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Michels TC, Sands JE. Dysuria: Evaluation and Differential Diagnosis in Adults. Am Fam Physician. 2015 Nov 1;92(9):778-86.

This comprehensive article covers the diagnosis, evaluation, and treatment of dysuria, or painful urination, from the perspective of the practicing family physician. The causes of dysuria can be broken down into three categories: infectious (cystitis, urethritis, sexually transmitted diseases, vaginitis), inflammatory (dermatologic conditions, foreign body in the urinary tract), and non-inflammatory (medications, abnormal anatomy of the urethra, injury, interstitial cystitis/bladder pain syndrome). During evaluation and workup, it’s important for the family physician to document features of a local cause, such as irritation of the urethra or vagina; along with any features that might lead to a complicated urinary tract infection, such as pregnancy or a urologic obstruction. If there are no complicating features, women with dysuria don’t typically need further evaluation and can be treated for cystitis; however, women should be evaluated for vaginitis if they have any symptoms of the vulva or vagina. If the patient has complicating features or recurrent symptoms, the clinician should perform a secondary evaluation that includes history, physical examination, urinalysis, and urine culture. Findings of that evaluation, along with selected laboratory tests or imaging studies, can help family physicians logically evaluate the cause and refer the patient to an appropriate specialist.