Clitoral Pain: Causes, Evaluation & When to Seek Care

Potential Etiologies

• Infectious – Candidiasis, BV, HSV, trichomonas, UTI.
• Dermatologic – Lichen sclerosus, lichen planus, contact dermatitis (soaps, laundry, lubricants), psoriasis.
• Trauma – Sexual, hair removal, childbirth, piercing.
• Neurologic – Pudendal neuralgia, referred from lumbar spine, diabetic neuropathy.
• Hormonal – Atrophy (menopause), vestibular sensitivity (OCP).
• Musculoskeletal – Pelvic floor hypertonia.
• Vulvodynia – Generalized/provoked vestibulodynia; clitoral component possible.

Evaluation

• Detailed history (timing, triggers, sexual activity, products).
• Exam: inspection, Q‑tip test (vestibule), pelvic floor assessment.
• Tests: wet mount, NAATs, culture, biopsy if lichenous changes.

Management

• Target cause: antifungals, antivirals, antibiotics, topical steroids/calcineurin inhibitors (lichen sclerosus).
• Pelvic floor PT (downtraining, biofeedback).
• Neuropathic agents (gabapentin, amitriptyline).
• Hormonal: vaginal estrogen, testosterone cream (off‑label).
• Cognitive‑behavioral / sex therapy for central sensitization.

Red Flags

• Ulcer, mass, bleeding, fixed lesion → biopsy to exclude malignancy.
• Neurologic deficits → imaging.

Clitoral pain is real, treatable, and deserves thorough evaluation—not dismissal.