The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 68-year-old woman (G1P1) presents to her primary care physician for recurrent symptoms of urinary urgency, frequency, and dysuria. She has not been sexually active in 7 years, owing to vaginal dryness and pain. She has sought medical attention at a local urgent care center multiple times during the past year for episodes of similar symptoms, which occur about every 2-3 months. Her urine was sent for testing at each visit, but she is unsure which test was performed.
She has been treated with antibiotics four times in the past year but does not recall which medications she took. She reports that her symptoms start over the course of 1-2 days and increase in intensity. They resolve around day 3 when she takes antibiotics as directed.
She has no history of urinary tract infections (UTIs) as a child. She reports constipation and has a bowel movement every 2-3 days. She does not have fevers, chills, night sweats, weight loss, hair loss, cough, diarrhea, joint pain, or back or flank pain.
She denies gross hematuria, pain with bladder filling, or urinary urgency or frequency symptoms outside of the acute episodes. She does not feel a vaginal bulge and has no urinary or fecal incontinence. She has not had any vaginal bleeding in 18 years. She has no hesitancy or straining with urination, and she feels that she empties her bladder completely. She has no postvoid dribbling.
Her past medical history is significant for hypertension, which is well controlled. She has never had surgery. She had one vaginal delivery at age 28 years. The infant weighed 8 lb (3.62 kg). She struggled with infertility and did not become pregnant again. She has had regular Pap smears throughout her life and reports that all were normal/negative.
Her medications include a daily multivitamin supplement and lisinopril 10 mg daily. She has no known drug allergies. She has never smoked. She does not drink alcohol or use illicit drugs, including tetrahydrocannabinol (THC). She is a retired social worker who lives with her husband. She has no family history of cancer, renal stones, or urinary tract abnormalities.
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Cite this: A Woman Avoiding Intercourse Has Recurrent Urinary Symptoms - Medscape - Feb 20, 2023.