Contrary to Google’s reassurance that VCUGs are “painless” for pediatric patients, research consistently shows that the voiding cystourethrogram (VCUG) procedure is not only widely over-performed, but is experienced as extremely painful.
Many former patients describe VCUGs as “excruciating.” Some go as far as to describe it as “the most painful thing” they’ve experienced in their lifetime.
What’s fueling the disconnect between online information and the actual VCUG patient experience?
For starters, there is virtually no research on the long-term health effects of VCUGs. This means that since the 1960s, VCUG patients have been largely ignored.
Until the Unsilenced Movement launched in 2023, the only source of truth was online misinformation presenting the VCUG test as safe, harmless, and low risk.
“I had to take my daughter when she was 3 months,” recalls one parent. “I was told it was ‘routine.’ It was horrific.”
“I had a VCUG when I was 7—21 years ago,” shares a former patient. “It was the most traumatic thing that happened. I remember screaming and crying, begging them to stop, while nurses held me down.”
In this blog, we break down 7 fundamental reasons why VCUGs are painful for children.
7 Reasons Why VCUGs Are Painful for Children
For decades, the only information provided to parents and families prior to VCUG has been misleading or blatantly incorrect.
For those who haven’t been on the VCUG table, a quick Google search will reveal words and phrases like “the test is usually painless,” your child won’t feel anything,” and “this is a painless procedure that will not harm your child.”
Sadly, none of these descriptions come from people who were actually on the table, but from hospitals and medical facilities assuming what VCUGs are truly like for kids.
“So I’m not the only person who has vividly remembered this since childhood?” one survivor asks, joining thousands of voices in the comments. “My mom cried the entire time and just kept apologizing to me because of how much it hurt.”
So, what critical information about the VCUG patient experience is missing online? Here are 7 key reasons why VCUGs are so painful:
1. Lack of Lidocaine & Numbing Gel
Despite longstanding consensus among clinicians that a topical numbing agent or lidocaine gel should be used for all catheterizations, regardless of age or gender, the vast majority of pediatric patients don't receive any topical numbing agent prior to VCUG catheterization.
This is alarming since most VCUG patients are preschool-aged children—primarily little girls, whose urethras have a “flattened, convoluted tube shape with epithelial folds that lie flat, making it prone to trauma during catheterization.”
“Historically, urethral lubrication with an anesthetic gel has been routinely used for men undergoing catheterization, but it was not until a [1993] publication that an anesthetic gel for women undergoing catheterization received serious consideration,” explains a 2009 Nursing Times article. “There is now consensus among most clinicians that a urethral gel should be routinely used for all male and female catheterization to reduce pain and discomfort and minimize trauma.”
With thousands of VCUG survivors speaking out across all of our Unsilenced platforms, it’s clearer than ever that VCUGs are rarely conducted with effective pain management:
“I was told that it didn't hurt and I was blowing it out of proportion when I told them it was burning." -Chris
“I think I had 2 done when I was a kid and it is probably one of my first memories of raw pain and fear.” -Ava
“I was 5 and had it done several times. They would give me nothing for pain and it took several nurses and two doctors to hold me down.” -Anonymous
“My pelvis was crushed in a car accident and my VCUG was by far the [worst] thing I had to endure in the hospital. I was crying and begging for it to be over.” -Anonymous
2. Use of Improperly Sized Equipment
Many VCUG patients report that improperly sized equipment was used during their VCUGs. Rather than pausing at the child’s complaints of pain, many providers continue to simply “force” adult-sized catheters, often without lidocaine or topical numbing agents.
This is a fact backed by critically appraised research, including this 2012 study presenting the bladder rupture of a 9-month-old patient “due to instilled action of dye by high pressure.” Researchers emphasize the necessity of using properly sized equipment:
“To perform a safe VCUG, we should pay attention to some factors such as bladder volume, the patient’s underlying disease, the velocity of the contrast instilled, and catheter size…The bladder volume is different among individuals, and the bladder dome which is the weakest part of bladder can easily be ruptured when excess volume is injected rapidly.
“In this case, the main causes of bladder rupture are considered to be the use of the Foley catheter instead of a feeding tube, manual injection of contrast media, and the excess volume instilled more than expected volume.”
“The first time I [had a VCUG] they used the wrong-sized catheter and ripped my urethra. I was bleeding all over and my mom flipped out […] After that they never let her in the room.” -Anonymous
“Had a VCUG when I was 4. Everything about that day is still so vivid in my mind. I remember the catheter they were trying to use was too big. Instead of getting a smaller one, I was held down, screaming and thrashing in pain while they continued to force it. Was told I needed to stop screaming and that if I stopped moving, it would be over sooner. I am still terrified of hospitals.” -Anonymous
“I had this done in the 70s, two males and two females, one [for] each arm and leg. The catheter wasn’t flexible…It looked like a large needle to a kid. I STILL go into involuntary shaking and hysterics if they mention a catheter. They were yelling at me, as I BEGGED them to stop [as I was] told to calm down and watch the ‘TV.’ I have not recovered from this.” -Anonymous
3. Most VCUG Patients Have an Active UTI
Recurring urinary tract infections are the sole clinical indication for VCUG referrals. Consequently, the vast majority of VCUG patients undergo this procedure fully awake with an active UTI or while recovering from one.
4. Frequent Use of Involuntary Restraints
In the vast majority of cases, VCUG patients must be involuntarily restrained to proceed with catheterization. This is because most VCUG patients are in pain—a fact that is still largely ignored and dismissed by the adults in the room, even by the patient’s own family.
Frequently restraining children against their will rather than acknowledging complaints of pain or requests to pause often leads to violent and physical altercations between patients and physicians, increasing the potential for pain.
