Clitoral Pain: Causes And Treatment For Clitorodynia

Clitoral pain is also known as clitorodynia. The medical term clitorodynia is a condition where a woman experiences discomfort or pain in the clitoris. 

Clitoral Pain: Anatomy

The clitoris is a part of the body found in the vulvar area. It is considered to be part of the external genitalia.

It has thousands of sensory nerves making it very sensitive to touch. This intricate and sensitive female genitalia is located at the front of a female’s vaginal opening. It is protected by a fold of skin called the clitoral hood. 

Experiencing pain in this area can be frustrating and concerning, especially during sexual arousal or when attempting to maintain good intimate hygiene. If a patient is experiencing pain during orgasm or an inability to orgasm that is also considered to be abnormal. Many people don’t realize that clitoral pain can not only be disruptive to your sex life but it can also interfere with your daily activities.

Clitoral Pain: Causes

There are several possible causes of clitoris pain, ranging from physical factors like inflammation, infection, hormonal imbalances, muscular spasms, and emotional factors such as stress or past trauma. Let’s take a look at some of the common causes of a painful clitoris.

Skin Conditions

Certain skin conditions can cause clitoral pain. Effective treatment depends on correct identification of the condition and proper treatment. Your gynecologist may need to involve a doctor who specializes in disorders of the vulvar area to help treat these.

Lichen Sclerosis And Lichen Planus

Lichen sclerosis and lichen planus are skin conditions that cause white patches and itching on the clitoris. Having either dermatological condition may lead to painful clitoral adhesions or keratin pearls. It is theorized that hormonal imbalances lead to lichen sclerosus and an immune response is responsible for lichen planus.

• Affected Areas: Lichen sclerosus usually affects the genital and anal regions. Lichen planus, however, can affect multiple areas, including the skin, mouth, genitals, and more.
• Appearance: Lichen sclerosus causes thin, white patches and lichen planus causes purplish, flat-topped bumps.
• Causes: Both conditions have unknown causes

Contact Dermatitis

Contact dermatitis can cause clitoral pain along with other symptoms in the genital area. Contact dermatitis is a type of inflammation of the skin that occurs when the skin comes in contact with an irritant or allergen. 

In the genital area, contact dermatitis can be caused using spermicides, sexual lubricants, condoms or other products that cause a reaction in the skin. Also, laundry detergents or fabric softeners used on underwear can cause contact dermatitis in this area. Vaginal douching (attempting to clean inside the vaginal which is self cleaning) can also do this. Tight fitting clothing and tight fitting underwear can also cause this.

Infections

Certain infections can also cause pain in the glans clitoris. Many of the infections mentioned below may not necessarily happen in the clitoris. However, because of the close proximity of the clitoris to the vagina, infections in the vagina may lead to clitoral pain.

Yeast Infection (Candida overgrowth) 

Yeast infections are also known as candidiasis. Yeast infections are caused by an overgrowth of the fungus Candida. 

Candida is a fungus that is naturally present in the body, including the vaginal area. When the balance of microorganisms in the vagina is disturbed, this fungus can multiply excessively, leading to an infection.

Patients with a yeast infection in the vaginal area may also develop the infection in the clitoral hood. 

In this situation the clitoris and the surrounding area can become irritated and painful due to the infection and inflammation caused by the overgrowth of yeast. This can lead to discomfort or pain in the clitoral area, especially when touched during sexual activity.

Bacterial Vaginosis 

Bacterial vaginosis (BV) is a common vaginal infection caused by an imbalance in the natural bacteria found in the vagina. While the primary symptoms of BV include unusual vaginal discharge, fishy odor, itching, and burning during urination, it can sometimes lead to clitoral pain. It usually causes vulvar irritation more often than clitoral pain.

Also in some cases BV may present alongside another infection like a yeast infection. This could then lead to clitoral discomfort or pain as mentioned above.

Urinary Tract Infections (UTIs) 

UTIs can cause inflammation and discomfort around the clitoris which can then cause clitoral pain.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) can cause clitoral pain among other symptoms. The presence of an STI in the genital area can lead to various symptoms, depending on the type of infection. 

There are many STIs that might cause discomfort, irritation, or pain in the clitoral area. They include Herpes Simplex (genital herpes), HPV (Human Papillomavirus), Chlamydia, Gonorrhea, Trichomoniasis, and Syphilis.

Sexual Activity

Vigorous sexual intercourse or inadequate lubrication during intercourse could result in injuries to, or irritation of, the clitoris. Overstimulation or direct friction can also trigger pain and soreness.

Clitoral Adhesions

A clitoral adhesion is when an abnormal connection develops in the tissue of the clitoral hood. This means that the clitoris may be stuck to the clitoral hood and can not move freely. 

Hormonal Changes

Pregnancy and menopause often involve fluctuations in hormone levels that may increase tenderness or pain in the clitoris. The imbalance in hormones may even start during the perimenopause period. The low estrogen levels can contribute to lower levels of lubrication in the vaginal and clitoral area. 

Vulvar Cancer

Vulvar cancer is a rare condition. It originates in the external female genital organs, such as the labia majora, labia minora, clitoris, and the vaginal opening. While it is a relatively rare type of cancer, it can lead to various symptoms depending on its location and stage.

If the cancer affects the clitoris or nearby areas, it can cause clitoral pain. The pain may result from the tumor itself, which can lead to pressure, irritation, or invasion of surrounding tissues. Additionally, if the cancer leads to ulceration or affects nerve pathways, this can also contribute to discomfort or pain in the clitoral area.

