Treatment of Clitoral Priapism
The primary treatment for clitoral priapism is immediate discontinuation of any causative medications (most commonly trazodone, bupropion, or antipsychotics), followed by conservative management with oral pseudoephedrine and analgesics, as most cases resolve with this approach. 1, 2
Initial Management Algorithm
Step 1: Discontinue Offending Agents
- Most reported cases of clitoral priapism are drug-induced, making cessation of the causative medication the cornerstone of treatment 1
- Common culprits include trazodone, bupropirin (Wellbutrin), and antipsychotic medications 2
- Important caveat: Unlike penile ischemic priapism, clitoral priapism does not require emergency invasive intervention 1
Step 2: Conservative Medical Management
- Oral pseudoephedrine around-the-clock is a reasonable first-line therapy that has demonstrated complete symptom resolution in documented cases 2
- Add analgesics for pain control during the resolution period 2
- This over-the-counter approach is both safe and effective, avoiding the need for invasive procedures 2
Step 3: Alternative Pharmacologic Options
- Phenylpropanolamine can be utilized as an alternative sympathomimetic agent 1
- Topical or injectable phenylephrine may be considered if oral agents fail, though evidence is limited 1
Key Differences from Penile Priapism
Critical distinction: Clitoral priapism does NOT follow the same emergency treatment algorithm as penile ischemic priapism 1. The available guidelines for penile priapism management (aspiration, intracavernosal phenylephrine injection, surgical shunting) are specific to male anatomy and the corpus cavernosum 3, 4, 5.
- There is no established role for aspiration or sympathomimetic injections directly into clitoral tissue 1
- The time-dependent risk of permanent dysfunction (critical after 24-48 hours in penile priapism) has not been established for clitoral priapism 4
- Surgical interventions are not described in the literature for clitoral priapism 1
Expected Timeline and Outcomes
- Symptoms may persist for several days even after medication discontinuation (documented case showed 5-day duration before treatment initiation) 2
- Complete resolution can be achieved with conservative management 2
- The condition presents with engorgement, pain, and swelling of the clitoris and surrounding tissue 1
Common Pitfalls to Avoid
- Do not apply penile priapism emergency protocols to clitoral priapism—the anatomy, pathophysiology, and treatment approaches differ significantly 1
- Do not delay medication discontinuation while pursuing other interventions 1, 2
- Recognize that this condition may be confused with persistent genital arousal disorder (PGAD), which has different underlying etiologies including anatomical abnormalities like Tarlov cysts 1
When Conservative Management Fails
The literature provides limited guidance on refractory cases, as most documented cases resolve with medication cessation and oral sympathomimetics 1, 2. Further investigation into treatment options for clitoral priapism is needed, as this remains an understudied condition compared to penile priapism 1.