Abstract: PD25-02
Sources of Funding: none

Introduction

Clitorodynia, which occurs in 5% of women with dyspareunia, is a distressing, often disabling sexual pain syndrome associated with burning, stinging, and/or sharp pain. Clitorodynia is considered a localized form of vulvodynia confined to the glans clitoris, common clitoral shaft and/or prepucial area. Like men with penile pain secondary to phimosis with underlying balanitis, a subgroup of women have clitorodynia secondary to adhesions of prepucial skin to the glans clitoris with clitoral pain secondary to underlying balanitis and keratin pearls. This pain is like a grain of sand in the eye. Since urologists are well-trained in surgical management of male prepucial disorders, they are in the best position to surgically manage phimosis/adhesion-associated clitorodynia. In-office lysis of adhesion under local anesthesia is a feasible treatment for the majority of patients. For those unable to tolerate the local procedure, or adhesions recur, we perform a dorsal slit procedure under anesthesia.

Methods

15 patients (mean age 35 years, range 18-62) with adhesions from clitoral hood to glans obscuring the corona of the glans clitoris were managed by a urologist.

Results

All 15 underwent in-office management of clitoral adhesions. A dorsal nerve block was performed with 5 mL of mixture lidocaine/bupivacaine. A Jacobson hemostat forceps was used to bluntly lyse epithelial adhesions and remove underlying keratin pearls until the corona was visualized completely around the circumference of the glans clitoris. Additional local anesthetic was injected for post-operative pain control. The patient was told to tub soak twice daily and carefully retract the clitoral hood sufficiently to see the corona to prevent re-adherence of the adjacent clitoral hood to the glans. Even after initial healing the corona should be seen by retracting the hood daily to prevent adhesions. No patient had recurrence of adhesions 6 months post procedure. 13/15 women had significant reduction of clitoral pain._x000D_

Conclusions

Urologists familiar with surgical management of the prepuce are uniquely positioned to treat phimosis/adhesion-based clitorodynia. Release of adhesions can be achieved in-office under local anesthesia with preservation of the prepuce or as a dorsal slit procedure. Closed compartment balanitis clitorodynia is a treatable and should be in the scope of a urologist&[prime]s care.

Funding

none