The urethral syndrome: a controlled evaluation

It has long been considered that psychological factors play an important rôle in women with urinary tract symptoms. Where no significant infection can be demonstrated, psychological factors have been claimed as paramount to the extent that the 'irritable urethral syndrome' has been postulated as a parallel to the irritable bowel. This paper reports on a controlled study of psychological and menstrual problems in women presenting in family practice with urinary symptoms. Women were assessed by structured interview. Two groups of women took part: (A) 54 women with urinary symptoms, 15 of whom later proved to have significant bacterial infection on culture. (B) 21 women attending for contraceptive advice also agreed to participate in a comparison group. Women presenting with urinary tract symptoms had higher mean scores on psychological and menstrual measures than comparison women, regardless of the presence of demonstrable infection. Thus, psychological and menstrual symptoms appear to determine whether a woman who experiences urinary tract symptoms attends her doctor, regardless of whether significant infection is present. No evidence was found, for the existence of an irritable urethral syndrome, in which psychological factors are postulated as the predominant cause.