in-office treatment of clitorodynia: lysis of clitoral …in-office treatment of clitorodynia: lysis...
TRANSCRIPT
![Page 1: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/1.jpg)
In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block
Sherita A. King, MD and Irwin Goldsein, MD
![Page 2: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/2.jpg)
Clitorodynia
• Uncommon, localized form of vulvodynia
• Confined to the to the glans clitoris, clitoral shaft, and/or the adjacent prepucial area
• Constant, intermittent or provoked• Burning, stinging, and/or sharp pain• Commonly increases with sexual activity• Generally chronic
• Typically managed with the same treatments used for generalized vulvodyniausually ineffective
![Page 3: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/3.jpg)
Anatomy of the Clitoris
Crus = 7cm
![Page 4: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/4.jpg)
Glands of Littre
Emb
ryo
logy
![Page 5: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/5.jpg)
![Page 6: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/6.jpg)
![Page 7: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/7.jpg)
![Page 8: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/8.jpg)
PRINCIPLE OF VULVOSCOPY
![Page 9: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/9.jpg)
![Page 10: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/10.jpg)
Clitoral Phimosis
• Clitoral hood obscures visualization of the glans clitoris
• Varying degrees
– Complete phimosis
– Adhesions of adjacent skin to the glans with numerous keratin pearls and sebum emanating through the adhesions that conceals the glans corona
• Persistent balanitis underneath the adhesions
![Page 11: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/11.jpg)
![Page 12: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/12.jpg)
![Page 13: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/13.jpg)
Methods
• 7 patients (mean age 37 years, range
18 - 62 years)
• Adhesions from the clitoral hood to
the glans, obscuring the corona of the
glans clitoris
• Vulvoscopy identified smegma
underneath the adhesions.
![Page 14: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/14.jpg)
![Page 15: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/15.jpg)
![Page 16: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/16.jpg)
Lysis of Adhesions
• Dorsal nerve block was performed with 5 mL of either of mixture lidocaine/bupivacaine or liposomal bupivacaine
• Jacobson hemostat forceps was used to bluntly lyse the epithelial adhesions and remove the underlying keratin pearls
• Continue until the corona was visualized completely around the circumference of glans clitoris
• An additional 5mL of the local anesthetic was injected around the prepuce and frenulum of the clitoris for post-operative pain control
![Page 17: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/17.jpg)
Before
![Page 18: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/18.jpg)
![Page 19: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/19.jpg)
![Page 20: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/20.jpg)
Post Procedure Instructions
• BID baths and soak the area
• Gentle retraction of the clitoral hood
• MUST visualize the corona to prevent the re-adherence of the adjacent clitoral hood to the glans
![Page 21: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/21.jpg)
Post Procedure Instructions
• Even after the initially healing period, it was
IMPORTANT for them to observe the corona
and to continue retracting the hood daily to
prevent adhesions
![Page 22: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/22.jpg)
BEFORE AFTER
![Page 23: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/23.jpg)
BEFORE AFTER
![Page 24: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/24.jpg)
Results
• None of the patients had recurrence of adhesions 6 months post procedure
• 5/7 women had significant reduction of clitoral pain
![Page 25: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/25.jpg)
Conclusion
• Clitorodynia can be caused by adhesion of adjacent skin to the glans clitoris • secondary to underlying unrecognized balanitis
• Release of these adhesions can be achieved in-office under local anesthesia with preservation of the prepuce
• The corona of the glans clitoris must be observed during physical examination of women with clitorodynia
• This closed compartment balanitis clitorodynia is an outpatient treatable form of chronic pain or trigger for women with PGAD
![Page 26: In-Office Treatment of Clitorodynia: Lysis of Clitoral …In-Office Treatment of Clitorodynia: Lysis of Clitoral Adhesions Following Dorsal Nerve Block Sherita A. King, MD and Irwin](https://reader031.vdocument.in/reader031/viewer/2022013002/5eccec09ef54ca3b8c18b38c/html5/thumbnails/26.jpg)
ITHURTS!
???