ABSTRACT
Background
Keratin pearls are intraepithelial accumulations of squamous cells and debris that
can be an etiology of vulvovaginal irritation in pediatric patients and are often
associated with clitoral adhesions. Historically, most cases have been managed with
manual or operative lysis of adhesions.
Case
Two prepubertal girls presented to our clinic with chronic clitoral irritation and
were found to have clitoral adhesions with keratin pearls. Both were managed with
topical estrogen cream, which resulted in resolution of their symptoms.
Summary and Conclusion
Keratin pearls can form when the overlying clitoral epithelium becomes blocked by
clitoral adhesions. Hypoestrogenism is thought to be implicated in adhesion development;
thus, topical estrogen cream is a reasonable option in initial management. Our results
demonstrate a noninvasive alternative to the initial treatment of clitoral keratin
pearls.
Key Words
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References
- Retrospective study of the prevalence and risk factors of clitoral adhesions: women's health providers should routinely examine the glans clitoris.Sex Med. 2018; 6: 2
- Clinical presentation of clitorodynia associated with clitoral adhesions and keratin pearls.J Sex Med. 2022; 19: 8
- Labial adhesions and outcomes of office management.J Pediatr Adolesc Gynecol. 2013; 28: 2
- (Edited by)Chronic clitoral pain and clitorodynia.in: Goldstein A Pukall C Goldstein I Female Sexual Pain Disorders: Evaluation and Management. 2nd ed. John Wiley & Sons Ltd., New Jersey2021: 375-380 (Edited by)
- Clitorodynia in a pediatric patient: lysis of clitoral adhesions following dorsal nerve block.J Sex Med. 2017; 14: 6
- Successful management of PGAD and clitorodynia caused by a closed compartment syndrome.J Sex Med. 2016; 13: 5
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- Clinical recommendation: labial adhesions.J Pediatr Adolesc Gynecol. 2015; 28: 5
Article info
Publication history
Published online: October 06, 2022
Accepted:
October 2,
2022
Received in revised form:
September 22,
2022
Received:
July 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
There was no source of funding for this study, nor do the authors have any financial interests to disclose.
Previously presented: (Poster Presentation) 33rd Annual North American Society for Pediatric and Adolescent Gynecology (NASPAG) Annual Clinical and Research Meeting. New Orleans, LA. April 2019.
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
