WTF?
The seventy-year-old female patient had a history of frequent urinary-tract infections. She had a fever and slight back pain, so I ordered a catheterized urine specimen to be sent to the lab. I went on to other patients, but the nurse soon returned and said she had tried to cath the woman but couldn’t find her urethra-the opening to the bladder. She had asked several other nurses to help her cath the lady, but no one could find the urethral opening. I decided to help, and went to the patient’s bedside. I found an elderly, pleasant woman who told me about the history of frequent urinary problems and told me she was childless.
I examined the woman’s perineum and identified the larger orifice of what appeared to be the vaginal vault, and searched above this for the urethral opening. I couldn’t find an opening either, but as I looked, some urine trickled out of the vagina. Suspecting a fistula connecting the bladder to the vagina, or an embedded urethral meatus, I decided to look inside the vagina with a speculum. As I readied to do this, however, I noticed something underneath the vagina, on the perineum, and looked closer. I found the patient’s vagina and intact hymen under what I had assumed was the vagina. I realized that the upper opening she was using as a vagina was in fact the patient’s urethra. I asked the woman if she had any problems with sexual relations with her husband.
“Not really. It hurt the first year or so, but it was fine after that.”
She had been married for fifty-two years.CHARLES HAGEN, M.D. Auburn, Alabama
