OBJECTIVES: To describe the role of general practitioners (GPs) in the initial management of women with UI in 4 European countries with different health care systems. METHODS: Cross-sectional community postal survey of 2,953 community-dwelling women with UI in France, Germany, Spain and the UK. RESULTS: There was an overall response rate of 53% (n = 1573). Forty eight percent had discussed their UI with a doctor. More women discussed UI in France and Germany than in the UK and Spain. The patient usually raised the issue, during consultations for some other reason. Fear of, or actual deterioration in UI was the most important reason for discussing UI. Overall 52% of incontinent women first discussed their UI with a GP and almost a third of women reported having all their UI discussions in a GP setting. Twenty nine per cent of women reported that GPs had either recommended treatment or monitoring of their condition before beginning treatment and 24% reported that the GP had referred them to another doctor for evaluation and treatment. Most women in the UK first discussed UI with a GP whereas in Germany most discussed UI with a specialist. In Spain and France about half the women first discussed their UI with a GP. CONCLUSIONS: GPs are involved to varying degrees in the initial management of UI in France, Germany, Spain and the UK. Even in countries where women have a choice of whether to see a GP or specialist about UI many choose to have their first contact with a GP.