A Case of Severe Clitoral Adhesions and Lysis in a 7-year-old female

S. Hanfling, C. Akunyili, R. Rubin

Clitoral adhesions, Phimosis, Lysis of adhesions

The clitoris, a homologous structure to the penis, comprises a glans, body, and prepuce. The prepuce should be freely retractable over the glans, but clitoral adhesions result in the accumulation of squamous debris leading to pain, irritation, or infection 1. Symptomatic adhesions may be treated with a lysis procedure, which has demonstrated pain reduction and improvement in sexual function in adults 2. Although pediatric foreskin concerns are routinely addressed by pediatric urologists, there is no standardized diagnostic or therapeutic approach for clitoral adhesions for female pediatric patients 3. We present the case of an 7-year-old prepubertal female with five years of genital pain and persistent complaints of a hair “stuck” in her clitoris. She was subsequently found to have complete clitoral phimosis. The patient was prescribed Clobetasol Propionate 0.05% and Estradiol 0.1 mg/gm cream daily. After two months of this regimen with incomplete resolution of symptoms, the patient was seen for a lysis of clitoral adhesions in the operating room. Fine Jacobson mosquito forceps were used to separate the glans from the prepuce and remove smegma. Upon completion of the procedure, the glans was completely visualized and the prepuce was easily retractable. For post-operative pain control, the surgeon performed a dorsal nerve block of the clitoris. The patient’s clitoral discomfort and pain resolved following the lysis procedure. The patient’s parents reported that by two weeks post-lysis, “Her pain has completely disappeared.” This case highlighted the first videotaped procedure of lysis of clitoral adhesions in a pediatric patient. While keratin pearls and clitoral smegmatic cysts are known to cause clitoral discomfort in young girls, there is no standardized management for their diagnosis and treatment.

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1. Romanello JP, Myers MC, Nico E, Rubin RS. Clitoral adhesions: a review of the literature. Sex Med Rev. 2023;11(3):196-201. doi:10.1093/sxmrev/qead004

2. Krapf JM, Kopits I, Holloway J, Lorenzini S, Mautz T, Goldstein AT. Efficacy of in-office lysis of clitoral adhesions with excision of keratin pearls on clitoral pain and sexual function: a pre-post interventional study. J Sex Med. 2024;21(5):443-451. doi:10.1093/jsxmed/qdae034