Reduced Satisfaction and Increased Recurrence after Lysis Procedure for Clitoral Adhesions in Patients with Persistent Genital Arousal Disorder
Authors: Myers M , Romanello J , Nico E , Sussman R , Marantidis J , Rubin R 
Published: July 2022

ABSTRACT

Introduction
Clitoral adhesions (CA) occur when preputial skin that normally moves over the glans clitoris to expose the corona becomes adhered, creating a closed compartment that is vulnerable to irritation, erythema, and infection. CAs can be associated with persistent genital arousal disorder (PGAD), which is characterized by persistent or recurrent, distressing feelings of genital arousal that are not associated with sexual interest or thoughts. One treatment option for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, but this procedure has not been specifically studied in women with PGAD.

Objective
To determine if women with PGAD treated for CA with the non-surgical lysis procedure reported satisfaction and outcomes that were different from women without PGAD.

Methods
61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice between the years of 2017 and 2021 were identified using a chart review and an online survey was sent to patients to evaluate patient satisfaction and the efficacy of the procedure in patients with and without PGAD.

Results
41 survey responses were received (67% response rate) and 4 women had a PGAD diagnosis. There was no difference in the procedure's ability to improve pain (50% vs 81%), ability to orgasm (75% vs. 63%), or sexual satisfaction (50% vs. 73%) between women with and without PGAD. 65% of all respondents (n=40) reported being “extremely satisfied” with their decision to have the lysis procedure; however, significantly fewer patients with PGAD reported being “extremely satisfied” as compared to the control group (25% vs. 69%; p=0.04). In addition, while only 27% of all participants reported that the procedure was painful, women with PGAD were significantly more likely to report pain than women without PGAD (75% vs. 22%; p=0.01). Lastly, 51% of respondents (n=37) reported recurrence of CA after the procedure, but the incidence of readherence was significantly higher in patients with PGAD compared to patients without PGAD (100% vs. 45%; p=0.02). The increased readherence in women with PGAD was not attributable to differences in post-procedural care (use of hormone cream, yeast cream, vaseline, or retraction of the clitoral hood) or risk factors for CA (history of yeast infections and urinary tract infections, use of hormonal-based contraceptives, blunt perineal or genital trauma, lichen sclerosus, or history of sexual pain) as these were not significantly different between study groups.

Conclusions
These results indicate that the non-surgical lysis procedure has similar efficacy in improving pain and sexual function in women with and without PGAD. However, this procedure may be a less favorable treatment for CA in women with PGAD as evidenced by lower reported satisfaction with the procedure, increased reports that the procedure was painful, and higher rates of readherence in this group. As only 4 women in our study had PGAD, future studies with more patients with both PGAD and CA may be necessary to provide insight into additional treatment options that may offer these patients more satisfaction and improved outcomes.

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