(Video Poster 05) In the Hood No More: Clitoral Adhesiolysis

Objectives: We present a stepwise approach to non-surgical lysis of clitoral adhesions. Adhesions occur when the clitoral prepuce fuses to the glans clitoris, obscuring visualization of the corona. After viewing this video, the gynecologic surgeon will be able to identify the severity of clitoral adhesions, be aware of underlying etiologies, and identify symptomatic patients who may benefit from non-surgical adhesiolysis. Viewers will understand specific techniques for the procedure that can be utilized in a spectrum of severity and be able to instruct patients on post-procedure care.

Methods: In this video, we present a visual demonstration of clitoral adhesiolysis using three patient examples, each case with increasing complexity. We provide an overview of pre-procedure set-up, including recommended tools for more complex cases and discuss procedural analgesia in both office and operative settings. In each unique patient case, video footage is shown of the technique used to restore anatomy and improve visualization of the clitoral glans and corona. We include descriptions of several techniques for troubleshooting severe adhesions, including use of mosquito forceps, fine-tipped forceps and lacrimal duct dilators. If these techniques prove unsuccessful to provide full exposure of the glans, a method for making a small incision in the prepuce is described. Finally, we discuss our approach to post-procedure care aimed at preventing recurrent adhesions.

Clinical Relevance: Clitoral adhesions correlate with clitoral hyper- or hyposensitivity, discomfort or clitorodynia, and even difficulty with arousal and orgasm in many patients. Lysis of clitoral adhesions is a low-risk procedure that has the potential to improve sexual function in symptomatic patients. Increased physician awareness and comfort with performing non-surgical clitoral adhesiolysis can improve patient access to this intervention.