This original study evaluated women’s ability to identify the urethral meatus and examined whether this practical anatomical knowledge is associated with demographic characteristics, education, and prior healthcare exposure. Intermittent self-catheterisation (CIC), a cornerstone of urological management, depends on accurate identification of the urethral meatus, making anatomical awareness essential for effective self-management. In addition, limited anatomical knowledge has been associated with reduced adherence and increased anxiety related to urological procedures. We hypothesised that significant knowledge gaps may exist even among women with prior clinical exposure.

A prospective cross-sectional questionnaire study was conducted in adult women attending urology clinics. Participants completed an anonymous structured questionnaire assessing demographic variables, education level, obstetric history, prior exposure to anatomical education (family, school, self-learning), healthcare-related education, previous urinary catheterisation, prior catheterisation training, pelvic surgery, cystoscopy, gynaecological examination, sexual activity, and self-rated familiarity with the genitourinary anatomy (Likert 1–5). Participants were then asked to identify the urethral meatus on an unlabeled anatomical diagram. The primary outcome was correct identification. Univariate analysis was performed, followed by a multivariate logistic regression model.

Of the 96 women included (mean age 49.1±13.3 years), only 49/96 (51.0%) correctly identified the urethral meatus. Despite high rates of prior gynaecological examination (91/95, 95.8%), accuracy remained limited (48/91, 52.7%). In univariate analysis, correct identification was associated with previous urinary catheterisation (36/60 [60.0%] vs 11/33 [33.3%], OR 3.00, p=0.025), healthcare-related education (19/27 [70.4%] vs 30/68 [44.1%], OR 3.01, p=0.037), a higher education level (p=0.014), and a smaller number of siblings (p=0.018). Self-reported familiarity showed a non-significant trend towards better performance (3.33±1.23 vs 2.87±1.33, p=0.086). In a multivariate logistic regression, only baseline general education level (p=0.011) and the number of siblings (p=0.031) emerged as robust, independent predictors of correct meatus identification. No significant associations were observed with age, marital status, religion, ethnicity, parity, prior pelvic surgery, cystoscopy, sexual activity, or prior anatomical education.

Only half of the women correctly identified the urethral meatus. Importantly, limited anatomical awareness persisted despite prior exposure to gynaecological and urological care. Even among women who had previously undergone urinary catheterisation, 40% failed to identify the urethral meatus correctly. The healthcare system frequently examines the female pelvis, yet fails to educate the patient during these encounters. The multivariate analysis indicates that a woman’s ability to navigate her own anatomy is driven almost entirely by broader socioeconomic markers, specifically general education level and family size, rather than her clinical history or her own perceived familiarity.

Women’s practical understanding of their lower urinary tract anatomy is limited. Neither prior clinical exposure nor self-confidence guarantees actual knowledge. Clinicians teaching self-care interventions like CIC must completely discard baseline assumptions. To prevent procedural anxiety and treatment failure, anatomical education must be highly visual, hands-on, and objectively verified, particularly for patients with lower educational backgrounds.

Continence 19S (2026) 102728
DOI: 10.1016/j.cont.2026.102728