You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy1 Apr 2016MP48-07 SUCCESSFUL MANAGEMENT OF CLITORODYNIA CLOSED COMPARTMENT SYNDROME Sherita King, Joshua Gonzalez, and Irwin Goldstein Sherita KingSherita King More articles by this author , Joshua GonzalezJoshua Gonzalez More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.347AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 24.7-36.8% of women complain of pain during sexual activity. Clitorodynia, a localized form of vulvodynia, is an uncommon, distressing, often disabling sexual pain syndrome with burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial area. The pain may be constant, intermittent or occurring only when provoked. The clitoral pain commonly increases with sexual activity, and is generally chronic. Women with clitorodynia are usually managed ineffectively with the same treatments used for generalized vulvodynia. METHODS We retrospectively reviewed prevalence and clinical management experience of distressing clitorodynia in our multidisciplinary sexual medicine facility in the last 5 years. RESULTS Of 430 women with vulvodynia we identified 15 with clitorodynia. The glans corona of 8 could not be identified on vulvoscopy, despite vigorous retraction maneuvers. Adjacent skin adhesions to the glans clitoris were identified and an oily waxy sebum material exuded through breaks in adhesions. Under higher magnification, keratin or epithelial pearl structures forming concentric layers 0.5-2 mm in diameter were seen under squamous skin epithelial adhesions. These 8 women underwent exploration, dorsal slit surgery and release of localized adjacent skin adhesions to the glans clitoris. In all 8 more than 50% of the glans was involved, balanitis noted below the glans skin adhesions above the corona. Two also had lichen sclerosis concomitantly managed with clobetasol. Six of 8 patients have significant improvement of clitoral pain at least 1 year postop. Of the 7 other women, 3 had clitoral priapism responding to adrenergic agonist treatment or shunt surgery, 2 had suffered blunt perineal trauma, suspected of having pudendal neuropathy, and 2 had blunt perineal trauma with clitoral neuromata on surgical exploration. CONCLUSIONS Clitorodynia, although rare, often appears to be caused by a closed compartment syndrome of adjacent skin adhesions to the glans clitoris, leading to underlying unrecognized balanitis, keratin pearl formation and chronic pain. If the corona of the glans clitoris cannot be visualized despite vigorous retraction, a closed compartment form of treatable chronic clitoral pain should be suspected. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e637-e638 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sherita King More articles by this author Joshua Gonzalez More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...