Clitoral Phimosis Should Have its own Diagnostic and Procedural Codes
Authors: Romanello J , Myers M , Nico E , Sussman R , Marantidis J , Rubin R 
Published: July 2022

ABSTRACT

Introduction
Clitoral phimosis occurs when the prepuce adheres to the glans clitoris. Similarly, penile phimosis occurs when the prepuce adheres to the glans penis. Symptoms of clitoral phimosis can include pain, difficulty with arousal, and muted or absent orgasm. While previous studies on the prevalence of clitoral phimosis in a group of 589 college students in a health clinic was 33%, and in a population of 614 patients with sexual dysfunction, it was 23%. There are no diagnosis codes (ICD codes) or procedure codes (CPT codes) for clitoral phimosis or the lysis procedure for clitoral phimosis. Proper codes ensure that patients receive adequate treatment and are charged appropriately for medical services.

Objective
To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that clitoral phimosis should have its own diagnosis and procedure codes.

Methods
To evaluate the efficacy and patient satisfaction of the lysis procedure, survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice were analyzed. The survey was sent to 61 patients and 41 responded (67% response rate).

Results
Among participants who reported pain as a symptom of phimosis (n=25), 76% saw an improvement in pain, with 44%, 28%, and 4% reporting significantly, moderately, or slightly reduced pain. Among those who reported difficulty with arousal before the procedure (n=40), 62.5% saw improvement, with 25%, 25%, and 12.5% considering it to be significantly, moderately, or slightly easier to become aroused. Among those who reported difficulty achieving orgasm before the procedure (n=39), 64% saw improvement, with 25.6%, 17.9%, and 20.5% reporting that they found it significantly, moderately, or slightly easier to achieve orgasm. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. 92.7% would recommend the procedure to a friend who had phimosis.

Conclusions
These findings show that most patients reported improvement in their pain and sexual function, and no patient reported a loss of functioning or worsening of symptoms. The lysis procedure should be recognized as a treatment for pain and sexual dysfunction associated with clitoral phimosis. The routine management of clitoral phimosis in clinical practice should be reflected in diagnosis and procedure codes, which currently do not exist. The lack of proper codes creates a barrier to diagnosis and treatment of clitoral phimosis. If doctors use the ICD code for phimosis, it is rejected by insurance - the codes for “phimosis” and “balanitis” are only designated for male patients. Proper codes support the importance and medical necessity for performing the lysis procedure, and would help communicate a patient's health to other healthcare providers, specialists, insurance payers, and data registries.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout, Absorption Pharmaceuticals