adhesions

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Since the clitoris is very similar to a miniature penis, smegma can collect under the clitoral hood resulting in irritation, pain, and inability to experience orgasm. The clitoral hood may also adhere to the glans entirely or in part preventing the hood from caressing the glans, making orgasm difficult or impossible.

Glands on the inner surface of the clitoral hood secrete an oily substance called sebum that lubricates the clitoral glans. These are the same glands that are on the inner surfaces of the male foreskin. Sebum results in the smooth shiny appearance of the clitoral glans. When this oily substance accumulates, it is called smegma, and has a white cheesy appearance.

The clitoral glans needs to be lubricated to allow the hood to slide over it effortlessly. The clitoris is usually most sensitive to frictional stimulation, versus direct pressure. Women's masturbation methods usually result in the clitoral hood sliding back and forth across the glans. If you simply press on the glans with a fingertip, a woman may feel very little in the way of erotic sensation.

If the hood does not conceal the glans fully, the glans may dry out and undergo cornification, resulting in a dull wrinkled appearance. Like the glans of a circumcised penis. While people have claimed otherwise, I have never seen any evidence that would indicate that this impairs orgasmic response. I know there are multi-orgasmic women with fully exposed glans. If the glans is still concealed by the inner and outer labia, it may not loose its shiny appearance even if the hood is short or removed.

If the smegma is not washed away on a regular bases, it can accumulate and dry out forming small hard kernels under the hood. The resulting irritation can be painful. This can result in pain during masturbation, vaginal intercourse, and perhaps when walking while wearing tight pants. In addition, using sanitary napkins may be painful. This accumulation of smegma can 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 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.

If the hood extends well past the glans, is thick or closed, the irritation may be totally concealed, with no visible indications. A doctor could examine a woman and not be aware that there is a problem. Women need to explicitly tell or show their doctor the location of any pain they experience in the area of their vulva. Women experiencing vulvar pain need to examine their vulva in a mirror, while trying to locate the source of the pain. Going to a doctor saying, "It hurts down there," is not likely to result in an accurate diagnoses. Doctors may not be aware of the possibility of dried smegma and clitoral adhesions, or unless they're requested to, reluctant to closely examine a woman's clitoris.

The irritation caused by the accumulated smegma may result in adhesions forming between the glans and hood. This is caused by the two tissues surfaces growing together as the body tries to heal and eliminate the source of the irritation. The adhesions may also form as a result of the hood laying in constant contact with the glans. Some references say girls are born with a hood that is adherent to their clitoral glans, other references say the adhesions form after birth. One reference says these adhesions normally remain until puberty.

Adhesions may prevent or at least limit the ability of the hood to slide across the glans. If you have adhesions, when you pull on the hood, the glans moves with it versus retracting. You may not be able to pull the hood back far enough to expose the entire glans if you have adhesions, or a small opening in the hood. This could make cleaning difficult or impossible. Pulling on the hood when you have adhesions may stress the clitoris resulting in pain. Sometimes the entire hood adheres to the glans, requiring special care from a doctor.

Some doctors have found that releasing clitoral adhesions resulted in 30 percent of preorgasmic women being able to experience orgasm. Before you get too excited though, many women have these adhesions and experience no sexual impairment. It would be unwise to expect that following the release of these clitoral adhesions that you will suddenly be orgasmic, 60% of women did not. Masters and report they have seldom seen a need for this procedure, but they do not say 'never' either. If you examine your clitoris and find you can not expose the glans of your clitoris, do not run right out and ask a doctor to modify your clitoris so that you can. If you are preorgasmic consider the procedure, but for medical and hygienic reasons, not sexual ones.

If you are orgasmic, but your clitoral glans is totally concealed, do not be to eager to ask a doctor to expose your clitoral glans, you may gain nothing. If you do have a concealed clitoral glans and experience frequent urinary or vaginal infections, the offending bacteria may reside undisturbed up 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.) A yeast infection may involve only the clitoris, and not the vagina.

I'm not aware that releasing adhesions can cause harm to a woman, needed or not, if done correctly and proper aftercare procedures are followed. Just as with a healthy adult penis, you should be able to retract the hood so that you can clean under it. If it's not broken though, do not fix it.

Minor adhesions may be released by a woman, or girl, herself without the need for a doctor's intervention. The adhesions may be released automatically by acts that place stress on the clitoral hood. Things like bathing, masturbation, bicycle riding, and horseback riding. If a girl or woman does not wash her vulva in a manner that places traction on her hood, or masturbate in a manner that does, she may not separate any adhesions that form, or prevent the formation of adhesions.

