The Clitoris: Small but Mighty

The clitoris. It’s a part of woman’s anatomy that has been both vilified and revered. But in the world of medicine, it’s been mainly just ignored.

I probably don’t have to tell you that the penis has most certainly *not* been overlooked in medicine (or anywhere else for that matter!).

The clitoris has likely been at least partially ignored because no one is talking (or teaching) about it. 

Urology residents are specially trained over many years to become experts in the examination of the penis, but there is no teaching on how to examine the female homologue of the penis, the clitoris. The clitoris and penis are homologous organs because they both originate from the genital tubercle of the fetus and have shared anatomic structure/function.

Interestingly, gynecology residency programs aren’t routinely teaching doctors how to examine the clitoris either.

Normally, the clitoral hood, also known as the prepuce, can be easily retracted or pulled back from the clitoral glans (the tip of the clitoris that is sensitive to touch and most visible externally). In women with a clitoral adhesion, the clitoral hood becomes adhered or ‘stuck’ to the clitoral glans, making it very difficult to retract the hood. At times, the clinician can see the white smegma and is able to carefully remove it with a cotton swab. However, if the adhesions are trapped under the clitoral hood, it potentially can lead to infection, inflammation, and irritation.  Women with clitoral adhesions may develop a hypersensitivity to touch or, interestingly enough, a deadening of sensation as the adhesions serve as a barrier to the oh so sensitive nerve endings on the clitoris. In more pronounced cases, a patient may be given an anesthetic to facilitate removal of the adhesions via a minimally invasive procedure in the office.

Women at increased risk for clitoral adhesions are those with a history of blunt genital trauma/injury, fungal or bacterial infections, dermatologic issues like lichen sclerosis, and inadequate levels of sex steroid hormones, specifically testosterone. It’s interesting to note that the clitoris, like its homologue the penis, is a testosterone-dependent organ. So, if there is a decline in testosterone (as is commonly seen with long-term birth control pill use), the clitoris can begin to atrophy, or decrease in size.

Women with pronounced clitoral adhesions may describe the sensation as similar to feeling a grain of sand in their eye. For most women with clitoral pain/discomfort/hypersensitivity, they have come to believe that there’s nothing that can be done. For some women, it’s too uncomfortable to have direct clitoral touch. For others, even wearing tight clothing can be unbearable. Unfortunately, this acceptance of their chronic discomfort is due to the lack of understanding about the clitoris in general, and clitoral pain specifically. 

Fortunately, research is increasing dramatically in the study of the clitoris. This perhaps is due to the large number of women entering gynecology and urology residency programs who are forwarding women’s health research. It is also likely because patients are beginning to speak up to their health care providers about sexual pain and discomfort and are no longer accepting having their pain dismissed. 

If you are experiencing any type of sexual pain/discomfort, it’s important to seek help. Sexual pain is not normal, and you don’t have to ‘just live with it.’ We can help. Contact us for a free phone consultation. 

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