From the Guidelines
Conservative treatment for clitorodynia should prioritize pelvic floor physical therapy, as it has been shown to significantly improve sexual function in survivors of gynecologic cancers 1. This approach is supported by the most recent guidelines, which emphasize the importance of addressing pelvic floor dysfunction in the treatment of sexual dysfunction 1. Key components of conservative treatment for clitorodynia include:
- Pelvic floor physical therapy to release muscle tension and improve blood flow to the area
- Topical treatments, such as vaginal estrogen or vaginal androgens (e.g., DHEA), to alleviate vaginal dryness and pain
- Avoiding activities that cause pressure on the clitoral area, such as cycling
- Considering the use of vaginal dilators for survivors with pain during sexual activity or vaginal stenosis from pelvic radiation
- Referral to a sexual health specialist for further evaluation and treatment, if necessary It is essential to note that the evidence base for interventions to treat female sexual dysfunction in survivors is weak, and high-quality studies are needed 1. However, based on the available evidence and consensus among experts, pelvic floor physical therapy and topical treatments are recommended as first-line treatments for clitorodynia 1. Oral medications, such as amitriptyline or gabapentin, may also be considered to modulate nerve pain signals, but their use should be guided by the specific type of problem and the patient's overall health status 1. Ultimately, a comprehensive treatment plan should be tailored to the individual patient's needs and should prioritize improving sexual function, reducing pain, and enhancing overall quality of life.
From the FDA Drug Label
Use temporarily relieves minor pain The answer to conservative treatment for clitorodynia is topical lidocaine as it can temporarily relieve minor pain 2.
- Key points:
- Lidocaine is used for temporary relief
- Relieves minor pain
- Clinical decision: Use lidocaine (TOP) for conservative treatment of clitorodynia to relieve minor pain.
From the Research
Conservative Treatment for Clitorodynia
- Clitorodynia is a type of localized vulvodynia, characterized by frequent and intense pain episodes that can be either provoked or unprovoked, causing significant impairment in daily and sexual function 3.
- The treatment of clitorodynia, like vulvodynia, is often individualized and may involve a combination of pharmacological and non-pharmacological approaches 4.
- Non-pharmacological interventions, such as psychological therapy and pelvic floor physical therapy, have strong evidence to support their use in the treatment of vulvodynia, which may also be applicable to clitorodynia 4.
- Topical agents, such as lidocaine, capsaicin, and amitriptyline, may be used in the conservative management of clitorodynia, although their efficacy has not been extensively investigated 5, 6.
- Conservative management of clitoral adhesions, which can cause clitorodynia, may include the application of topical agents and manual retraction of the prepuce, although the efficacy of these interventions has not been investigated 5.
Pharmacological Treatments
- Pharmacological treatments, such as antinociceptive agents (e.g., lidocaine, capsaicin), anti-inflammatory agents (e.g., corticosteroids, interferon), and neuromodulating medications (e.g., anticonvulsants and antidepressants), may be beneficial in the treatment of vulvodynia and clitorodynia, but require further research 4, 6.
- Oral tricyclic antidepressants and gabapentin are commonly used treatments for vulvodynia pain, due to their ease of use and patient preference 6.