Introduction In the United States, medical education on sexual medicine varies throughout the country and between institutions. With limited standardization, medical students and subsequent trainees have little to no training in how to approach a patient with concerns surrounding their sexual health. In 2018, half of the medical institutions in the United States required formal instruction in sexual medicine. Of those institutions that do include didactic material on sexual medicine, most of the material is dedicated to anatomy, physiology, and sexually transmitted infections, with limited or no information on sexual dysfunction and sexual history taking. Therefore, we identified a need to determine which components of sexual medicine, particularly female sexual medicine, are currently being covered in undergraduate medical education with the goal of proposing and developing standardized curriculum materials to be utilized by medical students during their preclinical education. Objective The aim of this study is to examine current preclinical curricula at all seven medical schools, including six allopathic and one osteopathic institution, in the Chicago, Illinois area to investigate which aspects of female sexual anatomy, physiology, pathology and pharmacology are being taught to medical students. Methods Curriculum materials on female sexual anatomy, physiology and pathology were collected from all seven medical schools in Chicago, Illinois. Courses covering topics on female sexual medicine varied between institutions due to differences in preclinical curriculum and coursework. To standardize our needs assessment, we utilized previous literature to identify specific components of anatomy, physiology, pathology, pharmacology, social sciences, and history and physical exam skills. Upon reviewing each institution's preclinical educational materials, we assessed curriculum content for saturation of specific concepts within each of the above areas. Results Curriculum materials were collected from seven (n=7) total medical schools in the surrounding Chicago, Illinois area. Out of the 7 institutions, 4/7 discussed clitoral anatomy, with 6/7 mentioning the glans, 1/7 mentioning the corona, 2/7 mentioning the clitoral hood, 6/7 mentioning the corpora cavernosa, 4/7 mentioning the corpus spongiosum, 6/7 mentioning the crus, 6/7 mentioning the bulb and 5/7 detailing the clitoral neurovasculature. In addition to the anatomy, 4/7 discussed the physiology of the female orgasm, 3/7 highlighted the rate and epidemiology of female sexual dysfunction (FSD), 3/7 included information on treatment for FSD, 1/7 taught a genitourinary physical exam specific to assessing FSD (external exam, internal exam, pelvic floor assessment), and 6/7 institutions included information on how to take a sexual history asking about sexual function, pleasure, and satisfaction. Conclusion Overall, our focused needs assessment of both allopathic and osteopathic medical schools in the Chicago, Illinois area highlights the need for restructuring of curriculum as it pertains to female sexual medicine and FSD in undergraduate medical education. Next steps include proposing individual curricular recommendations to institutions, due to the variation in current curriculum design, as to how they can better teach on areas surrounding FSD, while also aiming to standardize what medical students are learning during their preclinical years. Disclosure Work supported by industry: no.

Introduction Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The etiology of clitoral adhesions remains largely unclear. Studies published to date on the presentation and management of clitoral adhesions are relatively recent and raise questions for future research. Objectives We sought to provide a background of existing knowledge on the prevalence, presentation, etiology, associated conditions, and management of clitoral adhesions and to identify areas for future research. Methods A review of literature was performed for studies that investigate clitoral adhesions. Results Conditions associated with chronic clitoral scarring appear to have a role in the development of clitoral adhesions. Symptoms include clitoral pain (clitorodynia), discomfort, hypersensitivity, hyposensitivity, difficulty with arousal, and muted or absent orgasm. Complications include inflammation, infection, and the development of keratin pearls and smegmatic pseudocysts. There are surgical and nonsurgical interventions to manage clitoral adhesions. Additionally, topical agents can be included in conservative and/or postprocedural management. Although many studies on clitoral adhesions are limited to patients with lichen sclerosus (LS), clitoral adhesions are not confined to this population. Conclusion Areas for future research include etiologies of clitoral adhesion; such knowledge is imperative to improve prevention and management. Also, in previous studies, patients were instructed to apply various topical agents and manually retract the prepuce for conservative management or postlysis care. However, the efficacy of these interventions has not been investigated. Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm that are causes of the sexual dysfunction associated with clitoral adhesion. Although previous studies have assessed efficacy and patient satisfaction, many of these studies were limited to small sample sizes and focused solely on patients with LS. Future studies are needed to inform a standard of care for the management of clitoral adhesions.

