A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions

Abstract

Background Clitoral adhesions are characterized by adherence of preputial tissue to the glans clitoris and can be managed using a non-surgical approach in order to relieve symptoms of sexual dysfunction. Aim To evaluate efficacy and patient satisfaction associated with the non-surgical lysis procedure in order to determine if it is an appropriate treatment for symptomatic clitoral adhesions. Methods The non-surgical lysis procedure is performed by using a fine Jacobsen mosquito forceps to separate the plane between the prepuce and the glans of the clitoris, removing smegma and/or keratin pearls from underneath the adhesions and allowing for visualization of the entire glans. A chart review of 61 women that were treated for clitoral adhesions using the non-surgical lysis procedure at 1 sexual medicine practice was performed and an online survey was sent to these patients. Main Outcome Measures Encrypted survey responses were used to evaluate patient satisfaction as well as self-reported improvement in sexual functioning and pain before and after the procedure. Results 41 survey responses were received out of 61 eligible (67% response rate). A large majority reported improvement in pain (76%), sexual arousal (63%), and ability to achieve orgasm (64%) and no participants reported worsening in these symptoms. Of the 16 women that reported the inability to orgasm from external clitoral stimulation prior to the procedure, 6 (38%) were able to do so afterwards. Seventy-one percent of respondents reported improvement in their satisfaction with sex and 83% reported being satisfied with their decision to have the procedure. Ninety-three percent of participants reported that they would recommend this procedure to a friend with clitoral adhesions. Clinical Implications The results of this study will help clinicians to recognize the non-surgical lysis procedure as a treatment option for clitoral adhesions. Strengths & Limitations This study is the first of its kind assessing a cohort of patients undergoing the non-surgical lysis procedure for clitoral adhesions. Its limitations include a small sample size from 1 clinic and lack of validated instrument to evaluate sexual function and pain before and after the procedure. Conclusion Providers should regularly examine the clitoris of patients with symptoms of sexual dysfunction in order to determine if they have clitoral adhesions. The non-surgical lysis procedure may be a viable therapeutic option for these patients that has demonstrated both satisfaction and symptom relief.

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

“…Further, clitoral adhesions may be indicative of local trauma, dermatologic disorders ( e.g. , lichen sclerosis), and varied infections [ 8 , 28 , 40 , 41 ]. Adhesions also predispose the development of infection [ 28 ].…”

“…Adhesions also predispose the development of infection [ 28 ]. Likewise, adhesions have been associated with a history of dyspareunia, blunt perineal or genital trauma, decreased free testosterone, menopause, long-term oral contraceptive use, and sexual dysfunctions including persistent genital arousal disorder/genitopelvic dysesthesia [ 8 ]. Accordingly, it is important to differentiate normal anatomy, or normal contact between the clitoris and the prepuce, from pathological adhesion.…”

“…Due to its approximation with the prepuce and glandopreputial sulcus, the clitoris is predisposed to adhesion development and phimosis with sequestration of desquamated epithelial cells, smegma, and keratin pearls which can result in vulvovaginal irritation and clitorodynia/vulvodynia that has been described akin to "having a grain of sand in the eye" [39,40]. Further, clitoral adhesions may be indicative of local trauma, dermatologic disorders (e.g., lichen sclerosis), and varied infections [8,28,40,41]. Adhesions also predispose the development of infection [28].…”

“…Despite the confusion regarding the presence of the CGC, and despite the lack of formally recognized terminology specific to the anatomy of the glans clitoris, the terms corona and coronal sulcus continue to be used in the modern-day clinical literature as they relate to the clitoris, especially in the context of disorders of sex development (DSD) (also known as differences in sex development, variations in sex characteristics, and diverse sex development) [1][2][3][4][5][6][7][8][9][10][25][26][27][28].…”

“…The corona of the glans clitoris (Latin: corona glandis clitoridis) (CGC) has been utilized as an anatomical landmark for varied urologic and gynecologic surgeries ( e.g. , clitoroplasty) [ 1 - 6 ], assessment and management of clitoral adhesions [ 7 , 8 ], measurement of the clitoral index for the determination of clitoromegaly and, accordingly, the identification of endocrinopathies including congenital adrenal hyperplasia, androgen-producing tumors, and polycystic ovarian syndrome [ 9 , 10 ]. However, despite the purported clinical importance of the CGC, there has been longstanding confusion regarding its prevalence and, moreover, its very existence.…”