Most healthcare providers don’t discuss clitoral adhesions which cause pain and discomfort, hence most women aren’t aware they exist. With studies suggesting that one in five women may have adhesions, it’s important to understand how untreated adhesions significantly impact sexual health and overall well-being. If you’ve been unable to get answers about why you’re experiencing pain, discomfort, or reduced sexual satisfaction, consider that you may be suffering from an adhesion.
CAUSES AND RISK FACTORS
A clitoral adhesion happens when the protective fold that conceals the clitoris becomes stuck to the exposed portion of the clitoris. Known as the clitoral hood, this fold protects the tender, delicate flesh of the clitoris from exposure to friction and bacteria. Here’s a rundown of the factors that can cause the hood to become stuck to the clitoris.
Lichen Sclerosus and Lichen Planus
Both lichen sclerosus and lichen planus belong to a family of noncommunicable inflammatory skin conditions. People with these conditions generally experienced thick, stiff, or “leathery” skin. The primary symptom with lichen planus is a rash-like presentation anywhere on the body. The rash can even occur in the genitals. Meanwhile, lichen sclerosus exclusively affects the genitals and anal area. We also know that postmenopausal women are at higher risk for developing lichen sclerosus.
Lichen sclerosus and lichen planus contribute to clitoral adhesions by thinning and scarring skin on the clitoral hood. The underlying cause for these conditions isn’t fully known. However, factors ranging from genetics to immune response are believed to be in play.
Hormonal Changes
Hormonal changes that occur with age or changes in sexual health can contribute to clitoral adhesions. This may be why adhesions are often seen in women during menopause. In these situations, dipping estrogen is the key driver of adhesions because of the loss of natural moisture and elasticity.
Trauma
Scarring caused by surgery, illness, or a traumatic injury can increase your vulnerability to clitoral adhesions. When vaginal tissue is damaged, the scar tissue that forms can be rough or irregular in nature. Scar tissue is also more likely to “fuse together” as it heals.
Bad Hygiene
Hygiene habits can irritate or inflame the skin of the clitoral hood and clitoris. Poor hygiene practices or infrequent bathing could allow for stool contamination that causes infection or inflammation of clitoral tissue. Even women who are vigilant about their personal hygiene could inadvertently increase their risk for adhesions by using products containing harsh additives or fragrances that irritate sensitive vaginal tissue.
DO I HAVE CLITORAL ADHESIONS?
Clitoral adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. If you suspect adhesions, an in-person exam with a care provider is the only way to confirm your diagnosis. Here are some telltale signs that should prompt you to book an exam.
Pain
Pain and discomfort are the top symptoms of clitoral adhesions. In addition to acute pain, you may experience hypersensitivity or irritation. It’s also common for the dry, thick scar tissue connecting the hood and clitoris to be itchy.
Discomfort During Sex
Pain during sexual intercourse or other activities that stimulate the clitoris is also common. The clitoris is likely to feel raw and tender.
Inability to Fully Expose the Clitoris
When an adhesion is present, it often becomes impossible to retract the clitoral hood to expose the clitoris. In addition, the entire area may be too swollen for you to retract the hood.
Increased or Decreased Sensitivity
Many women with adhesions experience dulled sensation during clitoral stimulation. This can greatly decrease both arousal and the ability to achieve orgasm. In other cases, hypersensitivity that increases clitoral sensitivity can make sexual contact overstimulating.
RELATED: What is Vulvar Vestibulitis? Symptoms, Causes, Misdiagnosis, and Treatment
TREATMENT OPTIONS FOR CLITORAL ADHESIONS
Many minimally invasive options can be used to heal clitoral adhesions. However, severe adhesions may require surgical separation.
Nonsurgical Lysis
In many cases, adhesions can be separated without the need for surgery. Using nonsurgical lysis, your doctor will use specialized forceps to separate the hood and clitoris after applying a topical numbing agent. Once separated, the hood will be gently stretched to knead out adhesions. Research on nonsurgical lysis for treating adhesions shows that 93% of participants would recommend this procedure to a friend with the same condition.
Hormonal Therapy
Hormonal therapy that boosts estrogen levels can be used to restore natural vaginal lubrication. In some cases, addressing dryness and “thinning” of vaginal tissue can be enough to heal adhesions.
Shockwave Therapy
Shockwave therapy has long been used for scar and wound healing throughout the body. It works by increasing blood flow to scar tissue that is starved of the nutrients needed for cell turnover. With repeated shockwave treatments, increased blood flow helps to promote cellular regeneration that helps to break up adhesions.
Topical Creams
With mild to moderate adhesions, topical creams can help to soothe and moisturize scar tissue that has turned dry and scaly. By softening the clitoral hood, creams allow you to gently separate the hood from the clitoris without tearing. Additionally, topical treatments can help to moisturize the hood to reduce the likelihood of future adhesions.
Surgery
Surgical lysis to remove adhesions is often recommended for more severe cases. During this procedure, adhesions are surgically separated. Any scar tissue that is still attached to the clitoris and hood is cleaned away. Depending on the extent of the scar tissue present, an incision may be made in the hood to clear out scarring in order to reduce the likelihood of a future adhesion.
Living with painful adhesions dramatically reduces quality of life and sexual satisfaction. Treating adhesions before they worsen is important. If you suspect that scarring is the cause of the discomfort, pain, or unexplained decrease in sexual satisfaction you’re experiencing, speak with Dr. Michael Tahery about treatment options. Specializing in women’s health and offering noninvasive surgical options, Dr. Tahery is an esteemed Los Angeles obstetrician-gynecologist (OB-GYN) and urogynecologist with more than 21 years of experience. Book an appointment today.