A Q&A About Clitoral Pain

In Female Pelvic Pain by Stephanie PrendergastLeave a Comment

By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles & Elizabeth Akincilar, MSPT, Cofounder, PHRC Merrimack

 

What are the possible causes of clitoral pain? How can each of these things cause it?

 

There are several possible causes of clitoral pain. This list of causes is not exhaustive, but are the most common causes of clitoral pain. It could be due to a hormonal insufficiency, particularly estradiol and testosterone. Hormonal insufficiency can cause atrophy in the vulva, including the clitoris, poor tissue integrity and health which can result in pain, and hypersensitivity to touch aka allodynia. It could be due to an infection, such as a yeast infection (vaginal candidiasis), which can cause tissue irritation and therefore pain. It could be due to pudendal neuralgia, particularly the dorsal branch, aka clitoral branch of the nerve. When the dorsal branch of the pudendal nerve is irritated it results in burning, shooting, stabbing, lancinating pain in the clitoris. There are many possible causes of pudendal neuralgia, which are too many to explain here. It could be due to pelvic floor muscle hypertonus which can cause referred pain to the clitoris. Again, there are many different reasons one can develop pelvic floor hypertonus and therefore too complicated to explain sufficiently here.  It could be due to a dermatological condition, such as lichens planus which can cause pain. Smegma/discharge/inflammation can also get trapped under the clitoral hood and adhere to both the hood and the clitoris, this is called a ‘Keratin Pearl’. These require medical attention for treatment,  procedures and sometimes surgery.

 

What should you do if you’re experiencing clitoral pain? Who should you talk to, and what should you tell them / ask them?

 

You should first consult with a gynecologist to rule out/in an infection, a dermatological condition, hormonal insufficiency, and/or other pathology of the vulva. If the suspicion is that the clitoral pain is due to pudendal neuralgia it is best to consult with a medical provider that specializes in pudendal neuralgia. This could be a urologist, a gynecologist, a pain management physician, and/or a pelvic floor physical therapist. If the suspicion is that the clitoral pain is due to muscular dysfunction, then you should consult with a pelvic floor physical therapist. When meeting with any provider you should describe your symptoms as thoroughly as possible, noting any changes to behavior, medications, menses, or other changes in your health that occurred in the weeks or months leading up to the start of your symptoms. 

 

What might be the potential treatments?

 

It is completely dependent on what the cause of the pain is. If it is due to an infection, then it will likely be treated with medication. If it is hormonally mediated, then hormonal supplementation will be indicated. If it is a dermatological condition then it will dictate a specific treatment. If it is due to pudendal neuralgia then likely a combination of interventions may be indicated, including medications, pelvic floor physical therapy, and/or nerve directed therapies. If it is due to a muscular dysfunction then pelvic floor physical therapy will likely be indicated. 

 

How can you advocate for yourself if your doctor doesn’t take this issue seriously?

 

A good pelvic floor physical therapist will often be able to refer you to a physician that is familiar with treating clitoral pain and will be able to work with you to figure out the right combination of interventions. 

 

Have more questions? Drop them in the comments!

 

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Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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