Women's Health Community

Dear An; Generally speaking there are a variety of reasons for clitoral pain or tenderness:

1. Infections such as herpes, yeast, or even a localized infection from skin bacteria.

2. Dermatology problems which can appear in the genital area such as lichen sclerosus, lichen planus, psoriasis, or a contact dermatitis from detergent/bath products/genital cosmetics.

3. Nerve issue where the surrounding nerves (and the clitoris has lots of nerve tissue) begin to fire inappropriately leading to a sensation of pain. Sometimes this problem can be initiated by an irritant such as herpes, yeast, or trauma to the site (eg bike seat).

4. Persisting genital arousal syndrome--see recent citation: J Sex Med. 2009 Oct;6(10):2778-87.

An, given what you have shared, my best GUESS is that you may have some kind of localized infection (analogous to an infected hair follicle on the vulvar area). PLEASE get in to see a GYN while your symptoms are most severe; that can make it easier to get a correct diagnosis. Depending upon the appearance a GYN might want to do a test for herpes. It is possible to have have a mild, unnoticed initial outbreak and more severe outbreaks later.

Yours,
Jane

Thank you very much for your response! And yes, I will be seeing someone as soon as possible.

Dear An: Thanks for the feedback. If you get a diagnosis which you are willing to share, would you be so kind to write us back? Through the magic of the internet search your well described subject line could lead other women with similar symptoms to your outcome.

In Gratitude,
Jane

Yup, hopefully it can be helpful to someone else!
The doctor said I had a pustule in the area. He tested for herpes as you said they likely would, although he doubts it is that. I have not gotten the results back yet, so I am a little nervous, but I honestly doubt that I have it.
He said that the pustule could be caused by my previously diagnosed non-specific vaginitis and prescribed an antibiotic if that was the case. The nurse gave me some hints to fight the pain, and got the doctor to prescribe a numbing gel. However the majority of the pustule drained the following night greatly relieving the pain, and I haven't used it.
Now I'm finishing up the prescription of antibiotics, and continuing to use the triamcinolone cream to treat the vaginitis in hopes of preventing another issue like this.

Thanks again for your help, Jane!

Dear An: Thank YOU! While most GYNs will want to rule out genital herpes, in your case it really sounds like a small pustule since the pain was relieved with draining the very small abscess. The use of the lidocaine gel was a novel idea, but it would make an area with lots of nerve endings more comfortable.

In Appreciation,
Jane

My clitoris is so sore that i can't even set down and its swollen really bad what can i put on it to help the pain? it hurts i can't even move it hurts so bad

Hi Jane,

I hate to bring up an old subject but I'm desperately reading about this and trying to figure out why this is happening to me. My gyno doesn't know what this keeps occuring either. I had a BAD case of this, swelling to where I couldn't walk for 2 days and was on vicoden, and took antibotics because i was in severe pain. This occurred from my bike seat. I originally thought it to be the particular bike shorts. But not sure that is the case since I haven't used them since. This first occurred in early November. I did a couple of mountain bike races and was fine. About a month ago, had a very minor flare up, laid off the bike a week and completely gone, deflated all the way, no swelling. I go back out on my bike this weekend and it is flaring up almost as bad as the first time. I have been riding and racing for 12 years and this is JUST beginning and will NOT go away. I dont understand what can be going on. I'm changing my detergent to All Free I think it is for sensitive skin. I use Body Glide in that spot and always have but wonder if they changed the formula and now allergic. I may call them today to find out. I will now start using just vasoline on that spot. Maybe one of the 2 will stop this craziness! Any advice, ideas, anything?? know one seems to understand this and can help. I live in Austin and seems like there would be a sports gyno here but haven't found one yet. I have a race next weekend and at this point, not sure if I can go. I'm afraid if this doesn't get sorted out, I will miss my entire spring racing season!

Oh forgot to add before you mention it may be the bike seat. This happened on my road bike the first time, 2nd time my mountain bike, swapped to the saddle to a better fit for me, the 3rd saddle did it too. There is NO rubbing from the saddle, only rubbing from the pad in the shorts. Nothing unusual. Been going on for 12 years.

Dear kkees: A sports GYN--what a great idea (and both Austin TX and Portland, OR would be a good place for that kind of specialty practice). According to your posts you have had this happen with three different bike saddles---hope I am tracking you correctly. Thus pressure MIGHT be involved, but not a specific fit of a seat.

It also sounds like you have been treated empirically with antibiotics. Yet the pain/swelling will subside without antibiotics if you just do not ride for a while. Literature searches at the National Library of Medicine site yielded two recent citations on both saddle design and handle bar effects of the female genital area:

J Sex Med. 2012 May;9(5):1367-73.
The bar sinister: does handlebar level damage the pelvic floor in female cyclists?
Partin SN, Connell KA, Schrader S, LaCombe J, Lowe B, Sweeney A, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Guess MK.

Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA.

