Clitoral Adhesions

What are "Clitoral Adhesions?"

Clitoral adhesions are similar to labial adhesions, except clitoral adhesions are located on and around a girl's/woman's clitoris or under her clitoral hood, which covers the clitoris most of the time. Clitoral adhesions limits and/or prevents the clitoral hood to freely slide across the glans of the clitoris.  You will know if you or your daughter has clitoral adhesions when you pull or retract on the clitoral hood, the glans of the clitoris moves with the clitoral hood instead of the clitoral hood retracting by itself, i.e., the glans of the clitoris moves with your pulling the clitoral hood. This can be very painful. If you are checking your young daughter for clitoral adhesions, be very gentle, as this is a very sensitive area and retracting her clitoral hood can be very painful if there are clitoral adhesions. 

You may not be able to pull the hood back far enough to expose the entire glans if you or your daughter has clitoral adhesions.  This could make cleaning the clitoral area difficult if not impossible.

Minor clitoral adhesions may be remedied by without the need for a doctor's intervention. The clitoral adhesions may be released through pressure on the clitoral hood. Things like bathing, masturbation, bicycle riding, and horseback riding.  If you do not properly wash your vulva in a manner that places traction on her hood, or masturbate in a manner that causes you to pull back the clitoral hood, you may not separate any clitoral adhesions that form, or prevent the formation of adhesions in the future.

If you believe you have clitoral or labial adhesions, you may be able to eliminate them by repeatedly pulling on your clitoral hood, in 360 degree directions (up, down, left, right, rotating in circles as well), or by taking a hot bath.

Clitoral adhesions will not disappear immediately as it took some time for the clitoral adhesions to form.

Women who experience pain can ask their partner or doctor to examine their vulva, and separating the labia, attempt to locate the source of the pain or by using a mirror and seeking the source of the pain themselves.  If you experience a clitoral adhesion, either you or your partner can moisten a q-tip with baby oil or vitamin E to clean and loosen the secretions. Remember, the clitoral hood needs to "glide" easily over the clitoris. To lubricate the clitoral hood and loosen the secretions underneath, you or your partner may want to massage the area with a topical cream or baby oil.  This may require you and/or your partner to do this for several days or for several weeks.  Due to the sensitive nature of the clitoris and clitoral glans, it may be painful during the cleaning or massage due to the adhesions.

In the event you are unable to treat the symptoms of clitoral adhesions, and you or your partner cannot determine the reason for the pain, a doctor may need to be consulted. If your clitoral hood extends well past the glans, or if your clitoral hood is thick or closed, the adhesions may be totally concealed, with no visible indications. You should be very explicit in your office visit with the physician regarding your pain and show him the exact location of the any pain, even retracting your clitoral hood, if necessary for his viewing. 

The clitoral adhesions caused by the accumulated smegma is caused by the two tissues surfaces growing together, due to failure to wash away these accumulations. As a result, the body tries to heal and eliminate the source of the irritation, thus causing the tissues to fuse as adhesions. These clitoral adhesions, or labial adhesions in the event the labia minora fuse together, may also form as a result of the hood laying in constant contact with the glans of the clitoris.

Additionally, either you or your partner may want to massage baby oil, vitamin E, or a petroleum based lubricant or antibacterial ointment up under your clitoral hood and on the glans of the clitoris.  

What are labial adhesions?

Young girls and adult women may get “labial adhesions.” Labial adhesions are similar to clitoral adhesions except the smegma adheres to the labia minora (sometimes the labia majora) or the “lips” of the vulva surrounding the vagina — that has caused the labia minora to fuse or become stuck together. This happens to about 5% to 10% percent of all young girls.  Young girls and women with labia that are stuck or fused together should immediately be seen by a pediatrician or gynecologist as the urine flow (and menstrual flow in adult women) can become blocked and a serious infection or infections are very likely to occur if she is not seen by a doctor. 

What causes labial adhesions?

This probably happened because your daughter has little to no estrogen. Baby girls get a large dose of estrogen while they're still in the uterus.  About one to two months after her birth, the maternal estrogen level drops off, and this hormonal change can affect many parts of a baby's body, including the lining of a girl's labia. Her labia may even stick together. This "adhesion" of her labia can continue or come and go throughout childhood, according to many pediatricians.

What can be done to treat labial adhesions?

First of all, parents should NOT try to pull or separate your daughter's labia apart, since that might hurt. Unless the adhesion is causing any problems, it's best to leave it alone. The idea of your daughter having labial adhesion probably worries you more than it bothers her.  However, if the adhesion extends to cover the opening of the urethra and is trapping urine in the genital area, then you'll definitely want to see your child's doctor about treatment. Trapped urine can cause irritation and possibly infection. You'll know if your daughter's labial adhesions are covering the urethral opening if you find less urine in her diaper (for a young child) or she's having trouble peeing, or if her genital area looks irritated, she's irritable and crying, and she has a fever (due to infection).

Normally doctors prescribe a topical estrogen cream to treat the problem. Your doctor will tell you to apply this cream directly to the affected tissue, and in about two weeks it should unseal the labia. You'll probably start by applying the cream two or three times a day, then two times a day, then just once a day. It's important to reduce the amount of estrogen cream you use gradually. If you just stop the treatment suddenly, the labia will close up again.

Will our daughter always have labial adhesions?

