Cystitis or not cystitis? Conditions often confused with cystitis

Burning during urination, urinary urgency and persistent pelvic pain are not always synonymous with cystitis.
Many women live for years with symptoms attributed to non-existent urinary tract infections, when the real cause is something else, as extensively documented in the articles on Cistite.info. There is a large group of gynaecological, neurological and musculo-fascial disorders that perfectly mimic the symptoms of cystitis but are not caused by infection.

This article explains which conditions are most often confused with cystitis, why this happens, and what the serious clinical, psychological, and economic consequences of a misdiagnosis or delayed diagnosis are.

• The misdiagnosis
• Conditions confused with cystitis
• Consequences of misdiagnosis
• The story of Rosanna
• The multidisciplinary approach

Why are many cases of ‘cystitis’ not actually cystitis?

Misdiagnosis of cystitis is still a widespread problem. The diagnosis of cystitis, especially in the presence of negative or only slightly positive urine cultures, is often made:

• without considering the neuropathic or inflammatory origin of the pain
• in the presence of negative or inconclusive urine cultures
• without a multidisciplinary assessment
• without a thorough medical history
• without assessment of the pelvic floor muscles
• without assessment of the nervous system (in particular the pudendal nerve)
• by taking a reductive approach to urinary symptoms

This approach leads to treating the symptom rather than the cause, with significant consequences for the course of the disease.

Further information: Aseptic cystitis 

Further reading: Antibiotics and cystitis: when they are not needed

The conditions most often misdiagnosed as cystitis

Vulvodynia

Vulvodynia is a chronic vulvar pain syndrome characterised by burning, stinging, tingling or cutting sensations, often invisible to clinical and instrumental examinations.
Symptoms similar to cystitis:

• urethral burning
• pain during and after urination
• pain during intercourse (dyspareunia)
• post-intercourse worsening

Common mistake: treating neuro-inflammatory pain with antibiotics and antifungals (local or oral), promoting chronicity and neurogenic inflammation.

Further information: Vulvodynia

Pelvic floor hypertonicity

Pelvic floor hypertonicity is a muscular condition characterised by persistent, involuntary contraction of the pelvic muscles.
Common symptoms with cystitis:

• urinary urgency
• difficulty emptying the bladder
• suprapubic or urethral pain

Without a functional diagnosis, antibiotic therapy is useless and often harmful, as it increases muscle tension and worsens chronic pain.

Further information: Pelvic floor hypertonicity

Pudendal nerve neuropathy

Pudendal nerve neuropathy is an often overlooked cause of pelvic, vulvar, perineal, and urethral pain.
Symptoms common to cystitis:

• deep burning pain
• worsening from sitting
• perineal and urethral irradiation
• feeling of incomplete bladder emptying
• urgency and frequency

Antibiotic treatment is not only ineffective, but also delays access to pain therapy.

Further information: Pudendal nerve neuropathy

Endometriosis

Endometriosis, particularly in its infiltrating forms, can mimic chronic cystitis.
Symptoms common to cystitis:

• cyclical pain
• pelvic pain
• recurrent urinary symptoms
• poor response to antibiotics
• premenstrual worsening of pain

A late diagnosis leads to years of avoidable suffering.

In-depth analysis: Endometriosis

Vulvovaginal atrophy (genitourinary syndrome)

Vulvovaginal atrophy (VVA) is a condition mainly linked to oestrogen deficiency, typical of the menopause but also possible during childbearing years (postpartum, breastfeeding, hormone therapies, contraceptives, cancer treatments).
Symptoms frequently confused with cystitis:

• persistent urinary burning
• pain or discomfort during urination
• urinary urgency
• sensation of urethral and bladder irritation
• pain during intercourse (dyspareunia)

In these cases, urine culture is often negative or inconclusive, but the symptoms are still attributed to recurrent cystitis, resulting in repeated prescriptions of antibiotics.

The improper use of antibiotics does not improve symptoms, further alters the mucosa and intestinal and vaginal microbiota, increases dryness, fragility and genital inflammation, promotes chronic pain and worsens symptoms.

Further information: Vulvovaginal atrophy

Vulvar lichen sclerosus

Lichen sclerosus vulvae is a chronic inflammatory condition that often goes unrecognised. Its initial symptoms are:

• burning sensation
• vulvar pain
• urinary discomfort

Failure to diagnose leads to inappropriate treatment (local antibiotics and antifungals) and worsening of the lesions.

