Is a Cystoscopy Painful for a Man?

Most men who undergo flexible cystoscopy describe the experience as uncomfortable rather than truly painful. On a 0-to-10 pain scale, the most uncomfortable moment during a standard flexible cystoscopy produces a median score of about 2.8 out of 10, roughly equivalent to a strong pinch or a brief stinging sensation.¹ That said, the experience varies quite a bit from one man to another, and several factors can push discomfort higher or keep it well below that average.

Where the Pain Actually Happens

Cystoscopy involves passing a thin, camera-tipped instrument through the urethra and into the bladder. For men, the urethra is considerably longer than it is in women, and it curves through the prostate and pelvic floor. Researchers who tracked pain at each stage of the procedure found that the sharpest moment is when the scope passes through the membranous urethra, the short stretch just beyond the prostate and surrounded by the pelvic-floor muscles. That passage produced the highest discomfort rating, while the scope traveling through the rest of the urethra and the inspection of the bladder itself barely registered.¹ Even the initial step of squirting numbing gel into the urethra rated less than 1 out of 10 for most patients.

Understanding that the discomfort is concentrated in one brief moment helps set expectations. The scope is not scraping its way through you for the entire procedure. Most of the time spent inside the bladder feels like mild pressure or a need to urinate, not pain. The whole thing typically takes five to ten minutes.

Flexible Versus Rigid Scopes

If you’ve been told you need a cystoscopy, one of the first things worth knowing is which type of scope your doctor plans to use. Flexible cystoscopes are thinner, bend with your anatomy, and are the standard for most diagnostic procedures done in an office setting. Rigid scopes are straight, slightly thicker, and used more often in operating rooms or when the doctor needs to do more than just look around.

The difference in comfort is significant. A large prospective study across multiple hospitals found that about 59% of men who had a flexible cystoscopy reported no pain at all, compared with only 24% of men who had a rigid one. Mild and moderate pain were both roughly twice as common with rigid instruments.² Severe pain was rare with either type. One smaller randomized trial found no statistical difference in pain scores between rigid and flexible scopes, but that study was looking at follow-up patients with bladder cancer who had experience with both types, which can influence how someone rates discomfort.³

Historically, all cystoscopies were rigid and required general anesthesia just to be tolerable. When flexible scopes were introduced, researchers compared patients who had previously undergone rigid cystoscopy under general anesthesia with those same patients later having flexible cystoscopy under local numbing. Only about 11% preferred the old rigid-under-general-anesthesia approach.⁴ If you’re having a routine diagnostic cystoscopy, chances are good your urologist will use a flexible scope.

Single-Use Versus Reusable Scopes

A newer development worth mentioning is the rise of single-use digital cystoscopes, which are used once and then discarded. These disposable scopes are becoming more common in clinics. One comparative study found no difference in pain between single-use and reusable instruments during stent-removal procedures.⁵ However, a separate prospective study reported that patients in the single-use group actually experienced milder pain and higher satisfaction.⁶ The practical takeaway is that single-use scopes are at least comparable and may be slightly gentler, possibly because they arrive brand new and perfectly calibrated rather than having been reprocessed dozens of times.

How Well Does Numbing Gel Actually Work?

Before a cystoscopy, lidocaine gel is typically squeezed into the urethra to numb the lining. You might assume this makes a dramatic difference in pain, but the evidence is more modest than you’d expect. A meta-analysis pooling data from twelve randomized trials with over 1,500 patients found that lidocaine gel produced only a small reduction in pain scores compared to plain lubricant without any numbing agent.⁷ The effect was statistically real but clinically subtle. That does not mean the gel is useless. It likely takes the edge off the worst moment and, just as importantly, provides the lubrication the scope needs to slide through without friction. But the gel alone is not what makes the difference between a painful and a comfortable procedure.

One question patients sometimes have is whether the gel needs to “sit” for several minutes before the scope goes in. A randomized trial tested immediate insertion versus a three-minute wait after applying lidocaine gel and found virtually no difference in pain scores.⁸ For rigid cystoscopy the story is different. A study on rigid scopes found that letting the gel dwell for about fifteen minutes provided clearly better pain relief than shorter waits.⁹ So if you’re having a rigid cystoscopy, it’s reasonable to ask whether your doctor plans to give the gel adequate dwell time.

Oral Painkillers Before the Procedure

Many men wonder whether popping a painkiller before the appointment will help. The answer depends on what you take. A study testing a specific anti-inflammatory drug combined with lidocaine gel found that pain scores were significantly lower than with gel alone, particularly in patients who were more pain-sensitive to begin with.¹⁰ However, plain paracetamol (acetaminophen) was tested in a separate trial and showed no benefit whatsoever over placebo when combined with lidocaine gel.¹¹ If you want to take something beforehand, an anti-inflammatory like ibuprofen is more likely to help than acetaminophen, but check with your urologist first since there may be bleeding considerations.

Nitrous Oxide for Higher-Anxiety Patients

For men who are particularly anxious or who’ve had a previous painful experience, inhaled nitrous oxide (the “laughing gas” used at dentist offices) is an option some clinics offer. A randomized trial in men under 55 found that nitrous oxide produced significantly lower pain scores and pulse rates during flexible cystoscopy. Patients in the air-only group were much more likely to say they’d want extra pain relief or even general anesthesia for a repeat procedure.¹² A separate trial testing nitrous oxide during rigid cystoscopy also showed a meaningful drop in pain scores compared with oxygen alone.¹³ Side effects were mild and short-lived. Nitrous oxide is not universally available in urology offices, but it’s worth asking about if you know anxiety is going to be a factor.

