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 therapists 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:
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.
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 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 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 therapy that includes relaxation exercises and stretches can often help manage this condition.
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 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 therapists at PHRC include a thorough vulvar examination, including examination of the clitoris in our physical 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.
Medical accounts to follow for more Information:
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.
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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