Clitorodynia in the Dermatology Clinic: Differential Considerations and Current Management Strategies

Abstract

Clitorodynia, a chronic pain condition affecting the clitoris, is often underrecognized in dermatology clinics despite its potential association with inflammatory, neuropathic, hormonal, and musculoskeletal disorders. Dermatologists frequently encounter patients with vulvar discomfort and are well-positioned to differentiate clitorodynia from conditions such as lichen sclerosus, erosive lichen planus, contact dermatitis, post-herpetic neuralgia, and pudendal neuralgia. A structured diagnostic approach includes a thorough history, dermatologic and neurologic examination, cotton swab testing, biopsy when indicated, and targeted laboratory or microbiologic assessments to rule out infections and hormonal imbalances. Effective management requires an etiology-specific approach, incorporating topical corticosteroids or calcineurin inhibitors for inflammatory dermatoses, neuromodulators such as gabapentin and amitriptyline for neuropathic pain, and hormone therapy for estrogen or androgen-related deficiencies. Emerging interventions, including platelet-rich plasma injections, botulinum toxin, and low-dose naltrexone, may relieve symptoms in refractory cases. A multidisciplinary treatment strategy involving pelvic floor physical therapists, gynecologists, and pain specialists is essential to addressing both peripheral and central pain mechanisms. Patient education on genital skincare, sexual health modifications, and cognitive behavioral therapy can further optimize clinical outcomes. Enhancing dermatologic awareness of clitorodynia and implementing standardized diagnostic and treatment protocols will improve early recognition and expand effective management options in dermatology practice.