Experts Recommend Routine Clitoral Exams

Clitoral adhesions can cause significant pain, and routine clitoral examinations could benefit women with sexual dysfunction, researchers say.

In their recent Sexual Medicine study, the research team focused on the prevalence and risk factors of clitoral adhesions.

In female anatomy, the glans clitoris (the external portion that is visible and most sensitive to touch) is covered by the prepuce (the “clitoral hood”). Typically, the prepuce can be easily retracted over the glans.

In women with clitoral adhesions, areas of the hood adhere to the glans, making retraction difficult. The result is a “closed compartment space” that can become infected and inflamed. The area may be red, swollen, painful, or hypersensitive. Some women compare the sensation to having a speck of sand in the eye. Many develop sexual problems.

The researchers retrospectively analyzed vulvoscopy photographs from 614 women who had sought help for sexual dysfunction. The photographs were taken between August 2007 to December 2015 as part of routine assessment. Patients also completed a series of sexual health questionnaires and underwent hormonal blood tests.

The researchers found that 140 women (23%) could be diagnosed with clitoral adhesions occurring in one or more areas. Of these, 62 cases (44%) were considered mild, 48 (34%) were moderate, and 30 (21%) were severe. Women with severe adhesions tended to be younger, with a median age of 40 compared to median ages of 47 and 46 for the mild and moderate groups, respectively.

Looking at the women’s medical histories, the researchers noted that 71% had a history of yeast infections, and 56% had had urinary tract infections. Almost a quarter had had trauma to the perineum, in some cases from riding bicycles or horses.

Questionnaire results suggested that pain was, in general, a large concern for the women compared to other sexual function domains like desire, arousal, lubrication, and orgasm. And while 14% of the women had come to the clinic because of clitorodynia (clitoral pain), most did not cite clitoral pain as the reason for their visit.

In some cases, women might have accepted clitoral pain, thinking that there was nothing that could be done. Some who did have clitorodynia had been told by previous doctors that nothing abnormal was found, the experts reported.

The authors identified several potential risk factors for clitoral adhesions, including blunt trauma, fungal or bacterial infections, dermatologic conditions like lichen sclerosis, and inadequate levels of sex steroid hormones. However, they added that more research is needed in this area.

Medical education programs do not always include assessment of the clitoris, the authors said, pointing out that “urology residency programs universally teach physical examination of the male homologue (the penis) but do not regularly teach how to examine the clitoris.” They added that “n gynecology training programs and clinical practice, physical examination of the clitoris is uncommon and not routinely taught.”

The authors acknowledged that the women in this study were already experiencing sexual dysfunction, so it is not known how common clitoral adhesions may be in the general population. Also, other conditions might have been linked to sexual pain, not just clitoral adhesions.

However, they recommended that clinicians receive training in clitoral physical exams and learn more about conditions that affect the clitoris.

Resources

Sexual Medicine

Aerts, Leen, MD, PhD, et al.
“Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women’s Health Providers Should Routinely Examine the Glans Clitoris”
(Full-text. Published online: March 17, 2018)
https://www.smoa.jsexmed.org/article/S2050-1161(18)30025-4/fulltext

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