{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:23:41Z","timestamp":1787649821607,"version":"build-2736575974"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Keratin pearls are foci of central keratinization within concentric layers of squamous cells that can form under the clitoral prepuce and cause pain (clitorodynia); in-office removal of keratin pearls may reduce clitoral pain and improve sexual function.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This study aims to investigate clitoral pain and sexual function in women with partial clitoral phimosis and keratin pearls before and after in-office lysis of clitoral adhesions with keratin pearl excision (LCA-KPE).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A pre-post interventional study evaluated patients who underwent LCA-KPE between January 2017 and February 2023 in 2 metropolitan gynecology clinics specializing in vulvar pain. Patients presenting with keratin pearls and partial clitoral phimosis identified through retrospective chart review were asked to complete postprocedure questionnaires and provide subjective responses on clitoral discomfort, sexual function, sexual distress, and their experience with in-office LCA-KPE. Bivariate analyses with paired t tests were conducted to determine the effect of LCA-KPE. Qualitative data were analyzed with thematic coding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>An 11-point pain visual analog scale was utilized to determine pre- and postprocedure clitoral discomfort and difficulty with orgasm. Female sexual dysfunction was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale\u2013Revised.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 32 of 74 patients who met inclusion criteria completed postprocedure surveys (43% response rate). Mean clitoral pain for respondents was 6.91 at baseline and 2.50 after LCA-KPE (P &amp;lt; .001). Mean difficulty with orgasm was significantly decreased from 5.45 at baseline to 3.13 after LCA-KPE (P &amp;lt; .001). Participants had a mean FSFI total score of 17.68 after treatment compared with a mean total baseline FSFI of 12.12 (P = .017). The mean FSFI score for pain was 2.43 at follow-up compared with 1.37 at baseline (P = .049). There was no significant difference in the mean Female Sexual Distress Scale\u2013Revised score before vs after the procedure (P = .27). Qualitative themes described the procedure as painful but worthwhile, with 77% of participants reporting the overall experience as positive. Recurrence rate overall was 28%, with a median of 2 repeat procedures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>Recognizing keratin pearls as a structural cause of clitoral pain and offering in-office treatment is an important tool in addressing clitorodynia and improving sexual function.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>This is the largest study to date documenting the occurrence, identifying associated pain conditions, and evaluating procedural outcomes for clitoral keratin pearls. This study was limited by a relatively small sample size.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In-office LCA-KPE significantly reduced clitoral discomfort and difficulty with orgasm.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdae034","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T06:54:40Z","timestamp":1711090480000},"page":"443-451","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy of in-office lysis of clitoral adhesions with excision of keratin pearls on clitoral pain and sexual function: a pre-post interventional study"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-0570","authenticated-orcid":false,"given":"Jill M","family":"Krapf","sequence":"first","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"},{"name":"Department of Obstetrics and Gynecology, George Washington University , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2372-4384","authenticated-orcid":false,"given":"Isabella","family":"Kopits","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Holloway","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Lorenzini","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Mautz","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Centers for Vulvovaginal Disorders , Washington DC 20037 , United States"},{"name":"Department of Obstetrics and Gynecology, George Washington University , Washington DC 20037 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"issue":"4","key":"2024050206213234300_ref1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jsxm.2016.02.167","article-title":"International Society for the Study of vulvovaginal disease (ISSVD). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia","volume":"13","author":"Bornstein","year":"2016","journal-title":"J Sex Med"},{"issue":"8","key":"2024050206213234300_ref2","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1111\/jsm.12934","article-title":"Clitorodynia: a descriptive study of clitoral pain","volume":"12","author":"Parada","year":"2015","journal-title":"J Sex Med"},{"issue":"suppl 1","key":"2024050206213234300_ref3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1080\/00926230252851249","article-title":"Clitoral pain: the great unexplored pain in women","volume":"28","author":"Gordon","year":"2002","journal-title":"J Sex Marital Ther"},{"issue":"2","key":"2024050206213234300_ref4","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.esxm.2018.01.003","article-title":"Retrospective study of the prevalence and risk factors of clitoral adhesions: Women\u2019s health providers should routinely examine the glans clitoris","volume":"6","author":"Aerts","year":"2018","journal-title":"Sex Med"},{"issue":"3","key":"2024050206213234300_ref5","first-page":"445","article-title":"Pathologic and physiologic phimosis: approach to the phimotic foreskin","volume":"53","author":"McGregor","year":"2007","journal-title":"Can Fam Physician"},{"issue":"4 Suppl","key":"2024050206213234300_ref6","article-title":"Mp48-07 successful management of Clitorodynia closed compartment syndrome","volume":"195","author":"King","year":"2016","journal-title":"J Urol"},{"issue":"Supplement_3","key":"2024050206213234300_ref7","doi-asserted-by":"crossref","first-page":"S220","DOI":"10.1016\/j.jsxm.2020.04.241","article-title":"005 Clitorodynia: the unexplored subtype of vulvodynia. 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