Most women have never heard of clitoral adhesions, even those who have them.
They’re not alone—most doctors haven’t heard of them either. But new research we published this week in The Journal of Sexual Medicine shows that many women suffer from this often uncomfortable and pleasure-reducing problem.
Fortunately, it also shows that our treatments can make a big difference.
Let’s back up and start from the beginning.
The clitoris can be found under the clitoral hood. It is almost completely ignored in medicine. The clitoris is under-funded, under-researched, under-cared for and under-examined. In fact most doctors--even gynecologists and urologists—receive no training in medical school or residency programs on how to examine the clitoris or its underlying pathologies (when things go wrong).
The clitoris and the penis are essentially the same organ. Both are made of erectile smooth muscle tissue and both are very important for sexual arousal, orgasm and pleasure.
Most of the clitoris lives deep under the skin of the pelvis, and the legs of the clitoris insert into the butt bones (so do the legs of the penis, actually).
The visible part of the clitoris (the head or glans) lives under the clitoral hood or “prepuce.” This hood is the same as the foreskin of the penis (which is also called the prepuce), which covers the entire head of an uncircumcised penis.
For those with uncircumcised penises, doctors start to recommend foreskin hygiene around puberty. Without proper retraction of the foreskin, oils and skin cells (called smegma) can build up, and the hood can stick to the head of the penis and cause something called phimosis. Phimosis can be painful and can make erections, pleasure and intimacy difficult. Pediatricians, primary care doctors and urologists all know how to diagnose and treat phimosis. We have several treatments including steroid creams, stretching maneuvers and surgery.
But what about the clitoris?
What if it hurts when you or someone else touch your clitoris? What if it feels uncomfortable? What if you can’t orgasm or your orgasm feels weak or muted? Is it all in your head? Could there be a physical anatomical issue going on?
We started to look at this a few years ago during my sexual medicine fellowship. I helped with a research project where we looked at hundreds of vulva pictures and found that 23% of all women patients at a sexual medicine practice—regardless of why they sought care—had mild, moderate or severe clitoral adhesions. Meaning in nearly a quarter of these women, the hood of the clitoris was stuck to the head of the clitoris
When the adhesions are thought to be symptomatic by the patient, and the pros and cons are discussed, the treatment is an office procedure called a clitoral lysis of adhesions.
This is a 30- to 60-minute office procedure where we apply topical numbing medication and stretch the clitoral hood to separate the adhesions. We aren’t cutting or damaging any tissue or nerves, no stitches are needed, and this is not genital cutting. We are just stretching and separating a plane between the head of the clitoris and the hood of the clitoris.
But what actually happens when you remove the adhesions, when we remove the oil and skin cells that can build up underneath and allow for the entire glans to be mobile? Do people notice a difference? Does orgasm improve?
That’s what our newly published study in the Journal of Sexual Medicine examined.
We sent a survey to 61 patients who had the in-office lysis procedure and asked them about their experience. We had a 67% response rate to our survey.
A large majority of patients reported improvement in pain (76%), sexual arousal (63%), and ability to achieve orgasm (64%), and no participants reported worsening of these symptoms.
Of the 16 women who 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.
More than 90% of participants reported that they would recommend this procedure to a friend with clitoral adhesions.
These were a few quotes from patients:
As with all science there are limitations to our research and many more questions to be answered. Who should have their adhesions treated? How do we prevent them from coming back? Should we be examining the clitoris and vulva at all pelvic exams?
I am so proud to be a part of this great research team that worked on this study. I couldn't have done this project without the help of incredible medical students Monica Meyers, Elsa Nico and Jen Romanello they are absolutely incredible!
I hope this article continues to spark more questions, more research, and more interest in the clitoris!
Read the full paper here and let us know what you think!