Urethral prolapse is an uncommon condition most often seen in prepubertal girls of African descent and in postmenopausal women of Northern European descent. Incidence is thought to be about 1 in 3000. Predisposing factors include persistent cough, constipation / straining with bowel movements, and trauma.

Before puberty, the estrogen-dependent tissues supporting the distal urethra are weak and atrophic. Prolapse may occur with any activity that results in an increase in abdominal pressure such as coughing or straining to defecate. Spontaneous prolapse is also possible.

After menopause, loss of estrogen may be a contributing risk factor.

Urethral prolapse often presents as bleeding with a polypoid or donut-shaped, edematous, violaceous, and nontender mass present at the urethral opening. The exposed mucosa is very friable, often leading to misdiagnosis as trauma. The friable and often excoriated tissue may be complicated by ulceration and infection. Pain is typically absent, but girls may have symptoms of dysuria and urinary frequency due to associated edema. This prolapse also can be an incidental finding during a routine examination.

Patients should be questioned about sexual abuse as part of a thorough assessment of genital abnormality, although there is not a known association between child sexual abuse and urethral prolapse.