Urethral Discharge as a Symptom of Psychiatric Disorder

Abstract

Attention is drawn to the symptom of urethral discharge accompanied by psychiatric disorder. Thirty patients have been studied with this discharge as the chief complaint and 8 patients presenting various nervous complaints in addition. These patients usually showed few or no pus cells in urethral or prostatic smears. Patients have been reported only in whom a definite psychiatric diagnosis was possible, as follows in order of frequency: reactive depression, anxiety state, hysteria, prepsychotic personality, and psychopathic personality. Previous personality characteristics were frequently as follows: excessive conscientiousness, excessive shyness, tendency to drift on the line of least resistance, hypochondriasis, and excessive dependency. Usually the sexual activity was that of continence with an occasional lapse always followed by guilt feelings. The discharge often developed after a period of continence with temptation, excepting in a proportion of cases in which it represented the persistence of an originally infective discharge. Its onset or persistence could usually be correlated with the psychiatric history. Twenty-eight patients were given psychiatric treatment, mostly psychotherapy at a fairly superficial level. Short term follow-up indicated improvement in the local condition as well as the psychiatric disorder, although failures occurred and risks were involved. Probable mechanisms have been discussed in relation to the relevant literature.