Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions
Authors: Myers M , Romanello J , Nico E , Sussman R , Marantidis J , Rubin R 
Published: July 2022

ABSTRACT

Introduction
In clitoral adhesions (CA), a closed compartment of space under the clitoral hood can lead to accumulation of squamous cells and smegma, irritation, erythema, and infection. This causes the prepuce to adhere to the glans clitoris and prevents the corona, a ridge of tissue between the glans clitoris and the clitoral body, from being visualized. CA can cause discomfort, hypersensitivity or hyposensitivity, difficulty reaching orgasm, and chronic vulvar pain including clitorodynia. One treatment for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, yet there is a paucity of data on its effectiveness in treatment of symptoms and restoration of function.

Objective
To evaluate patient-reported outcomes of the non-surgical lysis procedure in order to determine if this procedure is an appropriate treatment for symptomatic CA that can be performed in the office-based setting.

Methods
61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a chart review and an online survey was sent to patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure.

Results
There were 41 survey responses (67% response rate). All women that reported the ability to achieve orgasm from external clitoral stimulation maintained this ability after the procedure (n=24), and of the women that could not do so before the procedure (n=16), 6 were able to afterwards. 76% of respondents reported improvement in pain with 44%, 28%, and 4% reporting significant, moderate, and slight improvement. 63% reported improvement in sexual arousal with 25%, 25%, and 13% reporting significant, moderate, and slight improvement. 64% reported improvement in their ability to achieve orgasm with 26%, 18%, and 21% reporting significant, moderate, and slight improvement. 71% reported improvement in their satisfaction with sex with 27%, 17%, and 27% reporting significant, moderate, and slight improvement. 80% of respondents reported they could have comfortable physical/sexual stimulation within one month of the procedure, and 31% of respondents reported that it took one week or less. 93% of participants would recommend the procedure to a friend who also had CA. 65% and 18% of respondents reported being extremely and mostly satisfied with their decision to have the procedure.

Conclusions
These findings indicate that most patients reported improvement in their pain and sexual functioning, and no participants reported worsening in their pain, sexual arousal, or ability to achieve orgasm. 6 of 16 patients that could not achieve orgasm from external clitoral stimulation prior to the procedure were able to afterwards. Thus, the non-surgical lysis procedure could be considered as a treatment for pain and sexual dysfunction associated with CA.

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