Interventions for Clitoral Adhesions/Phimosis in Adult Women: A Systematic Review and Meta-Analysis of Sexual...

Clitoral adhesions/phimosis is increasingly recognized in women with sexual pain or arousal/orgasm difficulty, yet outcomes and post-lysis care are poorly standardized. We synthesized clinical evidence and quantified effects on pain and sexual function, and developed adjunct educational schematics of key procedures and aftercare.

Systematic review and meta-analysis conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline, using MEDLINE, Embase, Scopus, Web of Science, and CENTRAL to 27 September 2025. Eligible studies enrolled adult women with clinically diagnosed clitoral adhesions/phimosis and reported outcomes after office lysis, lysis with keratin-pearl excision (LCA-KPE), or surgical/laser release. Primary outcomes were change in pain on visual analogue or numeric rating scales (VAS/NRS) and Female Sexual Function Index (FSFI total). Random-effects models (REML with Hartung-Knapp) synthesized change scores; prespecified subgroups examined technique, lichen sclerosus, post-lysis care intensity, follow-up, and menopausal status. The protocol was finalized a priori but not registered.

We identified 482 database records plus 24 from other sources; 151 duplicates were removed. After screening 355 records, 104 full texts were sought (4 not retrievable); 100 were assessed, and 14 were included; 8 contributed to meta-analyses. Interventions yielded clinically meaningful within-participant improvements: pooled pain reduction MD -2.4 (95% CI -3.0 to -1.8; I² = 58%) and pooled FSFI total MD +4.1 (95% CI +3.5 to +4.7; I² = 52%). Subgroup patterns suggested larger gains with LCA-KPE. Recurrence was common (aggregate ≈31%; variable definitions). Adverse events were uncommon and generally minor. Certainty for primary outcomes was low owing to small, single-arm designs and heterogeneous reporting.

Release procedures, particularly with keratin-pearl excision, reduce pain and improve sexual function. Durability likely depends on standardized post-lysis care. To support clinical translation, we also provide educational schematic figures and a structured post-lysis care algorithm, alongside priorities for a severity classification, core outcomes (including FSFI domains and recurrence), and prospective comparative trials.