Topical Therapy of Periclitoral Lesions Associated With Dysuria and Pelvic Pain

Background: Chronic dysuria can be diagnostically challenging as it may be a symptom of a variety of conditions, including infectious, inflammatory, hormonal, and neoplastic etiologies. The evaluation of dysuria may encompass multiple diagnostic tests, including cultures, imaging, and instrumentation and lead to the potential overuse of antibiotics and analgesics. We sought to evaluate the association of dysuria and vulvar vestibule pain with periurethral anatomic lesions and response to treatment of same. Methods: Twelve women were referred for evaluation of chronic dysuria and periurethral or periclitoral burning. Patient ages ranged from 17 to 73 years (mean, 51; median, 46). All patients had a history of irritating urinary symptoms and dyspareunia and had failed courses of empiric antibiotics with negative urinary cultures. On physical examination, all patients were found to have tender punctate erythematous erosions of the midline periclitoral and periurethral mucosa. For 4 weeks, 3 patients were treated with topical estradiol cream and clobetasol to the periclitoral area and 9 were treated only with topical estradiol cream.