The Impact of Clitoral Adhesions on Female Sexual Pleasure and Health

Introduction

While we are constantly bombarded with information about feminine hygiene, one aspect we never hear mention of concerns sebum and clitoral adhesions. Given the clitoris has many of the same structures as a penis, and functions in much the same way, it too has glands that produce sebum, which when it accumulates is called smegma. While smegma is of great concern in men and boys, and is often the justification for routine circumcision, its existence in girls and women is most often overlooked.

This is unfortunate, as smegma can harden under the clitoral hood, causing irritation and pain in girls and women. This irritation may result in the tissues of clitoral glans and hood fusing together, partially or fully, forming adhesions. These adhesions may prevent the clitoral hood from caressing the glans during sexual stimulation, alone and with a partner, making orgasm difficult or impossible to experience. When adhesions are present, the clitoris cannot be exposed to frictional stimulation, which may result in a clitoris that is insensitive to stimulation, causing a woman to believe her clitoris is absent or defective.

It is important to know the clitoral hood is normally fused to the glans of infant and young preadolescent girls, as is the case with infant and young boys who are not circumcised, and not a reason for concern unless it is the cause of infection or irritation. Labial adhesions, the fusing together of the inner labia, during infancy and childhood are not normal, but never the less common, and not a reason for concern unless they cause irritation or restrict the flow of urine. Increasing estrogen levels during puberty usually result in the spontaneous resolution, separation, of clitoral and vulvar adhesions. Decreasing estrogen levels during menopause increases the incidence of adhesions, and vulvar and vaginal dryness.

Sebum

Glands on the inner surface of the clitoral hood, and throughout the vulva, secrete an oily substance called sebum, which lubricates the clitoral glans and vulvar tissues, and helps prevent irritation and infection. These same glands are also located on the inner surface of the intact male foreskin. The presence of sebum results in the shiny smooth appearance of the clitoral glans and vulvar mucous membranes. When this oily substance accumulates it is called smegma, and has a white cheesy appearance, as shown in the following photographs.

Note: Oil producing sebaceous glands are called Fordyce Spots when there is no associated hair follicle. They present as "small (1-5mm), slightly elevated yellowish or white papules or spots that can appear on the glans or shaft of the penis, labia of the female, inside of the cheeks and on the lips." If they appear on the penile glans then they also appear on the clitoral glans.

These photos show the collection of sebum between the inner and outer labia.

It is important to note that sebum is a normal and healthy body fluid that serves a necessary and beneficial function. The presence of sebum is not an indication of a "dirty" or "unclean" vulva. While girls and women should rinse away accumulated sebum on a regular basis, perhaps once daily, they must be careful not to cause irritation or infection by doing so too frequently, or harshly. A gentle daily rinsing with fresh running water and your fingers will suffice. Soap frequently irritates the tissues of the inner vulva and should not be used. Since there are beneficial and necessary bacteria present on the vulva, and inside the vagina, antibacterial soaps should not be used, as killing off these good bacteria can cause an infection rather than preventing one. A "clean" vulva and vagina are not healthy!

Sebum and smegma may have a distinct or strong scent associated with them, as a result of the bacteria that feed on them, especially when it is not rinsed away on regular basis. The resulting scent is normal and indicates the presence of a healthy vulva. A healthy vulva should smell like a vulva, not flowers, perfumes, or have no scent at all. Monitoring the scent of your vulva will help you to know when it requires rinsing, and if an infection is possibly developing. The scent of your vulva, and the taste, will likely change during your menstrual cycle, and as a result of the foods, medications, and chemicals you put in your body. It is recommended girls and women of all ages monitor the scent, and possibly the taste of their vulva, on a daily basis to help ensure they are healthy.

Irritation

If the sebum is not rinsed away on a regular basis it can accumulate and dry out forming small hard kernels under the clitoral hood, as shown in the photo at the top of this page. These hard kernels may act like sandpaper and irritate the clitoral glans and hood. The resulting irritation can cause pain and discomfort during daily activities, and during solo and partnered sexual activities.

Women and girls can be distracted by this mild irritation, feeling a need to masturbate or engage in frequent sexual activities, as a result of their clitoris being exposed to constant stimulation. This sensation should not be confused with that of having an engorged or erect clitoris during sexual arousal, which may occur on a frequent basis in teens and women experiencing sexual desire. Irritation in the clitoral area can also be an indication of a yeast infection, which can affect the clitoris without necessarily affecting the vagina. Given the close proximity of the clitoris and urethra, irritation of the clitoris has been mistaken for a urinary tract infection (UTI). When the irritation is severe, while the desire to touch the area may exist, the inflammation makes any contact extremely painful. This means accumulated smegma can either increase the desire for sexual stimulation, or make it impossible.

