Improvement in the Ability to Orgasm after the Non-Surgical Lysis Procedure for Clitoral Adhesions
Authors: Nico E , Romanello J , Myers M , Sussman R , Marantidis J , Rubin R 
Published: July 2022

ABSTRACT

Introduction
Clitoral stimulation is an essential component of the orgasm experience for many women during sexual intercourse. Stimulating the clitoris indirectly stimulates other parts of the genital area, including the vagina, and ultimately affects the ability to have an orgasm experience. In a 2017 study looking at women's experiences with genital touching, sexual pleasure, and orgasm by Herbenick et al, 36.6% of women noted clitoral stimulation was necessary for orgasm and another 36% of women indicated that even though clitoral stimulation was not required it did make orgasms feel better. Clitoral adhesions (CA) can be associated with the inability to reach orgasm with clitoral stimulation. CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, and chronic vulvodynia. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical office-based procedure that stretches the preputial tissue open. There are no studies that explore the ability of the non-surgical lysis of CA procedure to improve a woman's ability to achieve orgasm with external clitoral stimulation.

Objective
The aim of this study is two-fold: 1) to evaluate the characteristics of women who were not able to orgasm with external clitoral stimulation prior to the non-surgical lysis of CA procedure and 2) to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in these same women.

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 an IRB-approved retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure.

Results
41 women participated in the study (67% response rate) and 16 (39%) of them could not achieve orgasm with external clitoral stimulation prior to the non-surgical lysis of CA procedure. Of those 16 women who could not achieve orgasm from external clitoral stimulation, 6 (38%) were able to do so after the non-surgical lysis of CA procedure. Of these 6 women prior to the procedure, 67% had a diagnosis of vulvodynia/vestibulodynia, 67% reported discomfort or pain during sexual activity that involves physical touch of the vulva, and 83% reported lack of clitoral sensation. Unfortunately, 50% of these women who were able to orgasm with clitoral stimulation after the procedure did lose this ability over time. Nonetheless, 83% were extremely satisfied with the procedure and 100% would recommend it to a friend who also had CA.

Conclusions
The non-surgical lysis of CA procedure may be a worthwhile option for women who are unable to achieve orgasm with external clitoral stimulation. Of note, many of these women with CA who were unable to orgasm with clitoral stimulation also had pain or discomfort with sexual intercourse which may exacerbate the problem.

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