Your daughter may continue to have clitoral or labial adhesions off and on throughout childhood, but the labia tend to unstick when a girl approaches puberty and her body starts producing higher levels of estrogen. Until then, though, there's no reason to worry about the adhesion(s) as long as they are not causing any problems. Many little girls never even know they have them.

Importance of proper feminine hygiene and vulva care

Baby girls are born with special glands that are located on the inner surfaces of the clitoral hood.  These glands produce an oily substance called sebum that lubricates the glans of the clitoris. The glans of the clitoris is the end or the tip of the clitoris that is sometimes exposed or can be exposed when you retract the clitoral "hood."  The clitoral hood is that portion of the vulva where the labia minora come together above the vagina and urethra and looks like an inverted "v"  ^ .   The clitoral hood protects the clitoris and in particular, the glans of the clitoris which is very sensitive. 

The sebum that comes from the glands that surround the clitoris produces a shiny appearance on the glans of the clitoris. When the sebum or oily substances are not regulary cleaned or bathed away, it accumulates, and then it is called smegma.  Smegma has a white cheesy appearance, that becomes sticky and begins to adhere to the skin surrounding the vulva with greater, the longer it is not cleaned or washed away. 

Without proper care and hygiene, the smegma will collect under the hood that covers the clitoris and the glans of the clitoris, which can result in pain, irritation and/or inability to experience orgasm.  When the smegma is not properly cleansed from the vulva, and in particular, the areas surrounding and under the clitoral hood, the clitoral hood will adhere to the glans of the clitoris, which is referred to as a "clitoral adhesion."    When the clitoral hood adheres to the clitoris, either partially or entirely, this prevents the hood from properly protecting and caressing the glans, making orgasm difficult or impossible.

It is very important for the glans of the clitoris to have adequate lubrication.  This permits the the clitoral hood to slide over the glans of the clitoris easily and without undue sensitivity or discomfort.  The clitoris, and especially the glans of the clitoris, is usually most sensitive to frictional stimulation, versus direct pressure. Womens masturbation methods almost always involve sliding the clitoral hood in various back and forth or circular motions across and over the glans of the clitoris.  Without proper lubrication from the glands next to the clitoris, pain will result in the stimulation of the clitoris and when there is movement of the clitoral hood.

Importance of washing and cleaning the vulva

The smegma accumulations of the vulva, specifically in the area of the clitoris, needs to be cleaned on a regular basis.  Otherwise, the smegma can accumulate and dry out, causing the smegma to harden beneath the clitoral hood, which causes resulting irritation leading to significant pain.  This can result in pain during masturbation, vaginal intercourse, and perhaps when walking, or wearing tight pants. In addition, using sanitary napkins may be painful.

This accumulation of smegma also occurs in infants and preadolescent girls. Parents should check their daughter's vulva for these accumulations of smegma at every diaper change and bath by gently separating the vulva and looking for the cheesy-white accumulations and gently wiping/cleaning away.  Always be sure to wipe her from the top of the vulva toward the bottom or rectum to prevent germs and bacteria from entering her vagina.  In mild cases the dried smegma may only slightly irritate the clitoris, resulting in your daughter's need to rub or scratch it. This can result in infants and young girls masturbating frequently. The resulting redness, irritation, caused by the frequent masturbation may conceal the primary problem. Adult women may also be distracted by this mild irritation, feeling a need to masturbate or engage in sex frequently. This sensation should not be confused with that of having an erect clitoris. When the irritation is severe though, while the desire to touch the area is there, the inflammation makes any contact extremely painful. So accumulated smegma can either increase the desire for sexual contact, or make it impossible.

Proper bathing and care of the vulva prevents clitoral adhesions

Preventing clitoral hood adhesions means that you need to retract the clitoral hood each time you bathe or shower, and wash out the secretions from this area. Most women need to be aware that simply wiping their vulva with a washcloth or their hand may not be enough to keep it clean.  The spaces between the labia minora, labia majora and the area under the clitoral hood can retain the sebum from the glands around the clitoris, as well as other accumulations such as sweat, vaginal lubrication, toilet paper, menstrual fluid, urine, bacteria and feminine hygiene products. The normal body fluids don't expose a woman to any harm as long as they are removed before bacteria that are normally present are able to reproduce, resulting in infection and odor. 

Special "feminine" soaps and washes are not necessary to clean your vulva. All one needs to use to wash and clean the vulva is plain water.  In fact, the use of soap and feminine hygiene products can irritate the delicate genital tissues. And douching is rarely, if ever needed, to cleanse your vagina.

Douches, vaginal deodorants or vulva deodorants, and chemical additives pose unnecessary risks when applied to the vulva and placed inside the vagina. These products have been linked to increased cases of vulvovaginitis and vaginal yeast infections.

Proper washing and cleaning of the vulva

Naturally, one of the best ways to keep from having clitoral adhesions is through proper washing of the vulva and to wash away the secretions before they turn into smegma. Proper care of your vulva or your daughter’s vulva means to wash away these secretions at every bath or shower. When you wash your vulva, it is important for you to retract the clitoral hood and wash this area. Also, be sure to wash the inner and outer portions and folds of the labia minora.

Parents can teach their daughters how to properly wash their vulva and help prevent them from experiencing the pain of clitoral or labial adhesions. Parents need to educate their young daughters about the various parts of their vulva so that they know they have more than "just a vagina," which they can't see, but a clitoris, clitoral hood, labia minora and labia majora, that they can see.