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Purpose: Vulvar high-grade squamous intraepithelial lesion (VHSIL) involving the clitoris is a rare and ill-defined condition. The authors evaluated the patient characteristics associated with clitoral vs. non-clitoral VHSIL and the clinical correlates of the disease. Materials and Methods: Data from 216 consecutive patients seen at an Italian tertiary referral centre (1981-2014) were analysed using the chi-square test and multiple logistic regression models. Results: Clitoral VHSIL was detected in 41 (19%) patients. HIV infection, associated cervical and vaginal intraepithelial neoplasia, and multifocality were significantly (p < 0.05) associated with clitoral VHSIL. In multivariate analysis, multifocality retained a strong effect [odds ratio (OR), 17.5; 95% confidence interval (CI), 6.9-44.7]. Clitoral VHSIL was a weak risk factor for patient loss to follow-up in univariate (24.4% vs. 13.1%; p = 0.072) and multivariate analysis (OR, 2.13; 95% CI, 0.92-4.92). The 60-month persistence/recurrence-free survival was non-significantly lower for patients with clitoral VHSIL. Conclusion: Multifocality was independently associated with clitoral VHSIL and this, in turn, with patient loss to follow-up. [ABSTRACT FROM AUTHOR]