If a woman knows she has adhesions she may be able to eliminate 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. (Keep petroleum based products away from 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. It may take you six months to a year to get the results you desire though. A visit to the doctor will accomplish the same thing more quickly, but with more initial trauma to the tissues involved. If you are experiencing pain or discomfort, go see a doctor.

The best way to prevent adhesions and the build up of smegma is through proper hygiene. Since it appears most young girls do not know they have a clitoris, and urinary tract infections are not uncommon for them, it is unlikely they are taught proper hygiene. It is impossible to teach a girl to bath her clitoris and labia if she does not know she has them.

Based on a discussion on an Internet message board I saw, it appears many if not most parents do not know how to bath their daughter's genitals, some seeing anything more than the washing of the outer surfaces of the outer labia as sexual abuse. I do not have any parenting manuals, so I do not know if they explain how, but I suspect not. In addition parents may be too embarrassed to ask their doctor what the correct method is.

My instincts are, parents need to very gently spread the inner and outer labia and wash between them. They also need to place gently traction on the hood of the clitoris in the direction of the girl's bellybutton while washing the exposed surfaces. The clitoral glans may not be exposed when you do this. If there are adhesions, do not forcibly try to remove them. The foreskins of uncircumcised infant boys are adherent to the glans and should not be forcible retracted, the same is probably true for girls as well. Forcibly removing the adhesions will traumatize the girl making future genital exams and cleanings impossible.

The genital tissues of preadolescent girls are very thin and delicate. You have to be gentle when touching them, and any soap you use should be very mild. Perhaps using plain water is best. If your daughter pulls away or cries when you touch her vulva, you are not being gentle enough, or she is experiencing some form of irritation which should be brought to your doctors attention. The correct touch is likely to be enjoyable to your daughter, resulting in a positive response. This is likely to result in the self exploration of her genitals, which is desirable as she needs to learn how masturbate, so as to begin her sexual development, and hopefully prevent or release and clitoral adhesions. Bathing your daughter's genitals creates a perfect opportunity to teach her the names of all its different parts. You should ask any girl who old enough to understand 'Yes' and 'No', if it is okay for you to bath her vulva, so that she learns this area is under her control.

The inner labia of young girls may fuse together as the result of mild irritation caused by such things as diaper rash. I would also presume that the labia must remain touching for extended periods of time for this to occur, perhaps indicating that the parents or the girl herself is not spreading her labia while bathing. If you should notice your daughter's inner labia have fused together, take her to the doctor. The doctor will prescribe a topical hormonal cream for you to apply to her vulva to remedy this. I gather labial adhesions are not uncommon.

Adult women also need to be aware that simply wiping their external vulva with a washcloth or their hand may not be sufficient to keep it healthy. The little folds of the vulva, and the space under the clitoral hood can trap, sweat, vaginal lubrication, toilet paper, menstrual fluid, urine, and bacteria. The normal body fluids do not expose a woman to any harm as long as they do not collect or are not removed before bacteria that are normally present are able to reproduce, resulting in infection and odor. Women should examine their vulva with a mirror to become familiar with its structure. Learning where all those little nooks and crannies are. They will then be able to tell what they must do to clean these areas. Like how to retract their clitoral hood with one hand while bathing their clitoris with the other. With practice though, a thorough cleaning will only take a few seconds. While I say women need to take special care of their vulva, I do not wish to indicate it is a dirty place, it is not.

All one needs to use to clean the vulva is plain water. The application of soap and "feminine hygiene" products can irritate the delicate genital tissues. Perfumes, deodorants, and chemical additives pose a risk to the health of women when applied to the vulva and vagina. You may not be aware of the mild irritation these products may cause, but you will be aware of the chronic infections you get as a result. It is wise to only use plain unscented tampons and sanitary napkins, and plain white unscented toilet paper as well. Most of the items in the "feminine hygiene" isle of your local store pose more risk than benefit to a healthy vulva.

Doctors can remove adhesions by inserting a blunt probe between the glans and hood. This procedure requires the use of a local anesthetic, because the tissues are so sensitive. After the adhesions are removed the area may be very sore, but a woman must follow her doctors instructions regarding the cleaning and aftercare to prevent the adhesions from immediately reforming. Unless a young girl is experiencing some form of irritation or infection involving her clitoris, this procedure should not be done on her. 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 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 but painless clitoris may be very desirable. Women should proceed cautiously if their doctor recommends circumcision, especially if the patient is a young girl.

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

Click On Image To See It Full Size From the book "Atlas of Human Sex Anatomy" by Latou Dickinson M.D., F.A.C.S. Copyright 1949 The & Wilkins Company. Reprinted by the E. Krieger Publishing Company.

An old medical article posted here, also presents information about clitoral adhesions and how to treat them. The article is incorrectly refereed to as female circumcision, no tissue is removed, so it is not accurate to refer to it as such.