INTRODUCTION:

Cycling is associated with genital neuropathies and erectile dysfunction in males. Women riders also have decreased genital sensation; however, sparse information exists addressing the effects of modifiable risks on neurological injuries in females.
AIM:

This study assesses the effects of bicycle setup and cyclists' attributes on GS and saddle pressures among female cyclists.
METHODS:

Previously, we compared genital sensation in competitive female cyclists (N = 48) to that of female runners (N = 22). The current study is a subanalysis of the 48 cyclists from the original study group. Nonpregnant, premenopausal women who rode at least 10 miles per week, 4 weeks per month were eligible for participation.
MAIN OUTCOME MEASURES:

Genital sensation was measured in microns using biosthesiometry measures of vibratory thresholds (VTs). Perineal and total saddle pressures were determined using a specialized pressure map and recorded in kilopascals (kPA).
RESULTS:

Handlebars positioned lower than the saddle correlated with increased perineum saddle pressures and decreased anterior vaginal and left labial genital sensation (P < 0.05, P < 0.02, P < 0.03, respectively). Low handlebars were not associated with total saddle pressures or altered genital sensation in other areas. After adjusting for age and saddle type, low handlebars were associated with a 3.47-kPA increase in mean perineum saddle pressures (P < 0.04) and a 0.86-micron increase in anterior vagina VT (P < 0.01).
CONCLUSION:

Handlebars positioned lower than the saddle were significantly associated with increased perineum saddle pressures and decreased genital sensation in female cyclists. Modifying bicycle setup may help alleviate neuropathies in females. Additional research is warranted to further assess the extent of the associations

[To be continued in additional post--JHH>

Continuation for kkees:

J Sex Med. 2011 Nov;8(11):3144-53. doi: 10.1111/j.1743-6109.2011.02437.x. Epub 2011 Aug 11.
Women's bike seats: a pressing matter for competitive female cyclists.
Guess MK, Partin SN, Schrader S, Lowe B, LaCombe J, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Connell KA.
Source

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA. marsha.guess@yale.edu

INTRODUCTION:

There are numerous genital complaints in women cyclists, including pain, numbness, and edema of pelvic floor structures. Debate ensues about the best saddle design for protection of the pelvic floor.
AIM:

To investigate the relationships between saddle design, seat pressures, and genital nerve function in female, competitive cyclists.
METHODS:

We previously compared genital sensation in healthy, premenopausal, competitive women bicyclists and runners. The 48 cyclists from our original study comprise the study group in this subanalysis.
MAIN OUTCOME MEASURES:

Main outcome measures were: (i) genital vibratory thresholds (VTs) determined using the Medoc Vibratory Sensation Analyzer 3000 and (ii) saddle pressures as determined using a specially designed map sensor.
RESULTS:

More than half of the participants (54.8%) used traditional saddles, and the remainder (45.2%) rode with cut-out saddles. On bivariate analysis, use of traditional saddles was associated with lower mean perineal saddle pressures (MPSP) than riding on cut-out saddles. Peak perineal saddle pressures (PPSP) were also lower; however, the difference did not reach statistical significance. Saddle design did not affect mean or peak total saddle pressures (MTSP, PTSP). Saddle width was significantly associated with PPSP, MTSP, and PTSP but not with MPSP. Women riding cut-out saddles had, on average, a 4 and 11 kPa increase in MPSP and PPSP, respectively, compared with women using traditional saddles (P = 0.008 and P = 0.010), after adjustment for other variables. Use of wider saddles was associated with lower PPSP and MTSP after adjustment. Although an inverse correlation was seen between saddle pressures and VTs on bivariate analysis, these differences were not significant after adjusting for age.
CONCLUSION:

Cut-out and narrower saddles negatively affect saddle pressures in female cyclists. Effects of saddle design on pudendal nerve sensory function were not apparent in this cross-sectional analysis. Longitudinal studies evaluating the long-term effects of saddle pressure on the integrity of the pudendal nerve, pelvic floor, and sexual function are warranted.

Finally kkees, there can be a hair tourniquet, which in your case would have to be a partial/recurrent condition:

Obstet Gynecol. 2002 May;99(5 Pt 2):939-41.
A hair tourniquet resulting in strangulation and amputation of the clitoris.
Kuo JH, Smith LM, Berkowitz CD.


Department of Pediatrics, Harbor-UCLA Medical Center, University of California, Los Angeles School of Medicine, Torrance, California, USA.

BACKGROUND:

Hair tourniquet syndrome involves fibers of hair or thread wrapped around an appendage producing tissue necrosis. Appendages commonly involved include the toe, finger, and penis. We report a hair tourniquet resulting in amputation of the clitoris.
CASE:

An adolescent presented with a 4-year history of intermittent genital pain that increased in severity over the preceding 5 days. Physical examination revealed a necrotic clitoris surrounded by a black hair. During the examination, the tissue fell off resulting in immediate improvement in the patient's pain....

In conclusion kkees, this may have to be a diagnosis of exclusion (infection, vascular hamartoma [doubt this since your condition will self resolve>, pressure on a lymph or blood drainage when riding, etc.). One last thought, you might want to see a pelvic floor physical therapist as another opinion as they have a strong focus on structural issues.

Yours,
Jane

Dear Dr.,

I too have been experiencing a swollen, inflamed clitoris accompanied by frequent, sometime severe itching and a creamy, pasty discharge. I am 7 weeks pregnant and was diagnosed with a UTI about a week and a half ago. Dr prescribed antibiotics which I have now finished but I honestly can not remember if the itching started before or just after I began taking the antibiotics. While my vaginal area has some itching too, it is mostly localized to the clitoris, one side more than the other.

I have been experiencing an itchy clitoris for 4 months. Sometimes the itch is worse then other times. I was exposed to herpes, had 3 negative blood tests and one equivocal. Diagnosed with BV 3 times since this started and last week diagnosed with Lichen Sclerosus. Have had red irritation on labia for 4 months as well. How does herpes act when it settles in the clitoris? Never had any lesions anywhere and no matter what I put on it nothing seems to help. Not sure if LS can be on the clitoris either but this is a terrible feeling and I cannot stand it when anything rubs against it. Cannot wear my jeans or certain pants. Any feedback would be appreciated. Thank you