Question: I've had a very painfully swollen and hardened clitoris for the last 2 days and the size of the swelling is increasing very rapidly - I think there is probably some sort of internal infection as I cannot see anything from the outside of the skin - but I can definitely feel a hardened area all around the clitoris mostly on the right side of it - this happened to me once before about 3-6 months ago and it took approximately a week to a week and a half for the pain to ease and the swelling to go down - this time it's more painful and the swelling is bigger - could you please tell me the possibilities of what the problem could be - the possible causes and treatments? Also, why it only seems to affect my clitoral area only and doesn't affect the ability or sensation for urinating.

Answer: I have heard from other women who have experienced painful swelling of the clitoris but I do not know the cause or a possible treatment. It could be the pelvic muscles are in spasm restricting the blood flow from the clitoris or possibly a hormonal imbalance. I can only advise you to see a doctor, especially since this has occurred more than once. It could be a symptom of a more serious problem.

Below is some information I found in a subsequent search of the Internet.

Obstetrics and Gynecology 2001 Apr;97(4 Suppl 1):S26-S27 (ISSN: 0029-7844)
Medina CA. University of Miami School of Medicine, Miami, FL, USA.

Background: Priapism of the clitoris is an exceedingly rare condition that often creates a very difficult situation for both the patient and physician. Although patients present with various symptoms, the most consistent initial symptoms have been clitoral swelling and pain. The majority of cases reported thus far stem from the use of certain psychotropic medications. Case report: A 47-year-old woman presented with vulvar and clitoral pain; she stated that the pain was mostly clitoral in origin. The symptoms initially started as clitoral burning of short duration (2-3 min) followed by swelling and pain. The events have been recurrent for the past 3-4 years, increasing in frequency and lasting for up to 6-8 hours at a time. The symptoms first appeared shortly after the patient received trazodone hydrochloride. She is not sexually active, and none of the episodes has been incited by stimulation or associated with orgasm. She is currently using sumatriptan succinate and lorazepam for migraine headaches and anxiety disorder, respectively. The clitoral swelling was witnessed by two physicians; no additional vulvar or pelvic pathology was identified. The patient responded initially to treatment with imipramine hydrochloride and discontinuation of trazodone hydrochloride. Conclusion: Clitoral priapism is a rare condition that may develop during therapy with certain psychotropic medications, specifically those having alpha-adrenergic blockade. Clinicians should be aware of this condition in order to avoid delays in diagnosis and treatment.

Int Clin Psychopharmacol 1999 Jul;14(4):257-8 (ISSN: 0268-1315)
Brodie-Meijer CC; Diemont WL; Buijs PJ Netherlands Pharmacovigilance Foundation Lareb, Hertogenbosch.

A case is presented of painful priapism of the clitoris lasting 3 days, with a strong temporal association with the administration of nefazodone hydrochloride. Priapism has been described as a rare side-effect of drugs with high alpha1-adrenergic blocking potential. However, the alpha1-adrenergic blocking potential of nefazodone is moderate. Drug-induced clitoral priapism has been described for citalopram, bromocriptine, fluoxetine and trazodone combined with fluoxetine. To our knowledge, this is the first report in the literature about priapism of the clitoris associated with nefazodone.

From: http://www.goaskalice.columbia.edu/1133.html

Priapism is a prolonged and painful erection that can last from several hours up to a few days. The priapismic erection is NOT associated with sexual thoughts or sexual activity. What happens is that blood flows into the penis, but is unable to drain as it would in a normally flaccid penis. Considering that the penis provides little room for blood to circulate, the blood becomes stagnant after a while, acidifies, and loses oxygen. Without oxygen, the red blood cells become stiff, and even less able to squeeze their way out of the penis [or clitoris.]

Very few cases of priapism are without an obvious cause. In most cases, priapism results from one of two things: certain medications or medical conditions. Under the category of medications, there are two primary culprits. For one, penile injections used to treat some forms of impotence can cause priapism; however, this usually only happens when a man decides, on his own, to increase the dosage. Second, psychiatric medications, such as anti-depressants, seem to cause some cases of priapism; however, how these drugs affect priapism is unclear. The second major cause of priapism is certain medical conditions and diseases -- generally, any that cause the blood to thicken, or cause red blood cells to lose their flexibility and mobility. Sickle-cell anemia and leukemia are probably the most common conditions that cause priapism.

Most men will seek treatment for this painful erection before it goes on for too long, usually within four to six hours. This is good since priapism can scar the penis if not treated early enough, and this can lead to impotence. In most cases, treatment involves draining the penis with a needle placed in the side of the penis. Medications that act on the blood vessels can also be injected to help shrink blood vessels and, thus, decrease blood flow into the penis. Sickle-cell anemia patients with priapism are usually treated by blood transfusion.

Interestingly, this condition was named after Priapus, the Greek god of fertility. Statues and pictures of Priapus always showed him to be rather well-endowed and, seemingly, perpetually erect. And, if Alice remembers correctly, there was a small rock band out of Somerville, MA that called themselves Priapism....