If the clitoral hood extends well beyond the glans, cannot be retracted to fully expose the glans, is thick, or the opening narrow, the presence of irritation or adhesions can be hidden from view during casual examination by a woman and her doctor. This is why a doctor can examine a woman's vulva during a gynecological examination and not become aware of clitoral irritation or adhesions. A woman should not assume her symptoms will or should be obvious to her doctor, during a physical examination. Going to a doctor saying, "It hurts down there" is not likely to result in an accurate diagnosis. For these reasons a woman needs to explicitly tell, or show, her doctor the location of any vulvar discomfort or pain she experiences, even if this means marking-up a photograph or illustration of a vulva and showing it to their doctor prior to the examination. Women experiencing vulvar pain need to closely examine their vulva in a mirror while trying to locate the source of the discomfort or pain.

Please note that doctors may not be aware of the possibility of dried smegma and clitoral adhesions, or unless they are specifically requested to, reluctant to closely examine a woman's clitoris, as it could be misconstrued as an overtly sexual act. Women should not assume their doctor is examining their clitoris during their annual gynecological exams, and may want to ask their doctor if they have. If you can not "talk" to your doctor then write them a note, handing it to them at the start of the examination.

This accumulation of smegma may also occur in infants and preadolescent girls. In mild cases the dried smegma may only slightly irritate the clitoris resulting in a need to rub or scratch the clitoris. This may cause them to masturbate frequently, but this is not the primary or only reason why they may do so. The resulting redness and irritation caused by the frequent itching, scratching, rubbing, or masturbation may conceal the primary cause. Teaching daughters to care for their vulva is essential, and is best taught by example at a young age.

Stimulation of the Clitoris

The clitoris is most often sensitive to frictional stimulation, versus direct pressure. If you simply press on the glans with a fingertip a woman may feel very little in the way of erotic sensation. She may only be aware of the initial touch, and/or pain when too much pressure, perhaps relatively light pressure, is applied. Women's masturbation techniques most often result in the clitoral hood sliding back and forth across the glans in a rapid and rhythmic manner. During vulvar massage a woman may respond very favorably to having her clitoral hood stimulated in a way that causes it to rhythmically move across her clitoral glans, and this is why this activity is the frequent cause of a woman's first orgasms during partnered sex.

The clitoral glans must be lubricated to allow the hood to slide over it effortlessly during sexual stimulation, and this lubrication is normally and naturally provided by sebum. If a woman's clitoral glans isn't lubricated the hood may not caress it during sexual stimulation, or she experiences pain rather than pleasure. It may feel like sandpaper is being rubbed against her clitoral glans, even when the lightest touch is applied, when the necessary lubrication is absent. Washing or frequent rinsing of the vulva may remove too much sebum, resulting in insufficient lubrication. This is particularly true for preadolescent girls and post menopausal women, as the increased estrogen levels that occur during the reproductive years increases the production of sebum and other vulvar/vaginal fluids. Washing or rinsing your vulva immediately prior to sex may actually be a bad thing, if it dries out the vulvar tissues.

Many if not most women will likely benefit by applying a lubricant to their vulva and clitoris prior to masturbation and partnered sex. Lubricants come in many different thicknesses, and a woman may need to experiment to see which is best for her. Women with long or tight clitoral hoods may be able to squirt lubricate under their hood using a plastic syringe having a pointed nozzle or plastic tube.

Cornification

If the hood does not fully conceal the glans of the clitoris, resulting in decreased or an absence of sebum, the glans may dry out and undergo cornification, resulting in a dull wrinkled appearance; like the glans of a circumcised penis. While some have claimed otherwise, I have not seen evidence that would indicate this impairs female orgasmic response. I know there are multi-orgasmic women who have a clitoral glans that is normally fully exposed, and having the appearance of a circumcised penis. Even if the hood is short, or removed, the glans is most likely concealed by the inner and outer labia and may not lose its shiny appearance, as additional sebaceous glands in the area would continue to lubricate the clitoris. Even so, I don't recommend circumcision for men or women, as both foreskins play an active and protective role. Recent medical research indicates the circumcised penis is less sensitive to stimulation, and this likely applies to the clitoris as well.

