Aunt Vadge: urethral problems, bladder problems, no diagnosis for lump

Dear Aunt Vadge, 

I have been having UTIs for few years on and off. But 10 months back, I noticed a lump growing just below the urethral opening, and now it is covering the urethral opening. The opening is still there, but this protruding lump covers it. It is below the urethral opening and above the vaginal opening, making the vaginal opening even smaller.

The main problem is that when I urinate, I have this very, very sharp pain like something is tearing inside. I went to the urologist, had blood test, culture, cystoscopy, MRI and also urethral dilation. At first I also had a problem where I couldn’t empty my bladder completely and I have to push urine out.

So the urologist diagnosed it as DSD and gave me pelvic muscle relaxers. And when I asked him about this lump, he said it’s nothing to worry about. At present, I can empty my bladder to an extent, that’s not a problem now. But this lump has got bigger and it is causing problem.

  • Before 10 months – it has got worse
  • The urologist diagnosed it as DSD and gave me pelvic muscle relaxers, the lump still exists
  • Pain is very SHARP and lingers for a while even after urination also have pelvic area pain, just below urethral opening, I think stress triggers it more and the lump gets hard and very painful.
  • No discharge
  • No bleeding
  • Pink same as the area around, size of a small pea, covering urethral opening, below urethral opening, hard, even harder when I urinate
  • Sometimes when the urination is not painful, the lump is not as hard as usual

It makes urination painful so I avoid going to the bathroom sometimes, and I fear it would affect my kidney, till now I am searching for answers online. But I had no luck – I found some people’s questions about this on some forums, but no answer. I would really like to get an idea of what this is.

India, Age 22


Dear Lumpy,

Thank you so much for writing to us about your problem and for sending over the diagram (great diagram!). It does sound like you have a lot going on.

DSD is a neurological condition that comes as part of a neurogenic bladder, so I must assume that you have some interruption of the signals that control your bladder and urethral sphincter either by accident or disease.

For those of you not familiar, DSD is caused by lesions on the spinal cord and/or brain, and results in blippy signals controlling the bladder’s contractions and relaxations in relation to the urethral sphincter’s contractions and relaxations – normally the bladder contracts and the urethral sphincter relaxes to let the urine out, but in DSD, this coordination is interrupted.

Because you have had so many examinations, I would expect that they have checked your urethral for prolapse, which is where the two parts of the urethra (like two socks, one inside the other) slide around because the ‘glue’ that ties them together becomes weak for some reason.

Or, perhaps urethral diverticulum – this is not a well-known condition whereby the Skene’s glands (which are just below the urethra on both sides) become blocked or otherwise enlarged and push the urethra into the vaginal wall. The glands can easily become obstructed, and for no particular reason you can identify. This obstruction can cause an Skene’s gland or duct abscess or cyst, and when that abscess or cyst bursts/develops, it creates a sort of hole (diverticula). This hole then collects urine, and can cause erosion, infection, and other major problems.

This condition is quite misunderstood, and medical specialists still aren’t sure exactly what causes it.

It would pay to get as much information as you can about this condition, and take it to your doctor to make sure they are aware of it (urethral diverticulum) and can test you accordingly, since you actually don’t mention why you were diagnosed with DSD. Check the symptoms lists for those conditions, and see what else matches. A protruding cyst or abscess on your Skene’s gland could look like that and after urination, it would be full of urine and inflamed, and could get hard as you mention.

They could cause the symptoms you have explained, with the external ‘growth’ outside your urethra and the pain you experience upon urinating.

It needs to be looked into further, because unless you have had damage to the area, at 22 you should not be experiencing these type of symptoms without a cause that can be identified.

Keep trying, and let us know how you go! It seems a very interesting case.

Write back anytime.

Warmest regards,
Aunt Vadge

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