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The Use of Specific Myofascial Release Techniques by a Physical Therapist to Treat Clitoral Phimosis and Dyspareunia

Morrison, Pamela MS, PT, DPT, BCB-PMD, IMTC1; Kellogg Spadt, Susan PhD, CRNP, IF, CST2; Goldstein, Andrew MD3

Journal of Women’s Health Physical Therapy: January/April 2015 - Volume 39 - Issue 1 - p 17–28
doi: 10.1097/JWH.0000000000000023
Case Reports
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Introduction: Clitoral phimosis is adherence of the clitoral prepuce to the glans and can result from inflammatory dermatoses, blunt trauma, chronic infection, and inadequate hygiene.

Aim: The aim of this report was to demonstrate myofascial release (MFR) techniques utilized by a physical therapist to treat clitoral phimosis.

Methods: The patient was a 41-year-old woman with low back pain, a bruised sensation of her pubic region, vulvar pain provoked by sexual arousal, decreased clitoral sensitivity, dyspareunia, and anorgasmia. The patient sustained a blunt trauma injury to the vulva. Examination revealed lumbosacral and pelvic dysfunction, pelvic floor muscle dysfunction, bone bruise of the pubic bone, and decreased retractability of the clitoral prepuce and scarring. Eleven physical therapy sessions over 16 weeks included stretching, joint mobilization, muscle energy techniques, transvaginal pelvic floor muscle massage, clitoral prepuce MFR techniques, biofeedback, Integrative Manual Therapy (IMT) techniques, nerve mobilization, and therapeutic and motor control exercises. The patient applied topical clobetasol 0.05% cream for 30 days.

Results: The low back pain was reduced and full resolution of her vulvar pain, dyspareunia, and pubic bone bruised sensation resulted. Mobility of the clitoral prepuce was restored. Normal clitoral sensitivity and clitoral orgasm returned. Symptom resolution was confirmed upon telephone evaluation at 6 months.

Conclusion: With proper training, physical therapists managing patients with dyspareunia can identify clitoral phimosis and use specific MFR as a conservative treatment approach. Physical therapy techniques can be performed alone or in concert with medical therapy.

1Pamela Morrison Physical Therapy, PC, New York.

2Academic Urology Center for Pelvic Medicine; Bryn Mawr, Pennsylvania.

3The Center for Vulvovaginal Disorders, Washington, District of Columbia.

The authors declare no conflicts of interest.

Copyright © 2015 by the Section on Women's Health, American Physical Therapy Association.
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