Introduction Clitoral adhesions (CA) occur when preputial skin that normally moves over the glans clitoris to expose the corona becomes adhered, creating a closed compartment that is vulnerable to irritation, erythema, and infection. CAs can be associated with persistent genital arousal disorder (PGAD), which is characterized by persistent or recurrent, distressing feelings of genital arousal that are not associated with sexual interest or thoughts. One treatment option for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, but this procedure has not been specifically studied in women with PGAD. Objective To determine if women with PGAD treated for CA with the non-surgical lysis procedure reported satisfaction and outcomes that were different from women without PGAD. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice between the years of 2017 and 2021 were identified using a chart review and an online survey was sent to patients to evaluate patient satisfaction and the efficacy of the procedure in patients with and without PGAD. Results 41 survey responses were received (67% response rate) and 4 women had a PGAD diagnosis. There was no difference in the procedure's ability to improve pain (50% vs 81%), ability to orgasm (75% vs. 63%), or sexual satisfaction (50% vs. 73%) between women with and without PGAD. 65% of all respondents (n=40) reported being “extremely satisfied” with their decision to have the lysis procedure; however, significantly fewer patients with PGAD reported being “extremely satisfied” as compared to the control group (25% vs. 69%; p=0.04). In addition, while only 27% of all participants reported that the procedure was painful, women with PGAD were significantly more likely to report pain than women without PGAD (75% vs. 22%; p=0.01). Lastly, 51% of respondents (n=37) reported recurrence of CA after the procedure, but the incidence of readherence was significantly higher in patients with PGAD compared to patients without PGAD (100% vs. 45%; p=0.02). The increased readherence in women with PGAD was not attributable to differences in post-procedural care (use of hormone cream, yeast cream, vaseline, or retraction of the clitoral hood) or risk factors for CA (history of yeast infections and urinary tract infections, use of hormonal-based contraceptives, blunt perineal or genital trauma, lichen sclerosus, or history of sexual pain) as these were not significantly different between study groups. Conclusions These results indicate that the non-surgical lysis procedure has similar efficacy in improving pain and sexual function in women with and without PGAD. However, this procedure may be a less favorable treatment for CA in women with PGAD as evidenced by lower reported satisfaction with the procedure, increased reports that the procedure was painful, and higher rates of readherence in this group. As only 4 women in our study had PGAD, future studies with more patients with both PGAD and CA may be necessary to provide insight into additional treatment options that may offer these patients more satisfaction and improved outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Introduction Lichen sclerosus (LS) is a chronic, inflammatory skin disorder in the anogenital region typically found in prepubertal or postmenopausal women that causes skin thinning, whitening, wrinkling, itching, and pain. LS is an established risk factor for the development of clitoral adhesions (CA). CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, difficulty reaching orgasm, and chronic vulvodynia. However, CA can also occur in the absence of LS. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical, office-based procedure that stretches the preputial tissue open. Previous studies explored LS patient satisfaction with surgical lysis or dorsal-slit surgery but not with the non-surgical approach. The non-surgical office-based procedure has also never been studied in patients without LS. Objective The aim of this study is two-fold: to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in women with LS and to compare the efficacy of the procedure in patients with and without LS. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results 41 women participated in the study (67% response rate) and 5 had a diagnosis of LS that was optimally treated with high-potent steroids. In terms of procedure satisfaction, there was no significant difference in patient satisfaction (80% vs 83%) or the likelihood of recommending the procedure to a friend who also had CA (80% vs. 94%) among women with and without LS. In regards to improving sexual functioning, there was no significant difference in the procedure's ability to improve sexual arousal (80% vs. 60%), ability to orgasm (80% vs. 62%), and sexual satisfaction (60 vs. 72%) between women with and without LS. Finally, there was no significant difference in reporting the procedure was painful (40% vs. 25%) or the incidence of recurrence of adhesions (40% vs. 51%). Conclusions This study demonstrates high patient satisfaction and improvement in sexual functioning associated with the non-surgical lysis procedure for CA in women with and without LS. CA should not be considered as an adjunct side-effect of LS but as an independent pathology. Physicians should examine the clitoris in women with and without LS in order to determine if a patient has CA. Once diagnosed, the non-surgical lysis procedure has similar efficacy and patient satisfaction in women with and without LS and could be considered as a treatment option for improving sexual function in women. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Introduction In clitoral adhesions (CA), a closed compartment of space under the clitoral hood can lead to accumulation of squamous cells and smegma, irritation, erythema, and infection. This causes the prepuce to adhere to the glans clitoris and prevents the corona, a ridge of tissue between the glans clitoris and the clitoral body, from being visualized. CA can cause discomfort, hypersensitivity or hyposensitivity, difficulty reaching orgasm, and chronic vulvar pain including clitorodynia. One treatment for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, yet there is a paucity of data on its effectiveness in treatment of symptoms and restoration of function. Objective To evaluate patient-reported outcomes of the non-surgical lysis procedure in order to determine if this procedure is an appropriate treatment for symptomatic CA that can be performed in the office-based setting. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a chart review and an online survey was sent to patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results There were 41 survey responses (67% response rate). All women that reported the ability to achieve orgasm from external clitoral stimulation maintained this ability after the procedure (n=24), and of the women that could not do so before the procedure (n=16), 6 were able to afterwards. 76% of respondents reported improvement in pain with 44%, 28%, and 4% reporting significant, moderate, and slight improvement. 63% reported improvement in sexual arousal with 25%, 25%, and 13% reporting significant, moderate, and slight improvement. 64% reported improvement in their ability to achieve orgasm with 26%, 18%, and 21% reporting significant, moderate, and slight improvement. 71% reported improvement in their satisfaction with sex with 27%, 17%, and 27% reporting significant, moderate, and slight improvement. 80% of respondents reported they could have comfortable physical/sexual stimulation within one month of the procedure, and 31% of respondents reported that it took one week or less. 93% of participants would recommend the procedure to a friend who also had CA. 65% and 18% of respondents reported being extremely and mostly satisfied with their decision to have the procedure. Conclusions These findings indicate that most patients reported improvement in their pain and sexual functioning, and no participants reported worsening in their pain, sexual arousal, or ability to achieve orgasm. 6 of 16 patients that could not achieve orgasm from external clitoral stimulation prior to the procedure were able to afterwards. Thus, the non-surgical lysis procedure could be considered as a treatment for pain and sexual dysfunction associated with CA. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals