Clitoral phimosis and the potential of testosterone cream to prevent/reverse it
Near the end after the GSM discussion.Like phimosis of the foreskin, clitoral adhesions (phimosis) can develop with low hormones, causing pain and reduced orgasm. Dr. Rubin’s research shows it’s common, and there is interest in using local testosterone or DHEA to treat or prevent it, but no formal studies.
Why this matters: Reveals an anatomical problem that most women and many clinicians have never heard of, which could be silently impairing sexual function.
Clitoral adhesions are analogous to the adhesions of the penile foreskin. The clitoral hood can scar and stick to the glans as estrogen and testosterone levels drop. This can be a hidden cause of diminished orgasm, pain, or difficulty with arousal.
Dr. Casperson notes that while Rachel Rubin published on clitoral adhesions, there are no RCTs on whether starting hormones in perimenopause would reduce their incidence, or whether a compounded testosterone or DHEA cream can reliably reverse them. The field is wide open. She advocates for thorough pelvic exams by knowledgeable clinicians because sexual pain has multiple possible drivers: atrophy, adhesions, vestibulodynia, vaginismus. Without recognizing clitoral phimosis, women may be told the pain is psychological. The discussion ties into GSM: the clitoris is a genital tissue with testosterone and estrogen receptors, and atrophy there can lead to adhesions just as vaginal atrophy does.
I would love to see more research looking at clitoral phimosis prevention. … If you have clitoral adhesions, can we reverse that reliably with a testosterone cream? We don’t know. We haven’t studied it.