Approach to Diagnosis and Management of Clitorodynia

Clitorodynia, pain involving the clitoris, is considered a localized form of vulvodynia. This review aims to provide the general obstetrician-gynecologist a general framework for diagnostic evaluation of clitorodynia. This is simplified by dividing chronic clitoral pain into structural causes and neuropathic causes. Knowledge of clitoral anatomy, including the corona of the glans clitoris, symptomatology, and evaluation based on the concept of regions is necessary in evaluating chronic clitoral pain. Structural causes are clitoral adhesions or phimosis with debris or keratin pearls, which may be managed with in-office lysis of clitoral adhesions. Neuropathic causes include pudendal neuralgia and meningeal and spinal pathology determined with neurophysiologic testing, imaging studies, and diagnostic nerve blocks. Treatment includes behavioral measures, pelvic floor physical therapy, serial nerve blocks, and targeted nerve release procedures. Obstetrician-gynecologists are well-positioned to identify and provide first-line approaches to diagnosis and treatment of clitorodynia.