Clitoral Adhesions / Clitoral Pain / Lysis Of Clitoral Adhesions

If you are experiencing clitoral adhesions, it is essential to seek professional medical evaluation and diagnosis. Dr. Karen Toubi, a specialist in female pelvic medicine, can provide a thorough assessment to determine the underlying cause of your symptoms.

The treatment for Clitorodynia depends on the underlying cause of the pain:

• Keratin Pearl Excision: If the primary cause is Keratin Pearls, this can be addressed through a procedure. It may be performed in-office or in the operating room, depending on the severity of clitoral adhesions between the clitoris and the prepuce. The procedure involves breaking up the adhesions with a fine metal probe and removing the Keratin Pearls. Patients may experience mild post-operative discomfort during the healing process, but it leads to a quick resolution of sharp, stabbing clitoral pain.
• Neuropathic Causes: If the clitoral adhesion is neuropathic, medications such as oral tricyclic antidepressants (e.g., amitriptyline, nortriptyline, and desipramine) can be used. These medications help “numb” nerves, reducing clitoral pain. The dosages used for Clitorodynia are typically lower than those used for depression. Alternatively, anticonvulsants like Neurontin (gabapentin) and Lyrica can be effective in treating neuropathic Clitorodynia with fewer side effects.
• Many times, imaging with an MRI of the Lubar/Sacral spine is helpful in diagnosing vulvar/clitoral pain.  The cause of the pain may actually be stemming from the spine.  Spinal blocks or surgery may be helpful in these cases. 
• Low Intensity shockwave therapy (LISWT): is considered experimental, but there is extensive data available on both the basic science and clinical improvement using it for multiple purposes.  There are a limited number of shockwave devices cleared for use on humans in the U.S.  Most are cleared for treatment of plantar fasciitis or other orthopedic conditions. The device we are using is FDA cleared for improved blood flow, connective tissue activation, pain amelioration and wound healing.  Shockwave therapy is considered non-significant risk by the FDA.

Patients receiving shockwave therapy relax while the wand is applied using warm ultrasound gel. Any discomfort felt during the procedure (depending upon where on the body the shocks are delivered) stops when the device stops.  The treatment may feel like a tapping, or a massage, or nothing at all.  It does not cause bruising or any other residual side effect.  Most people experience the peak of positive effects about 3 months after treatment.  About 70% of patients will experience clinical improvement in their vulvar or clitoral pain.  86% of patients will experience an increased intensity and frequency of orgasm.