Clitoral pain

“Clitorodynia” is an abnormal pain of the clitoris. Typical symptoms are a sharp, stabbing pain or a rawness/irritation of the clitoris that can be exacerbated by touch, walking, wearing tight underwear or moving at certain angles. The most common cause of clitorodynia is a build up of Keratin Pearls (a hard, grain-of-sand like material) between the clitoris and the hood of the clitoris (prepuce). Additional causes of clitorodynia include skin diseases affecting the vulva such as lichen sclerosus or lichen planus, a herniated disc or cyst in the sacral or lumbar spine, injury of the pudendal nerve or the dorsal clitoral branch of the pudendal nerve.


Treatment

The treatments options for clitorodynia depending on the cause of the pain. The treatment for the Keratin Pearl excision may be done in-office or in the operating room (depending on the severity of clitoral adhesions between the clitoris and prepuce). The procedure consists of breaking up the adhesions with a fine metal probe and then removing the Keratin Pearls. Patients have some mild post-operative discomfort during the healing process, but will have quick resolution of their sharp, stabbing clitoral pain.

If the cause of the clitorodynia is neuropathic in nature, oral tricyclic antidepressants, such as amitriptyline, nortriptyline, and desipramine can be used. These medications “numb nerves” thereby decreasing the clitoral pain.  The dosages of tricyclic antidepressants used for clitorodynia are significantly less than those used for depression. Alternatively, anticonvulsants such as Neurontin (gabapentin) and Lyrica can be used to treat neuropathic causes clitorodynia and they typically have fewer side effects than tricyclic antidepressants.

Conditions we treat

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