Not only that, but having your arms and legs pinned down against your will—often while naked without a parent present—can significantly increase the potential for trauma during VCUGs.
“I had a VCUG a few years ago and I was in tears begging the doctor to stop and they just kept saying, ‘It’s not that big a deal.’ I thought I was overreacting.” -Anonymous
“This led me to realize VCUG is what happened to me as a child. Vivid memories of nurses putting all their weight onto my legs as I scream and writhe in pain.” -Shiloh
“I had this when I was about 10. It was traumatic. I remember being bodily restrained on the table and my legs forcibly spread apart as they inserted the [catheter].” -Anonymous
5. Lack of Sedation
Despite decades-old research establishing sedation during VCUG as safe, effective, and necessary, the vast majority of families aren’t offered any sedation options for the procedure. Many cite “compromised test results” as the reason for not offering sedation, but this has been debunked for many years.
Dr. Karen Blumberg, a pediatric radiologist with over 25 years of experience, wrote in her 2011 publication, “I was taught during residency and fellowship that the patient needs to be conscious for voiding and that the procedure is not painful. I believed it.”
She goes on to establish two reliable sedation options for VCUGs: “Conscious sedation utilizing either midazolam or inhaled nitrous oxide has been shown to be safe and to reduce distress in children undergoing VCUG without compromising the procedure results. The patients achieve sedation but are awake and able to respond to questions and to void.”
“Lived through this more than 5x. No sedation. Destroyed so much for me.” -Stephanie
“I had this done when I was 10. Never knew what it was called until today. No consent from me, no medication, no one told me what was happening. Laid me on a cold table and shoved a cold catheter [in]…” -Tristen
“It makes no sense to me that they don’t sedate for VCUGs. Dentists offer sedation for minor procedures, but hospitals aren’t using it for this?!” -Anonymous
“My daughter was 4 when she had this. I remember they asked [if] we want her sedated or not. I said is that even a question. I can’t believe anyone would put their child through it [without being] sedated.” -Anonymous
6. Frequent Bladder Overfilling
Decades of research highlight yet another alarming cause of pain during VCUG: the prevalence of bladder overfilling.
In one 2018 study, researchers found a high rate of overfilling during VCUG: “Bladders were filled above the estimated age-adjusted capacity in mL at the following rates: 32% in the whole group and 64% in infants undergoing VCUG.”
These are staggering numbers, given this test has been performed since the 1960s and children are susceptible to bladder rupture and other life-threatening risks during VCUGs.
7. Potential for Inexperienced Care
The VCUG exam room is always a crowded one. With at least 3-4 adults in the room, the potential for pain during involuntary catheterization (often without any sedation or topical agents for pain relief) is already high.
However, what many fail to realize is how receiving rushed, inexperienced, or poor care affects pain during VCUGs.
While some patients undergo VCUGs at designated children’s hospitals, which are specifically equipped to serve this young and vulnerable patient demographic with child life specialists and developmentally appropriate preparation, many families undergo testing at outpatient radiology centers and clinics that primarily serve adults.
Often, these facilities lack the necessary time and resources necessary to deliver compassionate care and help pediatric patients cope with such a painful and traumatic procedure.
Additionally, the already-full exam room is often made fuller by allowing medical students in the exam room to “practice” VCUGs. While learning, training, and performing various procedures is clearly essential to train future providers, it does beg the question: Is it best to let male-dominated student groups practice on toddler-aged children for a test involving direct, painful, and embarrassing genital penetration?
“I had this done when I was 12. My mom wasn’t allowed in the room because I was ‘old enough to do it alone’ and then the nurses made a joke about making sure to put the catheter in the right hole.” -Christi
“I was 5 when they did mine. No explanation, just told going to the doctor with Mom. I cried so hard, the nurses also started crying, then left the room while I was still on the table." -Anonymous
“I had this done every year until I was 8. The last time the doctor left halfway through…I laid there in pain with the catheter halfway in for an hour and a half…never again.” -Anonymous
“I’m an ER tech and even assisting the nurses with straight [catheterizations] is nauseating. I have to look away every time. I can’t imagine what VCUG is like for the patients.” -Anonymous
Join the Unsilenced Movement
Today, the conversation surrounding the management of vesicoureteral reflux (VUR) and VCUGs is more important than ever. With zero standardized protocol since the 1960s, generations of children have suffered greatly due to significant medical and sexual trauma—and thousands more will suffer unless we do something about it now.
The VCUG procedure is over-performed and falsely promoted as a low-risk test. It’s also pushed as the only diagnostic option for kidney reflux, despite the availability of several safe and effective alternatives with an equal or greater diagnostic value. Today, up to 1 million children undergo VCUGs every year. Only 25-30% of these patients will actually have the condition this test is intended to diagnose.
Those who promote VCUG as the lifesaving “gold standard” reasonably promote its high diagnostic value, but as former VCUG patients, we ask: “At what cost?” What use is saving lives with a diagnostic test, only to lose them to suicide later on?
That’s why we launched the Unsilenced Movement. Our founders set out with one mission in mind: to amplify the voices of former VCUG patients all over the world. We never tell anyone what they "should" or shouldn't do with their healthcare—our focus is empowering families to make informed decisions by providing as many resources as possible.
At Unsilenced, we believe that bodily autonomy is the right of all individuals, regardless of age, gender, or background. Join us in the fight for overdue reform in pediatric urology by subscribing to our website and following us on TikTok, Reddit, and YouTube.
Help us raise awareness about the real and lasting effects of VCUG trauma. Join the Unsilenced Movement to make your voice heard!
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