Preorgasmic & Orgasmic Women

Some medical research found releasing clitoral adhesions resulted in 30 percent of preorgasmic women being able to experience orgasm for the first time. Before you get too excited, please take note of the fact that many women have these adhesions and experience no sexual impairment. It would be unwise to assume that following the release of these adhesions that you will suddenly and automatically be orgasmic, as 60 percent of preorgasmic women did not. To put things into perspective, if 10-20 percent of women are preorgasmic then this procedure may benefit 3 to 6 women out of 100. Masters and Johnson report they have seldom seen a need for this procedure, but they do not say 'never.'

If you examine your clitoris and find you cannot expose the glans, do not run right out and ask a doctor to modify your hood so you can. If you are preorgasmic, consider the procedure, for medical and hygienic reasons, not sexual ones. If you do have a concealed clitoral glans and experience frequent urinary or vaginal infections, the offending bacteria may reside undisturbed under the hood of your clitoris. This may result in repeated outbreaks of infection. I'm not aware of the probability of this, just that there is a possibility. If it's not broken, do not try to fix it, or you may inadvertently break it.

If you are orgasmic and your clitoral glans is totally concealed, do not be too eager to ask a doctor to expose your clitoral glans, as a means of improving or supercharging your sexual experiences, as you may gain nothing, or you may find your exposed clitoris too sensitive to touch and stimulate afterwards.

I'm not aware that releasing adhesions can cause harm to a woman, needed or not, if done correctly and when proper aftercare procedures are followed. If removing the adhesions results in infection or scarring that would have undesired results on your sensitivity to stimulation. Medical and surgical procedures always have at least minor risks associated with them, and one must justify the potential benefits, if any.

Removing Adhesions

Minor adhesions can be released by a woman or girl all by themselves, without the need for a doctor's intervention. The adhesions can be released spontaneously by acts that place stress on the tissues of clitoral hood. Activities like bathing, masturbation, and bicycle and horseback riding will tend to move the tissues of the vulva about and place varying degrees of tension and traction on them.

If a woman knows she has adhesions, she may be able to release them by repeatedly pulling, gently but firmly, on her hood, in multiple directions, while soaking in a hot bath, for several minutes. It may not happen quickly, but perhaps over a period of several weeks. She may want to massage a petroleum based lubricant, or antibacterial ointment, up under her hood, during each session of massage, perhaps twice a day. (Keep petroleum based products away from "inside" the vagina.)

Hoods that totally conceal the clitoral glans can also be modified by intentionally and repeatedly stretching them, over an extended period of time. I am guessing it may take six months to a year to achieve visible results. A visit to the doctor will accomplish the same thing more quickly, but with the possibility for greater initial trauma to the tissues involved. If you are experiencing pain or discomfort, go see a doctor. A vertical hood piercing may also serve to stretch the hood and allow for easier access to the clitoral glans.

Doctors can remove adhesions by inserting a blunt probe between the glans and hood, as shown in the illustration shown below. This procedure requires the use of a local anesthetic, because the tissues are extremely sensitive. After the adhesions are removed the area will likely be very sore, but a woman must follow her doctor's instructions regarding the cleaning and aftercare, to prevent the adhesions from immediately reforming.

Adhesions may also be removed by the application of a topical hormone, estrogen or testosterone, depending on the circumstances.

Unless a infant or preadolescent girl is experiencing some form of irritation or infection involving her clitoris, this procedure should not be done on them. Most women probably will never need this procedure, as their clitoris is easily exposed by pulling up and back on their hood, or they simply do not have any problems with the function of their clitoris.

In severe cases, clitoral circumcision, removal of the hood, may be required. If a clitoris and its hood are highly irritated by an infection, and antibiotics cannot clear up the infection, the hood may need to be trimmed or removed to allow the removal of the material causing the infection. This is probably a very rare occurrence. Circumcision should not be used as a cure for mild adhesions, or hidden clitorises. The reason being, the exposed clitoris is often times extremely sensitive, too sensitive. If you have been experiencing extreme clitoral pain for an extended period of time, a highly sensitive yet painless clitoris may be very desirable. Women should proceed cautiously if their doctor recommends circumcision, especially if the patient is a young girl.

The following illustration shows an adherent hood and the steps a doctor uses to remove them.