Introduction
Female reproductive tract infections, including clitoris infections, are endemic in developing countries. They can entail a heavy toll on affected women's quality of life. If untreated, they can lead to adverse health outcomes, including infertility, ectopic pregnancy, and increased risk of transmission of the human immunodeficiency virus. Infections in female reproductive tracts also involve infections of the vulva, which consists of tissue structures mons pubis, labia, clitoris, and perineum. This article provides detailed information on infections involving the clitoris and their prevention and management.
What Is the Clitoris?
The clitoris is a sex organ in women that functions as a sensory organ. It can be considered homologous to the penis in males. The clitoris consists of the glans clitoris and the clitoral body. The underlying tissue of the body of the clitoris is the corpus cavernosum which is also present in the penis in men. The corpus cavernosum is a type of erectile tissue that gets engorged with blood and swells during sexual stimulation. Hence it is considered a female penis. The two separate proximally situated ends of the tissue form the legs (crus) of the clitoris and the clitorial body. The glans of the clitoris are the only visible clitorial part, and it is highly rich with numerous innervation by nerves and contains rich blood vessels. Some research estimated that the clitorial glans are innervated by around eight thousand nerve endings, facilitating its erection and engorgement with blood during sexual stimulation and arousal. The clitoris also contains smooth muscle, elastic tissue, and collagen.
Clitorial skin differs from the body's in hydration, permeability, visually discernible irritation, and friction. Moreover, the skin of the clitoris is more susceptible to topical agents than forearm skin due to its higher hydration, occlusion, and frictional properties. It is non-keratinized. So, it is more permeable than keratinized skin. Moreover, the clitorial skin contains large hair follicles, making it easier for bacteria and other substances to enter the skin.
What Are Clitoris Infections?
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Clitoral Candidiasis: It is characterized by a white, odorless, curdy discharge with clitorial irritation, which is more common in women during the reproductive years. The clitoral skin has an asymmetrical or irregular pattern, mild to moderate redness, and possible edema. Triggers for symptomatic infection include poorly controlled diabetes, pregnancy, and recent antibiotic use.
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Bacterial Clitoral Infections: Infections involving female genitals, including the clitoris, are often polymicrobial, consisting of aerobic and anaerobic bacteria.
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Sexually Transmitted Infections (STIs):
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Haemophilus ducreyi.
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Klebsiella granulomatis.
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Chlamydia trachomatis.
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Neisseria gonorrhoeae.
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Syphilis.
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Herpes simplex virus.
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Human papillomavirus.
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Human immunodeficiency virus.
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Hepatitis B and C.
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Rare infections: Clitoral myiasis (infection with a fly larva) was reported in a woman collecting wood in a forest who did not wear undergarments. In some cases, the clitoral infection may occur as a part of a systemic disease such as Crohn's disease.
What Are the Causes of Clitoris Infection?
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Using panty liners with a non-breathable back sheet can increase the temperature, moisture, and pH of the clitoral skin, significantly changing the microclimate of the vulva.
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Hair removal in the genital area may cause skin microtrauma with the subsequent spread of infectious agents. Severe consequences may include irritation and infection of genital skin, including the clitoris, and the spread of sexually transmitted infections such as molluscum contagiosum and herpes simplex virus. In addition, pubic hair functions as a physical barrier for the female genital area, and its complete removal could increase susceptibility to infection. However, clear study data suggest this link is not present.
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Washing the internal genital area using water or harsh surfactants can also be abrasive, may impact the local bacterial flora, and can lead to dry skin and itching, thereby increasing the chances of infection.
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Some women routinely use intimate hygiene products for daily cleansing for cleanliness and odor control, but some may alter the normal pH level needed for protection against infection.
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Clitorial skin pH is around 3.5 to 4.7. Various factors may affect it, including endogenous factors such as humidity, vaginal discharge, menstruation, urine, sweat, fecal contamination, genetics, and age. While exogenous factors such as cosmetic products, lubricants, spermicides, or sanitary pads. Prolonged drying of the clitoral skin also significantly reduces its pH.
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Many other factors, including immune deficiency, hormonal changes, and stress, may also upset the normal bacterial flora and cause infections. The vulva, along with the clitoris, is susceptible to dermatological conditions, including dermatitis, particularly when the barrier protection of the skin gets compromised by factors that may constitute the normal vulvar environment, such as moisture due to urine and vaginal discharge, enzymes present in stool residue, friction, and heat.
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The anatomical location of the vagina, clitoris, urethra, and anus allows for bacterial cross-contamination between them. Hence, any infection around these areas can spread easily.
What Are the Symptoms of Clitoris Infection?
Clitoral infective lesions can give rise to the following symptoms:
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Pain or discomfort in the clitoral area.
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Clitoral swelling.
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Malodorous vaginal discharge.
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Drainage of purulent material.
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Changes in color and texture of clitorial skin.
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Ulcerations on the clitoris in severe cases.
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Sleep disturbances and decreased quality of life.
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Itching, burning, irritation.
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Dyspareunia (painful sex).
How to Prevent Clitoris Infection?
Doctors usually advise the following preventive measures to avoid female genital tract infections, including clitoral infections:
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Washing with water can dry skin, which makes itching worse. Thus, use less water to clean intimate areas.
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Take a shower rather than bathe. Moreover, clean the genital area, including the clitoris, only once a day, as cleaning can aggravate symptoms of contact dermatitis.
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An emollient (moisturizer) may be helpful.
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Avoid using sponges or flannels to clean the genitals. Just using their hand, gently pat dry with a soft towel.
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Wear loose-fitting cotton or silk underwear. Avoid tight-fitting clothes. Replace tights with stockings.
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Sleep without underwear and skip underwear under long skirts.
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Consider washing underwear separately using a non-biological laundry detergent.
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Avoid using soap, shower gel, bubble baths, scrubs, baby wipes, douches, or baby wipes on the vulva and clitoris.
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Avoid the use of panty liners or sanitary pads regularly.
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Some over-the-counter creams, such as nappy, herbal, and thrush treatments, may include irritants.
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Avoid antiseptic cream in the vulvar area.
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Avoid scratching genital skin and using nail varnishes on fingernails in case of scratching the genitals.
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Avoid using colored toilet paper.
How Is Clitoris Infection Diagnosed?
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The doctor will take a detailed history and perform a physical examination to know the extent of the infection and the areas involved.
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Culture of the Lesion: The doctor will advise culture assessment to determine its causative organism for diagnosis.
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Blood Tests: the doctor will advise a blood test to rule out STDs.
How Is Clitoris Infection Treated?
The initial step in managing clitoral infection is to uncover the cause of the infection. After the diagnosis, the doctor will advise avoiding certain activities that may cause clitoris infection, such as hot tub use, douching, or hard soap use. In case of a bacterial clitoral infection, the doctor will prescribe a systemic antibiotic to resolve the infection. If the doctor diagnoses clitoral infection as a result of STDs, then the doctor will prescribe medications and adjunctive therapies based on that particular STD.
Conclusion
Clitoral infection can be a great source of discomfort and pain to affected women. It may decrease women's overall quality of life, especially interpersonal relationships with partners. Any of the symptoms related to the genital infection, including on the clitoris, requires effective treatment and management to relieve symptoms and avoid severe consequences.
