Diagnosis of dysuria in adolescent girls. A protocol encompassing common, often nonurinary, causes

Vulvovaginitis, not urinary tract infection, is the most common cause of dysuria in adolescent girls, and the work-up for this condition involves more than just ordering urinalysis and urine culture. Factors essential to proper evaluation of dysuria include determination of the patient's age, stage of pubertal development, and sexual activity, as well as assessment of associated symptoms, concomitant conditions, and use of contraceptive or feminine hygiene products that may cause irritation. Thus, a thorough history and physical examination, including examination of the genital area, are mandatory.