Key takeaways

• Clitoral adhesions are scar‑like attachments between the clitoral hood and glans that limit hood retraction and reduce glans exposure.

• Ongoing inflammation from infections, lichen sclerosus/lichen planus, or recurrent dermatitis encourages fibrosis and adhesion formation.

• Local trauma — including previous vulvar injury, surgical procedures, or female genital mutilation — can trigger healing that leads to adhesions.

• Mechanical irritation (tight clothing, repetitive friction, retained moisture, or smegma under the hood) increases irritation and the risk of adhesions.

• Hormonal changes and individual tendencies to scar alter tissue elasticity and healing, making some people more prone to adhesions.

Understanding what clitoral adhesions are

So what exactly are clitoral adhesions, and how do they form? They’re pathological attachments where the clitoral hood sticks to the glans clitoris, limiting retraction and preventing full exposure of the glans. Clinically, adhesions range from thin, movable bands to dense scar tissue that can make cleaning difficult and change sensation. They commonly follow local dermal injury, ongoing vulvar inflammation, or buildup of smegma and debris beneath the hood. Scarring conditions such as lichen sclerosus make fixed adhesions more likely. Inflammation or infection encourages fibrosis, and hormonal shifts can affect skin resilience and repair. Studies show adhesions are not rare in women evaluated for sexual concerns, so recognizing them during a genital exam is important.

Common causes and risk factors

Why do adhesions form in some people but not others? Several factors usually interact. Scarring from vulvar conditions like lichen sclerosus or lichen planus makes tissue more likely to fuse, while trauma (including FGM/C or other prior injuries) starts a healing response that can produce adhesions. Chronic inflammation from recurring infections, STIs, or bacterial imbalance promotes tissue stickiness and fibrosis. Hormonal influences that thin or atrophy the skin change susceptibility. Mechanical factors — repeated friction from tight clothing or exercise, aggressive washing, or trapped moisture and smegma under the hood — add irritation and bacterial growth. Using irritating soaps or detergents can worsen dermatitis and scarring. These combined elements are the main risk factors for clitoral adhesions.

Signs and symptoms to watch for

After considering risk factors, it helps to know what to look for. Early signs include reduced ability to retract the clitoral hood and limited glans exposure, plus ongoing clitoral pain or discomfort, especially with arousal or when cleaning. On exam you may see smegma buildup beneath the hood, visible tethering, keratinized changes, or local redness and inflammation. Sensory changes — increased sensitivity or numbness near the glans — can occur. A history of trauma, repeated friction, or aggressive cleansing often accompanies these findings. If symptoms are persistent, worsening, or linked with conditions like lichen sclerosus or lichen planus, seek medical evaluation to confirm adhesions and rule out infection.

Non‑surgical management and prevention

How are clitoral adhesions often managed without surgery? Many cases respond to office‑based measures such as gentle lysis under local anesthesia, topical corticosteroids to reduce inflammation, and conservative steps to improve comfort and function. After lysis, recommended care includes gentle retraction exercises, warm‑water cleansing, and avoiding irritants to prevent smegma buildup and recurrence. In selected cases, topical hormone treatments (for example, estradiol or testosterone creams) can help support tissue health. Regular follow‑up lets your clinician check healing and watch for recurrence.

When medical or surgical care is needed

When should you consider medical or surgical care for clitoral adhesions? Treatment is recommended if adhesions cause persistent pain, limit hood retraction, or lead to sexual dysfunction despite conservative steps. First‑line medical care often combines topical corticosteroids to calm inflammation and help separation, with topical hormone creams (estrogen and/or testosterone) when appropriate for tissue support and to reduce recurrence. Office lysis under local anesthesia is a minimally invasive option to mechanically release adhesions and can improve pain and arousal for many people. Surgical lysis is reserved for severe or recurrent cases when office lysis is insufficient or scarring is extensive; it may give greater relief but carries higher risk and a longer recovery. Follow‑up is important to ensure proper healing and to address any contributing factors.