Further information: Lichen sclerosus

Consequences of a misdiagnosis of cystitis

What happens when these conditions are treated as cystitis?

An incorrect diagnosis of cystitis and the resulting delay in diagnosis lead to:

• progressive clinical deterioration
• chronic pelvic pain
• prolongation of the diagnostic-therapeutic pathway
• increase in healthcare and personal costs
• distrust in medicine
• significant psychological impact (many patients develop anxiety, depression, and a sense of isolation, feeling disbelieved)
• impairment of social, sexual, and relational life

The story of Rosanna Piancone

The story of Rosanna Piancone, as told on Cistite.info, represents an emblematic example of a prolonged misdiagnosis and is representative of the experience of many women: years of symptoms labeled as cystitis, ineffective treatments, and missed diagnoses.
Only when the real cause was identified was it possible to embark on an appropriate therapeutic path.

Her experience shows how a correct diagnosis can radically change the course of the disease and quality of life, transforming suffering into knowledge and awareness-raising.
From this experience, Cistite.info was born, along with a commitment to accurate information and awareness.

Read Rosanna’s full testimony

Why is a multidisciplinary approach needed

The correct management of chronic urinary symptoms requires an integrated approach, involving:

• gynecologists specialized in pelvic pain
• urologists with a non-exclusive infectious perspective
• pelvic floor physiotherapists
• neurologists and pain therapists
• dedicated psychological support
• sexologists

If the symptoms do not go away it will be useful:

• get accurate information
• avoid insisting on useless antibiotics
• seek trained professionals
• listen to your own body

Continuing to treat as cystitis what is not prolongs suffering, delays the correct diagnosis, and compromises patients’ quality of life
Accurate, updated, and multidisciplinary information is now a fundamental therapeutic tool.

Cystitis is not always an infection. Recognizing the conditions that mimic cystitis is the first step to restoring dignity, listening, and appropriate care to thousands of women.

By clicking here you can find a list of doctors recommended by Cistite.info who can help you on your healing journey.

Bibliography

1. Vulvodynia (StatPearls, aggiornato 2025)
2. Vulvodynia: Assessment and Treatment (review su Sexual Medicine Reviews) https://www.sciencedirect.com/science/article/abs/pii/S1743609516003064
3. Evaluation and Medical Management of Chronic Pelvic Pain (PMC, 2023) https://pmc.ncbi.nlm.nih.gov/articles/PMC10415055/
4. Pudendal Neuralgia, Management of Chronic Pelvic Pain (Cambridge University Press) https://www.cambridge.org/core/books/abs/management-of-chronic-pelvic-pain/pudendal-neuralgia/F5DD0D0F9265AF5EC37AF92EE512E092
5. Possible factors for pelvic floor tenderness in endometriosis patients (PMC) https://pmc.ncbi.nlm.nih.gov/articles/PMC10579168/
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7. La sindrome genito-urinaria della menopausa (National Geographic): condizione diffusa con sintomi urinari e genitali legati all’ipoestrogenismo. https://www.nationalgeographic.it/una-sindrome-poco-conosciuta-prolunga-i-sintomi-della-menopausa-anche-dopo-la-sua-fine
8. Sindrome Genito-Urinaria in Menopausa (GSM) — glossario clinico su Medical Net: rapporto tra atrofia vulvo-vaginale e sintomi urinari. https://www.medical-net.it/eventi/23/la-sindrome-genito-urinaria-in-menopausa-gsm-
9. GYNECO AOGOI – Atrofia vulvovaginale della menopausa: discussione scientifica su prevalenza, segni e sintomi in donne peri- e post-menopausa.
10. https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427?utm_source=chatgpt.com
11. Persistent Vulvar Pain (ACOG — American College of Obstetricians and Gynecologists): guida clinica per riconoscere il dolore vulvare cronico. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain
12. Vulvovaginal atrophy and genitourinary symptoms in postmenopausal women: an international survey. Menopause. 2010.
13. Endocrine Society Clinical Practice Guideline: Treatment of Symptoms of the Menopause. Journal of Clinical Endocrinology & Metabolism. 2015.