Neuropathic Issues

Neuropathic pain in the clitoris, often referred to as clitorodynia when specifically related to pain in the clitoral area, is a type of pain that arises from a dysfunction or damage to the nervous system rather than from a specific injury or inflammation in the clitoral tissue itself. This condition is a subset of vulvodynia, which is chronic pain or discomfort around the opening of the vagina (vulva) for which there’s no identifiable cause and no visible signs of a skin condition or infection.

Neuropathic pain is characterized by sensations that may be described as burning, stabbing, tingling, itching or a feeling of electric shocks. 

The pudendal nerve has an innervation to the dorsal nerve to the clitoris (this innervates the clitoris). When the pudendal nerve is irritated or entrapped it can cause clitoral pain and inability to orgasm or having a painful orgasm. The pudendal nerve can be affected in the following ways:

• Nerve damage from surgery, trauma, or infection.
• Certain physical activities like biking, horseback riding, sitting for extended periods of time.
• Chronic inflammation or irritation
• Hormonal changes, particularly those related to menopause
• Endometriosis
• Pelvic floor muscle dysfunction
• Persistent genital arousal disorder (continuous sexual stimulation and arousal in the clitoris that is not associated with pleasure) 

Clitoral Pain: Diagnosis 

Diagnosing clitoral pain can be challenging so its best to see a medical doctor who specializes in pelvic pain.

Medical History

It is common for the clinician to ask the patient about their medical history, including relevant past medical conditions or traumas that could contribute to the pain. The doctor will want to know about your lifestyle habits, exercise habits, previous pregnancies (vaginal childbirth or C section) and deliveries, and any pain during pregnancies. 

Physical Exam

A doctor will typically start with a physical exam, during which they will carefully assess the area for any visible signs of infection, injury, or skin conditions. They may also check for tenderness or swelling. The doctor may also do a Q tip test to evaluate to see if the clitoral pain is provoked or unprovoked. 

In some cases, a rectal exam may be needed to evaluate the pelvic floor muscles. This may be especially helpful in the case of pudendal nerve pain. 

Consulting Other Specialists

In addition to a pelvic pain doctor, seeing other specialists can be helpful. A pelvic pain doctor may be someone who is trained in Urogynecology, Physiatry, Gynecology, or Urology.

A physical therapist might be involved in your treatment plan. The pelvic physical therapist can help you improve your quality of life through pelvic floor therapy. A pelvic floor physical therapist can also evaluate a patient’s pelvic floor muscles for any signs of pelvic floor dysfunction or pudendal neuralgia. If the pain is thought to be related to the pudendal nerve, additional tests for nerve function might be needed.

Identifying Underlying Conditions

If the physical evaluation does not reveal a clear cause of the clitoral pain, further tests and assessments may be needed to identify any underlying medical conditions. A healthcare provider may look for signs of pudendal neuralgia or vulvar cancer. 

Clitoral Pain: Treatments

Several medical treatments can be considered for dealing with clitoral pain. 

Lifestyle Changes And Home Remedies

Lifestyle changes and home remedies can also play a crucial role in managing clitoral pain.  

Some other beneficial lifestyle changes include:

• Practicing good hygiene
• Avoid tight clothing, wearing loose-fitting clothing
• Using fragrance-free, gentle soaps and laundry detergents
• Avoiding irritants in personal care products
• Taking warm baths to relax the pelvic muscles
• Using a water-based lubricant during sexual activities

Physical Therapy

Patients will want to aim to decrease tension of their pelvic floor. This will help to improve blood flow. When appropriate, and under the guidance of a pelvic floor physician, they can then proceed to strengthen the pelvic floor muscles.

Exercises like Kegel exercises are confusing for patients. Strengthening the pelvic floor muscles too soon could make the problem worse and actually increase pain. 

Pain Medication

Doctors may prescribe pain relievers such as over-the-counter anti-inflammatory medications. In some cases, topical local anesthetic can help to temporarily relieve pain, but this is not a long term solution. 

In some cases, nerve medications like tricyclic antidepressants, neuromodulators like gabapentin, SNRI (serotonin norepinephrine reuptake inhibitors), or anticonvulsants can be prescribed to manage this pain effectively. These medications may be used alone or in combination as directed by your doctor. 

Psychosexual Therapy

In some cases, clitoral pain may also be linked to mental health issues, such as anxiety, depression, or relationship conflicts. To address these sexual function issues, psychosexual therapy can be considered as one of the treatment options. 

This type of therapy involves working with a licensed therapist who specializes in sexual health and can help individuals address any psychological or emotional factors contributing to their pain. Maintaining open communication with your partner about your sexual health is also vital in managing clitoral pain effectively.

Clitoral Pain: Summary

Clitoral pain can be very severe because of the high amount of nerve endings in this part of the human body. From mild pain to severe pain, the most common causes of clitoral pain include inflammation, hormonal imbalances, clitoral adhesions, pudendal neuralgia, and even an allergic reaction. 

Find the underlying causes chronic pelvic pain and treating treating them can improve an individual’s daily life and sexual pleasure. Being aware of the common causes and solutions for clitoral pain can help in maintaining sexual health. 

Seeking professional help through sexual medicine or integrative health services can provide guidance and support in addressing these issues. A pelvic pain doctor who is an expert in finding issues in the external genitals can help. They will conduct a careful examination of your pelvic region, as well as ask you a detailed medical history.