Introduction Clitoral phimosis occurs when the prepuce adheres to the glans clitoris. Similarly, penile phimosis occurs when the prepuce adheres to the glans penis. Symptoms of clitoral phimosis can include pain, difficulty with arousal, and muted or absent orgasm. While previous studies on the prevalence of clitoral phimosis in a group of 589 college students in a health clinic was 33%, and in a population of 614 patients with sexual dysfunction, it was 23%. There are no diagnosis codes (ICD codes) or procedure codes (CPT codes) for clitoral phimosis or the lysis procedure for clitoral phimosis. Proper codes ensure that patients receive adequate treatment and are charged appropriately for medical services. Objective To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that clitoral phimosis should have its own diagnosis and procedure codes. Methods To evaluate the efficacy and patient satisfaction of the lysis procedure, survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice were analyzed. The survey was sent to 61 patients and 41 responded (67% response rate). Results Among participants who reported pain as a symptom of phimosis (n=25), 76% saw an improvement in pain, with 44%, 28%, and 4% reporting significantly, moderately, or slightly reduced pain. Among those who reported difficulty with arousal before the procedure (n=40), 62.5% saw improvement, with 25%, 25%, and 12.5% considering it to be significantly, moderately, or slightly easier to become aroused. Among those who reported difficulty achieving orgasm before the procedure (n=39), 64% saw improvement, with 25.6%, 17.9%, and 20.5% reporting that they found it significantly, moderately, or slightly easier to achieve orgasm. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. 92.7% would recommend the procedure to a friend who had phimosis. Conclusions These findings show that most patients reported improvement in their pain and sexual function, and no patient reported a loss of functioning or worsening of symptoms. The lysis procedure should be recognized as a treatment for pain and sexual dysfunction associated with clitoral phimosis. The routine management of clitoral phimosis in clinical practice should be reflected in diagnosis and procedure codes, which currently do not exist. The lack of proper codes creates a barrier to diagnosis and treatment of clitoral phimosis. If doctors use the ICD code for phimosis, it is rejected by insurance - the codes for “phimosis” and “balanitis” are only designated for male patients. Proper codes support the importance and medical necessity for performing the lysis procedure, and would help communicate a patient's health to other healthcare providers, specialists, insurance payers, and data registries. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout, Absorption Pharmaceuticals

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ANOVA, chi square, and regression analyses, adjusting for body mass index (BMI), fetal sex, and gestational age at sample collection. RESULTS: 1475 patients were included. Mean gestational age was 14.3 (AE4.4) weeks and mean BMI 26.9kg/m2 (AE6.7). Overall, 3% (N¼42) had a documented AID, with 25 on no therapy and 17 on IM therapy. There was a significant stepwise decrease in mean FF, with 12.0%, 10.4% and 9.6% in the control, AID on IM therapy, and AID on no therapy groups, respectively (p¼0.03) [Figure 1A]. An inverse relationship was observed in the rate of indeterminate results from 3% to 6% to 24% for controls, AID on IM therapy, and AID on no therapy, respectively (p<0.001) [Figure 1B]. Logistic regression showed an increased odds of an indeterminate result for women with AID on no therapy compared to controls, OR 9.1 (95%CI 3.2, 25.7). Linear regression showed a significant decrease in FF for women with AID on no therapy compared to controls, b -2.0 (95% CI -3.8, -0.2). CONCLUSION: Women with AID on no therapy have higher rates of indeterminate cfDNA results compared to controls. Treatment of AID with IM therapies may improve FF, which could be further evaluated in future studies.

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.