Monterey Pelvic Medicine and Pain Management

Clitorodynia

Clitorodynia (come again?) Klit-or-oh-di-nia (clitoro- +‎ dynia)

It is a complicated medical term that simply means pain in the clitoris. It is a subset of general vulvar pain (vulvodynia).However, because the clitoris is a powerful organ of sexual pleasure (the tip has thousands of sensory nerve endings, more than any other body part,)  painful clitoris is usually associated with orgasmic or arousal feeling even without sexual desire (Pain-Pleasure Dichotomy). This is a very disturbing condition that causes embarrassment, great agony to women and often misunderstood and underestimated by medical providers. Women describe it as …

This is the worst thing EVER! A new symptom of constant VERY unwanted feeling of swelling and arousal in the clitoris. It is making me crazy and I feel so disgusting about my body and just really emotionally vulnerable that my body is producing these feelings that are so unwanted!”

“I felt like someone was piercing my clitoris! I cannot stand it when that happens, but at least for me it is intermittent and resolves on its own. I don’t even want to go on, it is a total nightmare!”

“yep, I’ve got it too. For me, I feel like a pencil is being rammed into my clitoris, and I have a throbbing feeling on my entire vulva, including my vagina. It could be described as pleasurable…but not constantly of course!”

For a long time medical community took a passive attitude declaring that this condition without known cause and offered no treatment. The International Society for the Study of Vulvovaginal Diseases (ISSVD) defined vulvodynia:

“chronic vulvar discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder,”Patients can be further classified by the anatomical site of the pain (e.g. generalized vulvodynia, hemivulvodynia, clitorodynia)” 

This is an archaic and defeatest attitude that did not offer any hope, as Stephanie Prendergast, a pelvic pain practitioner and researcher, noted

Reading this archaic, horrendous definition left me thinking WTF? How would I feel if I was diagnosed with Vulvodynia, and read online that it is chronic (doomed for life!), absence of relevant visible findings (I suppose it is all in my head and the fact that I am in pain is ‘irrelevant’), and that I would be ‘classified’ based on where my pain is?

The good news that is changing, International Pelvic Pain Society,is identifying causes and management to this difficult condition. Causation includes mechanical irritation from clothing to bicycle riding, chemical irritation from exposure, anatomical causes such as abnormal skin covering.  Additionally, skin conditions like any other location should be considered.  Newer development include the pudendal nerve neuropathy plays a major part in this. The dorsal branch of the pudendal innervate the Clitotoros.

Currently, there are many treatments available from topical anesthetics, hormonal, compound topical can be formulated to combat nerve ending pathology. Oral medications to alleviate and help coping with the effect of this condition. Finally, treating peripheral nerve neuropathy including nerve block is effective.

This is a difficult condition, but not hopeless, there are many modalities in diagnosing and successfully treating CLITORODYNIA!

 

Tags: ,