I may have mentioned that I found a vulvar dermatologist at Stanford named Dr. Badger, a lovely woman who reminds me of a blond Mary Poppins, including the phrase, "Oh dear!"
She put me on Desonide 0.05% ointment for an unusually copious presence of smegma. Below is an image of what was extracted by my husband (yes, this is graphic, but I think it is helpful to see). The tweezers were used to lift the smegma off the clitoris once it was expelled (see the "Clitoral Adhesions" entry for my how-to)
See my post "Clitoral Adhesions Update" for an image of smegma and a topical steroid ointment I used call Desonide that resolved a flare. Thank you to the many commenters that suggested the right topical steroids and made my adhesions leave.
Clitoral adhesions are not given too much medical attention and will likely confound your gynecologist who may have never heard of this. I have gone in to appointments with a drawing of my adhesions (drawn by my not-so-artistic husband). Adhesions develop when your outer clitoral hood fuses (to a lesser or greater extent) with the clitoris. The cause is the continual irritation between to two surfaces. As the body tries to heal itself, the two raw areas begin to heal onto each other. The clitoral hood is supposed to slide back and forth over the clitoris, but in this case, it becomes stuck. Often you develop pockets of sebaceous fluid which normally lubricates the area and allows for slide between the two, but in this case it becomes trapped in inside of the adhesions and becomes a further irritant. When it can't be discharged, it dries out and goes from an oil-like lubricant to smegma. You can see this smegma trapped inside the adhesions. Smegma is white and hard.
The treatment, invented by me and my husband is this:
- I spread my labia and clitoral hood apart so that he can see the area;
- He uses a black head extractor with a soft point on the end shown here. If you wince, fine. If you cry, stop as you are just damaging yourself at this point.
- He may use a little oil - baby, olive, whatever - or sometimes goes dry;
- He slides from top to down along the seam prodding it open (again, I am holding the clitoral hood and the clitoris as open as possible so that he can see);
- I then try to put my fingers on each side of the crevice and pull it apart gently (this alternates with the other approach);
- It is importantly to work on this a bit and then leave it for a a few days before you come back to do some more loosening as this process inflames the skin and that is what you do not want to happen.
- Yes, this hurts. We once had to work on one individual adhesion for 4 years (it had probably been there for a very long time) to get it open and it recently returned. This time it took only a few weeks to open. The important thing is to catch it before it starts to fuse again.
- Open the clitoral hood and clitoris in the shower and gently pull the two sides apart once every 2-4 weeks (daily will just irritate you and make the skin more raw). I gently, gently wash with Cetaphil. No scrubbing. It is more just like how women apply face wash in commercials with the light touch, moving in slow circles for a brief moment.
- After a session, slather on some ointment like Lidocaine 5% or Vaseline to give the skin a barrier protectant.