Karis Buford et al., 2024: Extracorporeal shock wave therapy as a treatment option for persistent clitoral priapism: a case report
Karis Buford 1, Lauren Phung 2, Bernadette M M Zwaans 1 2, Priya Padmanabhan 1 2, Rachel S Rubin 3, Kenneth M Peters 1 2
1Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, United States.
2Oakland University William Beaumont School of Medicine, Rochester, MI 48309, United States.
3Georgetown University Hospital Department of Urology, Washington, DC 20007, United States.
Abstract
Introduction: Clitoral priapism is persistent clitoral engorgement without sexual stimulation. Presentation is sparse, and therefore limited treatment options have been investigated.
Aim: We present a case report of a 34-year-old female presenting with persistent nonischemic clitoral priapism 5 years after aggressive clitoral stimulation.
Methods: Patient underwent six weekly Li-ESWT sessions at frequency 4 Hz, energy 0.11 mJ for 2000 shocks per session. Assessment included physical examination of clitoral glans engorgement and retraction, global response assessment (GRA) score, need for topical phenylephrine, and ability to achieve orgasm.
Results: At the end of the therapy, examination revealed complete resolution of priapism with a normal-appearing clitoris fully retracted behind the clitoral hood. The patient reported no longer requiring topical phenylephrine, a significant improvement in GRA, and the ability to achieve orgasm.
Conclusion: We present a case of nonischemic clitoral priapism resolved with Li-ESWT. More investigation regarding the utilization of Li-ESWT in the treatment of clitoral priapism is highly encouraged.
Sex Med. 2024 Dec 3;12(6):qfae082. doi: 10.1093/sexmed/qfae082. eCollection 2024 Dec.
PMID: 39664412 PMCID: PMC11630007 FREE PMC ARTICLE
Comments 1
Comment:
Priapism is defined as a prolonged erection lasting over four hours without sexual stimulation. While penile priapism is well-documented, clitoral priapism is rare and presents unique challenges in diagnosis and treatment. This article investigates the effectiveness of low-intensity extracorporeal shock wave therapy (Li-ESWT) as a treatment for high-flow clitoral priapism in a case study.
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Case Presentation
• 34-year-old female
• Symptoms: Severe clitoral pain, anorgasmia, sexual aversion, mild urinary hesitancy, and urgency, which began five years prior after aggressive clitoral stimulation.
• Medical History: No significant medical or family history, previous cosmetic surgery.
• Previous Treatments include several ineffective treatments for chronic clitorodynia, like dorsal clitoral nerve block, Clitoral adhesion release, pudendal nerve blocks, and clitoral platelet-rich plasma injection
Diagnosis: Physical examination revealed an engorgement of the glans clitoris and retraction of the clitoral hood. Normal lumbar MRI and CT angiogram ruled out nerve compression and arteriovenous fistula, respectively. Initial treatments with pseudoephedrine and phenylephrine provided limited relief.
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Therapeutic Intervention: The patient received six weekly sessions of Li-ESWT using the SoftWave® device, each session involved 2000 shocks at 4.0 Hz and 0.11 mJ energy.
Assessment Methods included physical examination, patient-reported pain scores, a global response assessment (GRA), and the ability to achieve orgasm.
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Follow-Up and Outcomes
• After First Session: Pain decreased, mild improvement in glans engorgement.
• By Third Session: The patient stopped using topical phenylephrine, with partial retraction of the clitoris noted.
• By Fourth Session: Significant improvement in clitoral pain and voiding symptoms; the patient reported a small orgasm.
• After Sixth Session: The patient reported an 80% improvement in symptoms, including resolution of sexual aversion and clitoral pain. While she experienced some difficulty achieving orgasms, she noted the ability to reach weak orgasms.
Patient Experience The patient tolerated the Li-ESWT well, reported minimal discomfort, and expressed willingness to undergo the treatment again if necessary.
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Discussion Clitoral priapism can result from medications (e.g., antidepressants) and other causes similar to penile priapism, often related to issues with venous outflow. Diagnostic protocols for clitoral priapism are lacking, and there is a need for differentiation between ischemic and non-ischemic types.
Li-ESWT works by reducing inflammation, promoting blood vessel growth, and recruiting stem cells, making it a potentially effective treatment for high-flow clitoral priapism.
Limitations: The case report highlights the need for further research due to the limited nature of the investigation and the underreported incidence of clitoral priapism.
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Conclusion This case demonstrates successful resolution of refractory clitoral priapism through Li-ESWT. Given the condition's potential impact on quality of life, further studies are warranted to explore Li-ESWT's efficacy for clitoral and penile priapism management. One should also consider Li-ESWT in the management of penile priapism.
Jens Rassweiler