By Stephanie A. Prendergast, MPT, Cofounder, PHRC Los Angeles
There are a number of treatable causes of clitoral pain, yet often patients are misdiagnosed and this distressing symptom can persist.
Hormonal deficiencies associated with birth control pills, acne medications, and age can lead to thinning of hormonally sensitive structures, such as the clitoris and clitoral hood. This can lead to micro tears, inflammation, pain and a few other symptoms described below.
Clitoral phimosis occurs when the clitoral hood fuses together. This can compress the clitoris and trap discharge under the hood and cause pain. Hormone deficiencies and vulvar diseases such as Lichen Sclerosus can lead to this type of architecture change.
Vaginal infections and vulvar infections can lead to inflammatory and infectious discharge that can accumulate under the clitoral hood and cause pain. It is important to note that vaginal swabs may be negative for infection but there can still be an infection on the vulva. Treatment for vaginal and vulvar infections are different.
Surgical scars in the suprapubic or vulvar area can lead to fascial restrictions, pelvic floor dysfunction, and/or peripheral neuralgias which can cause clitoral pain. Understanding what the cause is leads to effective treatment, which is often a combination of medical management and pelvic floor physical therapy.
Vulvar Lichen Sclerosus and other dermatologic diseases can cause clitoral pain. These diseases are thought to be autoimmune and are diagnosed via a biopsy and can be successfully treated with medical management.
Our bodies have right and left pudendal nerves with dorsal branches that are responsible for sensory information to and from the clitoris. If either of these branches become irritated, people may feel unilateral or bilateral clitoral pain. A diagnosis of pudendal neuralgia is made by history and physical examination. Pelvic floor dysfunction is associated with most pelvic pain diagnoses. Dysfunctional pelvic floor muscles can refer to pain in multiple places, including the bladder, urethra, clitoris, vulva, and vestibule. A diagnosis of pelvic floor dysfunction is made by a physical examination.
Clitoral pain is scary. The good news is that it is treatable when the underlying causes are identified and treated. There can be various reasons people suffer from clitoral pain.
- Identifying and addressing the underlying cause
- Pelvic floor physical therapy
- Home exercises for tissue mobility
- Proper hygiene
If pudendal neuralgia is the cause, it needs to be treated. If a disease such as lichen sclerosus is the cause, it needs to be identified and treated. This is the case for everything on our list. Many providers may not understand all the causes of clitoral pain, if you are not getting the answers you need we recommend consulting with a vulvar health expert.
How to find informed medical providers
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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