Why Anxiety Makes It Hurt More

This is one of the most consistent findings across cystoscopy research: the more anxious you are going in, the more pain you tend to report afterward. A prospective study found strong positive correlations between pre-procedure anxiety and both pain and embarrassment during and after the exam.¹⁴ Another study quantified how powerfully pre-procedure anxiety predicted post-procedure pain, finding that baseline anxiety scores explained nearly 39% of the variance in pain ratings.¹⁵

This is not a polite way of saying “it’s all in your head.” Anxiety causes real physiological changes. Tense muscles in the pelvic floor squeeze around the urethra, making it harder for the scope to pass smoothly. Stress hormones lower pain thresholds. The worry itself amplifies the sensory experience. Some researchers have tested simple behavioral techniques to address this. One study asked men to mimic a voiding (urinating) posture and consciously relax their pelvic floor during insertion. The group that received this “voiding instruction” reported significantly lower pain scores, averaging about 3 out of 10 versus about 5 out of 10 in the group that received no instruction.¹⁶ That is a meaningful difference, achieved with no drugs at all.

Does Watching the Screen Help?

Because the cystoscope has a camera, many doctors can show you what’s happening on a monitor during the procedure. The idea is that watching gives you a sense of control and distracts from the sensation itself. The evidence here is genuinely mixed for men. One early study found that men who watched the screen had significantly lower pain scores than those who didn’t.¹⁷ A Chinese trial confirmed this, with watchers scoring roughly 1 out of 10 versus about 3.3 out of 10 for non-watchers.¹⁸ But a later study found no significant pain difference in men, though it did find a benefit in women.¹⁹

A separate study looked at whether watching the monitor mattered and found no clear difference regardless of the patient’s prior experience with cystoscopy.²⁰ The honest read of this evidence is that watching the screen helps some men and does nothing for others. If you find medical procedures fascinating, ask if you can watch. If the idea makes you squeamish, don’t feel pressured to look.

Listening to Music During the Procedure

Music has been tested more consistently and with clearer results. Multiple randomized trials show that listening to music during cystoscopy reduces both anxiety and pain. One trial found significantly lower anxiety and pain scores in the music group along with greater satisfaction.²¹ A larger randomized study tested two types of music (self-selected versus a standardized calming playlist) and found that both music groups reported much lower pain than the no-music control, with median pain scores of 1.7 and 2.3 versus 5.2 out of 10.²² A 2025 study specifically in men undergoing flexible cystoscopy confirmed lower pain and higher satisfaction in the music group.²³

Bringing headphones and a favorite playlist to your appointment is one of the simplest and most effective things you can do. It costs nothing, has no side effects, and the evidence is consistent across studies.

Does the Doctor’s Experience Level Matter?

A common concern is whether having a trainee perform the procedure will hurt more. The research is reassuring on this point. A study comparing cystoscopies performed by attending urologists versus residents at various training levels found no statistically significant difference in patient pain scores.²⁴ Another study found that while doctors tended to underestimate patient pain in general, the level of physician experience had no significant effect on how much pain the patient actually felt. Interestingly, less experienced doctors (residents) were actually better at accurately gauging their patients’ pain than more seasoned specialists.²⁵ So if a resident is doing your procedure under supervision, there’s no reason to expect it will hurt more.

What to Expect Afterward

The procedure itself is the part most people worry about, but the hours and days after deserve attention too. A study tracking patients after day-case flexible cystoscopy found that the most common complaints on the first day were tiredness, blood-tinged urine, stinging during urination, pain over the bladder area, and some difficulty voiding. These problems were also present on the second day, but by the third day, average symptom scores had dropped considerably.²⁶ Drinking extra water in the first 24 hours helps flush the bladder and dilutes urine, which reduces stinging.

Urinary tract infection is the main complication to watch for. A randomized trial found that about 15% of men developed a culture-positive UTI after cystoscopy overall, though that rate was cut to about 7% when antiseptic was applied beforehand.²⁷ If you develop a fever, worsening burning, cloudy or foul-smelling urine, or pain that gets worse rather than better after a couple of days, contact your doctor. These can signal an infection that needs antibiotics.

Repeat Cystoscopies and What Changes Over Time

Many men need cystoscopy more than once, especially those being monitored for bladder cancer. The prospect of repeat procedures adds a layer of dread that can itself worsen the experience. Some research describes patients who find the pain “unbearable” and begin avoiding follow-up appointments altogether.²⁸ If you’re in a surveillance program, being proactive about comfort measures matters. Ask about music, pelvic-floor relaxation techniques, and whether nitrous oxide is available at your clinic. A painful first experience does not mean every future cystoscopy has to feel the same way. Identifying what made the first one uncomfortable and addressing it specifically, whether that was anxiety, a rigid scope, or inadequate numbing, can make repeat procedures genuinely easier.

Some urologists will also switch from a rigid to a flexible scope for surveillance patients who found the rigid version uncomfortable. Given the large difference in pain-free rates between the two scope types, this simple change alone can transform the experience.