Swollen and painful clitoris

One of my inner vagina lips is larger

Ovarian cyst

White spots around the clitoris

Why is the neck of my womb swollen?

Question

I have a swollen and painful clitoris. I also seem to be going to the toilet an awful lot, even after a very small drink. I wake up about three times in the night to go to the toilet.

I've always urinated a lot and it never hurts, so I don't think it is cystitis.

I have seen the doctor and a gynaecologist, who say there is nothing wrong, but my clitoris can be very painful even when I sit down or walk.

I use non-biological powder and non-perfumed soaps and wear cotton pants, but the problem is not going away.

I am getting more worried about it, but people tell me it is in my mind, but it's not. It doesn't hurt all the time, but more often than not it does.

Answer

While it is quite possible that this is a condition associated with the depression and anxiety you mention, it does not seem to have responded to the treatment you are having. And the fact that it is so persistent makes me think that you should ask for some further investigations.

I wonder exactly what was done when you saw the gynaecologist? If he just examined you in the normal way, it may not be enough to detect some of the slight changes that could be present.

There is a way of examining the genital area under a type of microscope called a colposcope. Minor changes, such as small bumps or thickening, become more apparent through this technique, and it might be that this would be useful in your case.

The kind of pain you get is also important. Burning or searing pain may be indicating vulvodynia. This is a medical term for a difficult to diagnose and treat condition in which symptoms occur without visible surface changes. However, there are some specialist treatments available for it.

Itching pain may indicate allergy, and I note that you are already avoiding things that might aggravate it.

The skin in this area is very sensitive, and reacts to a wide range of allergens including things you have not mentioned like coloured or scented toilet paper, fabric softener, and bath additives. It is also possible to become allergic to things you have used for years.

Creams are available to treat allergies in this area, and I wonder if you have tried anything such as a simple 1 per cent hydrocortisone, which you can buy quite cheaply over the counter.

The clitoris can also enlarge due to hormonal changes, although this is rare. There are conditions where excess male hormones are produced that can make the clitoris enlarge and feel uncomfortable.

If you had this rare condition you might notice other changes like excess hair growth, acne, weight gain, and lowering of the voice.

Have you had any blood tests of your hormone levels? These are quite easy to do.

For completeness, I ought to ask also whether you have any past or current sexual practices that might irritate the clitoris.

As I said at the beginning, it may be just due to your depression and anxiety, but after all this time I think you owe it to yourself to try to get to the bottom of the problem.

I would ask your doctor if you could see the gynaecologist again, so you can ask about these issues. If you weren't happy with that encounter, ask if you can have a second opinion from another specialist, which you are entitled to do.

Yours sincerely

Dr Keith Barnard, GP

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