Could it be clitoral adhesions? A sex therapist explains.
It’s a part of your body that’s supposed to bring you pleasure. But what happens when it doesn’t? What if touch feels uncomfortable, numbed out, or even painful? Clitoral adhesions are a little-known, surprisingly underdiagnosed issue that can impact sexual health. Let’s talk about it!
A refresher on the clitoris
When most people think clitoris, they’re thinking of the glans, the part of the clitoris that is visible. The actual clitoris is much bigger, about 9-12 centimeters long and has internal structures that extend down the sides of the vulva.
The clitoris has over 10,000 nerve endings, which is twice as many as a penis.
If this surprises you, you’re not alone! The clitoris was only described in full detail in 2005 in an article in The Journal of Urology. Helen O’Connell and her colleagues argued that “those omissions not only hinder surgeons’ ability to perform surgery on the clitoris but also reflect a dominant culture of misvaluing the female body”
What are clitoral adhesions?
Basically, it’s when the hood gets stuck to the clitoris itself. You might also hear more technical language like “fusion of the prepuce to the glans clitoris.”
If you want to see pictures of what this looks like, Dr. Rachel Rubin has some great comparison slides of a clitoris with adhesions and one without.
What causes clitoral adhesions?
Clitoral adhesions can be caused by a variety of vulvovaginal conditions like lichen sclerosus, long-term hormonal birth control use, physical injuries, or hormonal changes like menopause.
One study found that 23-33% of people with vulvas had some degree of clitoral adhesions. 17% of which were menopausal, 73% of which had a history of hormonal birth control use, 59% of which had a history of at least one UTI and 56% of which had a history of yeast infections. We don’t know these conditions cause the adhesions, or if they are correlated.
Signs and symptoms
Some people have clitoral adhesions and have no symptoms, but others have significant pain and don’t realize the adhesions are the cause.
One study examined college-aged women who were undergoing a routine women’s health exam, and they found that 58% of women had some form of adhesions, and 25% of women had major adhesions.
Another study found that 22% of women who were seeking treatment for sexual dysfunction had clitoral adhesions.
For some people, the adhesions cause general pelvic pain, hyper or hypo sensitivity in the clitoris, or the feeling similar to having a grain of sand stuck in your eye (this is called foreign body sensation).
Clitoral adhesions can cause or contribute to sexual dysfunction, they may make it more difficult to have an orgasm, or mute the intensity and pleasure of the orgasm.
Why are clitoral adhesions so often undiagnosed?
Clitoral adhesions are diagnosed by physical exam, usually by a gynecologist, but even qualified medical providers can miss them, or be unaware of the significance.
Rachel Rubin, a urology and sexual medicine physician, is quoted on her website as saying: “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.”
What to do if you think you have clitoral adhesions
You can always grab a mirror and take a look! See if you can retract the hood of your clitoris easily and without pain. If you’re unsure, or if this self-exam is uncomfortable, see your gynecologist, and don’t be afraid to tell them you think you have clitoral adhesions.
What kind of treatment options exist?
A procedure called “lysis of adhesions” involves very gently breaking up the fibers connecting the clitoral hood and the clitoris, so the hood can retract and the clitoris can be exposed.
The procedure involves applying a very strong topical numbing agent to the clitoris, and then injecting more numbing agent on either side of the clitoris. Once you’re totally numb, your doctor will very gently use a tool called a fine Jacobsen mosquito forceps (they kind of look like fancy tweezers) to break up the adhesions. You won’t feel any pain, but it might feel weird, like a rubber band is being pulled apart.
The procedure also involves removing anything that has built up under the clitoral hood, like keratin pearls and smegma.
What are the outcomes of the lysis of adhesions?
Most patients experience significant improvement. One study reported that:
- 76% had a reduction in pain
- 71% noted improved sexual satisfaction
- 63% experienced increased sexual arousal
- 64% reported increased ability to orgasm
Importantly, no one in the study reported worsening pain.
Not every gynecologist performs lysis, so you might have challenges finding a provider. The International Society for the Study of Women’s Sexual Health has a provider search feature that might help locate providers.
When we have patients who suspect they have clitoral adhesions, we refer them to the Centers for Vulvovaginal Disorders which have offices in Tampa, Washington and New York City. Dr. Goldstein literally wrote the book on pelvic pain (When Sex Hurts), and his team take great care of our patients.
How can sex therapy help?
The Pomegranate Institute specializes in providing sex therapy to patients suffering from vulvar pain disorders (like lichen sclerosus, vulvodynia, vestibulodynia, Genitourinary syndrome of menopause (GSM), and HSV).
We help patients process the emotional impact of being in pain, and teach evidence-based strategies for reducing pain.
If you’re looking for a sex therapist in Massachusetts, reach out!
Sarah Chotkowski, LICSW | Kink-Aware Therapist in Massachusetts
Based in Western Massachusetts, Sarah is a therapist who specializes in treating patients from erotically marginalized communities. She is queer, LGBTQIA+ affirming, kink-aware, pleasure-positive, and passionate about working with people who practice Ethical Non-Monogamy/Polyamory and folks who have been or are involved in sex work.
