Dealing with Clitoral Phimosis

In Female Pelvic Pain by Stephanie Prendergast

By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles

Clitoral phimosis, while not widely discussed, is a condition that affects many worldwide. It’s characterized by the formation of adhesions or scar tissue that covers the clitoris, causing discomfort, pain, and sexual dysfunction. Understanding and managing this condition can significantly improve the quality of life for those affected.

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What is Clitoral Phimosis?

Clitoral phimosis is a medical condition where the clitoral hood becomes adhered to the clitoris due to the formation of adhesions or scar tissue. This often results in decreased sensitivity, discomfort, or pain during sexual activity. It’s a common symptom of lichen sclerosus, an autoimmune skin condition, but it can also occur due to aging, hormonal changes, or daily life factors that include things such as hair getting ‘stuck’ under the clitoral hood and causing inflammation and/or infection. 

Symptoms and Diagnosis

Symptoms of clitoral phimosis include decreased sensitivity or pleasure during sexual activity, discomfort or pain in the clitoral area, symptoms of persistent genital arousal, and challenges with urination.

Diagnosis is typically made through a physical examination by a healthcare provider. If you notice any changes in your clitoral area, such as increased sensitivity, pain, or visible adhesions, it’s crucial to consult with a healthcare provider.

Treatment Options

Treatment options for clitoral phimosis depend on the severity of the condition and the underlying cause. Here are some possible treatments:

  1. Topical Steroids: Topical corticosteroids are often the first line of treatment. They help reduce inflammation and can break down the adhesions causing the phimosis.
  2. Hormonal Therapy: If the phimosis is due to hormonal changes, hormonal therapy might be recommended. This could involve topical estrogen creams or systemic hormone replacement therapy.
  3. Surgery: In severe cases, surgery may be necessary to release the adhesions. This is typically a last resort when other treatments have failed.
  4. Sexual Counseling and Therapy: Since clitoral phimosis can impact sexual function and pleasure, sexual counseling or therapy can be beneficial. This type of therapy can help individuals and couples navigate changes in their sexual relationships due to this condition.

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Coping with Clitoral Phimosis

Living with clitoral phimosis can be challenging, both physically and emotionally. Here are some strategies to cope:

  • Education: Understanding the condition can help reduce anxiety and fear. Read about it, ask your doctor questions, and consider joining support groups.
  • Communication: If you’re in a relationship, openly communicate with your partner about your condition, how it impacts your sexual activity, and ways you can work together to maintain intimacy.
  • Self-Care: Regular gentle cleaning of the clitoral area can help prevent further adhesions. Avoid harsh soaps or irritants that could exacerbate the condition.
  • Seek Help: Don’t hesitate to reach out to healthcare professionals if you’re struggling with physical discomfort or emotional distress.

Clitoral phimosis, like many sexual health issues, can feel isolating. But remember, you’re not alone. With the right information, treatment, and support, you can navigate this condition and maintain a fulfilling sexual life. If you think you might have clitoral phimosis, consult with a healthcare provider to discuss your symptoms and treatment options.

 

Resources:

  1. Herman & Wallace Pelvic Rehabilitation Institute:
    • Rachel Kilgore, a certified pelvic rehabilitation practitioner, discusses the use of specific myofascial release as a treatment for clitoral phimosis in this blog post.
  2. International Society for the Study of Women’s Sexual Health (ISSWSH):
    • This position statement on lichen sclerosus from ISSWSH provides detailed information about this condition, which is often associated with clitoral phimosis.
    • You can also explore their educational videos section for more insights into women’s sexual health issues.
  3. LS Support Network:
    • The LS Support Network provides a comprehensive article about the relationship between the clitoris, lichen sclerosus, and clitoral phimosis. You can find it here.

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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 therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists 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 therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist 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 therapist 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 therapist 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 therapist 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 therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical 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 therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical 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 therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists 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 therapists 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 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.