Lysis of Clitoral Adhesions: An In-Office Procedure

Ponce, S, Davide, M, Conrado, J, Doshi, C Yih, J, Rubin R

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Clitoral adhesions occur when the preputial skin adheres to the glans clitoris at one or more points distal to the balanopreputial sulcus. These adhesions are present in approximately 23% of individuals experiencing sexual dysfunction.1 When adhesions create a closed compartment, they can lead to balanitis, causing irritation, erythema, or infection. Additionally, keratin pearls, which are accumulations of smegma and squamous cells, may form beneath the prepuce. This can contribute to discomfort, hypersensitivity, foreign body sensation, orgasm difficulties, or clitorodynia. Treatment can be performed in an office setting under local anesthesia. After applying a topical anesthetic, microfine Jacobson mosquito forceps are gently maneuvered around the balanopreputial sulcus to release adhesions, separate the glans from the prepuce, and remove any foreign bodies or keratin pearls. Once the adhesions are cleared, the corona should be fully visible circumferentially. This procedure has been shown to significantly improve clitoral pain, increase total Female Sexual Function Index (FSFI) scores, decrease mean FSFI score for pain, and enhance orgasmic function.2 This video outlines a minimally invasive approach to addressing common sexual concerns in female patients, and is accessible to clinicians of varying specialties and scopes of practice.

The authors would like to acknowledge Coloplast and Laborie for their support in fostering education through the Video Journal of Sexual Medicine. The authors would also like to thank Dr. Irwin Goldstein for being an innovator in the field of female sexual medicine and training the authors on the techniques outlined in this video.

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