Lysis of Clitoral Adhesions Should be in the Scope of a Urologist's Care

Abstract

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%. While the treatment of penile phimosis is widely practiced by urologists, training on the diagnosis and treatment of clitoral phimosis is lacking. Lysis of clitoral phimosis is a minimally invasive, office-based procedure to stretch the preputial tissue. Lysis of clitoral phimosis can be performed with a topical anesthetic or nerve block of the dorsal nerve of the clitoris. A fine Jacobsen mosquito forceps can then be used to separate the plane between the prepuce and the glans clitoris. Following the procedure, patients are instructed to pull back the prepuce at least once daily to prevent re-adherence. Objective To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that diagnosing and treating clitoral phimosis should be in the scope of a urologist's practice. Methods Survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice. 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 improved 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. Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). 92.7% (n=41) 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 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. Since urologists are trained in procedural management of male preputial disorders, urologists are uniquely positioned to also routinely manage clitoral phimosis. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Anatomy of the clitoris: the corona of the glans clitoris, clitoral coronal papillae, and the coronopreputial frenulum

“…Adhesions and subsequent sequestration of smegma and development of clitoral pearls (including smegmaliths) may predispose one to dyspareunia. Further, CPAs are associated with pain and difficulties with arousal and orgasm [43]. Thus, in the setting of sexual dysfunction, it is prudent to recognize and assess the interface between the prepuce and glans including the anatomy surrounding the CGC.…”