibiotic susceptibility

• STI tests (PCR/swabs) as indicated

• Ultrasound of kidneys and bladder (incl. residual urine); with recurrences/hematuria — extended work-up, sometimes cystoscopy

• In men with obstructive symptoms — prostate assessment

Treatment — depends on the cause

1) Supportive, non-drug measures

• Increase fluids (unless medically restricted), keep warm; temporarily avoid caffeine, alcohol, very spicy/acidic foods

• Gentle intimate hygiene; stop harsh cleansers/spermicides

• Pain relievers/NSAIDs only with medical advice (caution with ulcer/kidney disease)

2) Medications (prescribed after evaluation)

• Antibiotics for bacterial UTI/urethritis — guided by culture and local recommendations

• Urinary analgesics/uroseptics, antispasmodics, analgesics for symptom control (as advised)

• For STIs — treat both sexual partners and abstain until cured

• Postmenopausal atrophic vaginitis — topical estrogen (when appropriate)

• Stones: analgesia, hydration; medical expulsive therapy where indicated, urology follow-up

• Men with obstruction — alpha-blockers/other targeted therapy per a urologist

Important: Do not start antibiotics on your own — this blurs the clinical picture and promotes resistance.

3) Additional directions

• Pelvic-floor physiotherapy, behavioral therapy for chronic pelvic pain/interstitial cystitis

• Management of underlying conditions (diabetes, hormonal issues)

Prevention

• Adequate hydration; don’t “hold it” — void regularly

• Gentle intimate hygiene; breathable cotton underwear; avoid irritants

• Urinate soon after sexual activity; practice safer sex

• For women — front-to-back wiping to reduce ascending infection risk

• With recurrent cystitis, discuss prevention plans with your doctor (culture-guided strategies and non-drug options)

Which specialist to see

Urologist (primary). Gynecologist for women with vaginal symptoms, dermatologist-venereologist for suspected STIs, nephrologist if kidneys are involved, pediatrician for children.

Services & care pathway in Yerevan

Typical care includes a specialist consultation, urinalysis and culture, ultrasound, and STI testing if needed, followed by tailored therapy. Costs vary by clinic and test package. On Doctor911.am you can choose a doctor and clinic, compare diagnostic bundles, and see current offers.

FAQ

Is it always cystitis?
Not necessarily. Causes range from urethritis and STIs to stones, prostatitis, or chemical irritation. Proper diagnosis is essential.

Is blood in urine dangerous?
Yes — it’s a red flag that requires in-person evaluation and further testing.

Do “home remedies” and cranberry help?
They may ease symptoms for some, but they don’t replace diagnosis and targeted treatment. Bacterial infections often need prescription therapy.

Can I wait for it to pass?
Delays raise the risk of ascending infection (pyelonephritis) and chronicity. It’s better to seek care early.

What about pregnancy?
With any symptoms in pregnancy, see a doctor promptly — UTIs during pregnancy require special management and safe regimens.