By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles
The sole purpose of the clitoris is to be a source of pleasure. For anyone who has experienced provoked or unprovoked clitoral pain their experience can be the opposite and very alarming. There are a number of reasons why people may have clitoral pain and there are also solutions. However like most conditions we treat and write about, clitoral pain is mismanaged and poorly understood by the medical community.
In 2022, one of our favorite sex med experts and beloved urologist Dr. Rachel Rubin published the first-ever scientific paper on clitoral adhesions. It is no surprise providers do not know how to examine or treat clitoral pain if they are not taught and they cannot be taught without scientific studies. Better late than never and while we have a long way to go this is a groundbreaking change for people with vulvas!
In 2023 Dr. Rachel Rubin teamed up with the York Times to talk about why the medical community is failing vulva owners in their powerful article Half the World has a Clitoris. Why Don’t Doctors Study It?
This blog post will help you learn what your doctors and physical and occupational therapistss and friends and family may not know yet. There is always a reason and solutions for clitoral pain.
What is Clitoral Pain?
Clitoral pain is medically known as clitorodynia, which simply means pain at the clitoris. The clitoris is part of the vulva and therefore the clitorodynia is considered a form of vulvodynia by some. The terms ‘vulvodynia’ and ‘clitorodynia’ only describe the anatomic location of the pain, they do not tell us why the pain exists. Today we will give you common causes.
Clitoral pain may be provoked, unprovoked, sharp, diffuse, and/or triggered before, during, or after arousal and/or orgasm. Being able to describe the different scenarios and symptoms that people experience helps us as providers clue in to underlying causes! We want to encourage people not to feel embarrassed, it is just anatomy after all.
This list of causes is not exhaustive, but are the most common causes of clitoral pain:
Hormonal Insufficiency
The vulva is a hormonally sensitive structure that depends on estrogen and testosterone to function normally. Hormonal insufficiencies can lead to changes in the vulvar tissues, including the clitoris. Hormonal insufficiency can cause atrophy, characterized by thinning, drying, and inflammation of the vulvar tissues leading to pain. Insufficiencies lead to decreased lubrication, lower pain thresholds, reduced blood flow and compromise tissue. All of these things cause hypersensitivity to touch, a condition known as allodynia.
Fact: Most people do not realize premenopausal, ovulating women can develop hormonal insufficiencies and women need testosterone too. Medications, lifestyle, and genetics can contribute to hormonal deficiencies in premenopausal women.
Infection
Infections, such as a yeast or bacterial infection , can cause tissue irritation and subsequent clitoral pain. Yeast infections are characterized by itching, burning, and a thick, white discharge. Antifungal medications are typically effective in treating yeast infections. Other infections like bacterial vaginosis or sexually transmitted infections may also cause similar symptoms and require appropriate treatment. Discharge from vaginal infections can get stuck under the clitoral hood and can cause pain after the vaginal infection is cleared. Local treatment in this area can help.
Pudendal Neuralgia
Pudendal neuralgia is a condition that occurs when the pudendal nerve (responsible for sensation in the genital area) is irritated. Specifically, irritation of the dorsal branch (also known as the clitoral branch) can result in burning, shooting, stabbing, or lancinating pain in the clitoris. Treatments for pudendal neuralgia often involve medications, nerve blocks, physical and occupational therapy, and in some cases, surgery.
Fact: Most providers think of pudendal neuralgia before considering infections, hormonal issues, or adhesions. The differential diagnosis is key for proper treatment and all factors need to be considered.
Pelvic Floor Muscle Hypertonus
Pelvic floor muscle hypertonus refers to a condition where the pelvic floor muscles are constantly contracted, leading to muscle tension and pain. This condition can cause referred pain to the clitoris and can also irritate the pudendal nerve which can cause clitoral pain. Pelvic floor physical and occupational therapy that includes relaxation exercises and stretches can often help manage this condition.
Dermatological Conditions
Dermatological conditions such as vulvar lichen sclerosus can cause clitoral pain. Lichen sclerosus is an inflammatory condition that can cause plaques and itching in the vulva. Additionally, smegma, discharge, or inflammation can get trapped under the clitoral hood, adhere to both the hood and the clitoris, forming what’s known as a ‘Keratin Pearl.’ These pearls can cause significant discomfort and require medical attention for treatment, which may include topical treatments, pelvic floor physical and occupational therapy, or surgical medical intervention.
Seeking Help is Crucial
Experiencing clitoral pain can be distressing, but remember, there’s no shame in seeking help. Health professionals are there to assist you. Discuss your symptoms with your healthcare provider; they can help identify the cause and recommend appropriate treatments. It’s essential to take care of your sexual health and wellbeing, and part of that involves addressing any discomfort or pain you may be experiencing.
The physical and occupational therapistss at PHRC include a thorough vulvar examination, including examination of the clitoris in our physical and occupational therapy evaluations. If you are suffering with these symptoms we are available in person and via digital health to help!
Your pain is valid, and you deserve to live a pain-free life. Don’t hesitate to seek help—you’re not alone in this journey.
Resources:
Clitoral Pain: Causes and Treatment
Clitoral Woes? Say It Ain’t So
Medical accounts to follow for more Information:
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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 and occupational therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical and occupational therapists will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical and occupational therapists will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical and occupational therapists will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical and occupational therapistss focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical and occupational therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.