Read on Twitter
1/14
#tweetorial for @Uro_Stream incoming!
Let’s get things started with a question: What has 2 corpora cavernosa, a glans, and a prepuce?
Where did your mind automatically go? Penis? NOT TODAY!
TODAY we are turning our attention to the great and glorious CLITORIS!
#tweetorial for @Uro_Stream incoming!
Let’s get things started with a question: What has 2 corpora cavernosa, a glans, and a prepuce?
Where did your mind automatically go? Penis? NOT TODAY!
TODAY we are turning our attention to the great and glorious CLITORIS!
2/
Time to check in on our biases: did it make you uncomfortable to read the word clitoris? If so, why?
The clitoris is the female homologue of the male penis, (arguably), the urologists’ favorite genital. So why are we more comfortable talking about them, but not clitorises?
Time to check in on our biases: did it make you uncomfortable to read the word clitoris? If so, why?
The clitoris is the female homologue of the male penis, (arguably), the urologists’ favorite genital. So why are we more comfortable talking about them, but not clitorises?
4/
#tweetorial time - clitoral adhesions.
Like the penis, the clitoris is covered by a prepuce that moves over the glans surface and can be retracted over the corona.
Adhesions occur when the prepuce is no longer able to be retracted over the entire surface of the glans.
#tweetorial time - clitoral adhesions.
Like the penis, the clitoris is covered by a prepuce that moves over the glans surface and can be retracted over the corona.
Adhesions occur when the prepuce is no longer able to be retracted over the entire surface of the glans.
5/
Classifications: mild, moderate, or severe based on % glans visualization.
Etiology: many times, unknown
, but have been known to occur d/t lichen sclerosus.
To date, no association has been found w/ demographic
or behavioral characteristics.
Classifications: mild, moderate, or severe based on % glans visualization.
Etiology: many times, unknown
, but have been known to occur d/t lichen sclerosus.To date, no association has been found w/ demographic
or behavioral characteristics.
6/
How prevalent
is this in the clinical population?
one study found that 
% of their patients demonstrated clitoral adhesions.
another found a larger %:
Clitoral adhesions can affect women of all ages
How prevalent
is this in the clinical population?one study found that % of their patients demonstrated clitoral adhesions.another found a larger %: Clitoral adhesions can affect women of all ages
7/
While some women are asymptomatic, others endorse sx such as:
sexual dysfunction and pain
urinary dysfunction
Severity of adhesions does not seem to correlate w/ sx; in one population, those w/ mild adhesions reported
levels of sexual pain.
While some women are asymptomatic, others endorse sx such as:
sexual dysfunction and painurinary dysfunctionSeverity of adhesions does not seem to correlate w/ sx; in one population, those w/ mild adhesions reported
levels of sexual pain.
8/
Dx? PHYSICAL
EXAM . A complete pelvic exam (bonus points for vulvoscopy!) w/ gentle clitoral preputial retraction is 
.
Be sure to note the size of the glans,
/
adhesions w/ underlying keratin pearls, smegma, and any dyspareunia, hypersensitivity, or discomfort.
Dx? PHYSICAL
EXAM . A complete pelvic exam (bonus points for vulvoscopy!) w/ gentle clitoral preputial retraction is . Be sure to note the size of the glans,
/adhesions w/ underlying keratin pearls, smegma, and any dyspareunia, hypersensitivity, or discomfort.
9/
What can we do for women affected?
The best tx currently available is lysis of adhesions!
can be done in the office
uses local anesthesia 
This procedure involves the use of fine forceps to bluntly lyse epithelial adhesions and remove any underlying keratin pearls.
What can we do for women affected?
The best tx currently available is lysis of adhesions!
can be done in the officeuses local anesthesia This procedure involves the use of fine forceps to bluntly lyse epithelial adhesions and remove any underlying keratin pearls.
10/
Other tx options documented in the literature include:
dorsal slit incision
the use of a CO2 laser
Studies
, but more research is needed 
https://pubmed.ncbi.nlm.nih.gov/19006493/
https://pubmed.ncbi.nlm.nih.gov/26797058/
https://pubmed.ncbi.nlm.nih.gov/22555140/
Other tx options documented in the literature include:
dorsal slit incision the use of a CO2 laserStudies
, but more research is needed https://pubmed.ncbi.nlm.nih.gov/19006493/ https://pubmed.ncbi.nlm.nih.gov/26797058/ https://pubmed.ncbi.nlm.nih.gov/22555140/
11/
points:
the clitoris is anatomically homologous to the penis
clitoral adhesions may affect up to 1/3 of women in a clinical setting
examine the vulva, vagina, and clitoris for 
w/ sx of sexual dysfxn
research needed on prevalence & tx satisfaction 
points:the clitoris is anatomically homologous to the penisclitoral adhesions may affect up to 1/3 of women in a clinical settingexamine the vulva, vagina, and clitoris for w/ sx of sexual dysfxn research needed on prevalence & tx satisfaction
12/
A PubMed search for “clitoral adhesions” yields 38 results.
The one for “phimosis”? 1515.
Sources:
https://pubmed.ncbi.nlm.nih.gov/29559206/
https://pubmed.ncbi.nlm.nih.gov/18820546/
https://www.jsm.jsexmed.org/article/S1743-6095(17)30475-7/pdf
A PubMed search for “clitoral adhesions” yields 38 results.
The one for “phimosis”? 1515.
Sources:
https://pubmed.ncbi.nlm.nih.gov/29559206/ https://pubmed.ncbi.nlm.nih.gov/18820546/ https://www.jsm.jsexmed.org/article/S1743-6095(17)30475-7/pdf
13/
About me: I’m Joanna, M4 @GUMedicine (shoutout @GUUrology) applying to urology this cycle!
I enjoy baking, rollerblading, and eating ice cream.
Current
: Normal People by Sally Rooney
Current
: any kind of pop on Spotify
Cannot wait to enter this amazing field!
About me: I’m Joanna, M4 @GUMedicine (shoutout @GUUrology) applying to urology this cycle!
I enjoy baking, rollerblading, and eating ice cream.
Current
: Normal People by Sally RooneyCurrent
: any kind of pop on SpotifyCannot wait to enter this amazing field!
14/14:
Special thanks to @rachelsrubin1 and @allie_tabakin for their mentorship, wisdom, and all-around awesomeness.
No better ladies than those in urology!
@WomenInSexMed #ilooklikeaurologist
Special thanks to @rachelsrubin1 and @allie_tabakin for their mentorship, wisdom, and all-around awesomeness.
No better ladies than those in urology!
@WomenInSexMed #ilooklikeaurologist
