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Abstract：
BACKGROUND: Surgery is the optimal treatment for a severe form of clitoral phimosis (CP) that is initiated by lichen sclerosus (LS) and causes female sexual dysfunction.
OBJECTIVE: We aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment.
METHODS: In this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20-45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment.
METHODS: Sexual function was evaluated using the Female Sexual Distress Scale-Revised and the Female Sexual Function Index, and the patient\'s genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients.
RESULTS: Various forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale-Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly.
CONCLUSIONS: The results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis.
UNASSIGNED: This is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations.
CONCLUSIONS: Surgical treatment of clitoral phimosis can improve sexual function, but because LS-a common underlying cause-is chronic in nature, patients may experience recurrence. Chmel R, M Nováčková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257-266.
OBJECTIVE: We aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment.
METHODS: In this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20-45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment.
METHODS: Sexual function was evaluated using the Female Sexual Distress Scale-Revised and the Female Sexual Function Index, and the patient\'s genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients.
RESULTS: Various forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale-Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly.
CONCLUSIONS: The results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis.
UNASSIGNED: This is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations.
CONCLUSIONS: Surgical treatment of clitoral phimosis can improve sexual function, but because LS-a common underlying cause-is chronic in nature, patients may experience recurrence. Chmel R, M Nováčková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257-266.
摘要：
背景：手术是治疗由硬化性苔藓（LS）引起的严重阴蒂包茎（CP）并导致女性性功能障碍的最佳治疗方法。
目的：我们旨在确定阴蒂包茎的病因，它对性功能的影响，手术治疗后的结果。
方法：在这项前瞻性队列研究中，我们观察了2014年9月至2016年9月3,650名性活跃的异性恋女性的阴蒂包茎的发生情况及相关变化,这些女性的平均年龄为34.8±14.9岁(20~45岁).最终,我们比较了9例严重阴蒂包茎患者在手术治疗后12个月的性功能和痛苦的变化以及对术后生殖器外观的满意度。
方法：使用修订的女性性困扰量表和女性性功能指数评估性功能，使用女性生殖器自我形象量表评估患者的生殖器自我形象；对所有患者进行妇科检查。
结果：在3,650例患者中有46例（1.3％）发现了各种形式的CP。在9例中发现了严重形式的CP，但只有2例合并阴道口狭窄。这9名患者接受了包皮环切术,其中2人接受了围手术。女性性功能障碍主要发生在患有LS和严重包茎的人群中。性功能,如女性性功能指数总分所示，术后12个月显著改善（17.9±0.9vs26.6±0.5；P<.001）。女性生殖器自我形象量表评估生殖器感知的评分在手术后明显高于接受阴蒂包皮环切术的女性(20±3.0vs12.3±3.3;P<.001)。女性性困扰量表修订后评分明显低于手术前（21.3±6.2vs33.8±6.9；P<.001）。2例CP伴阴道口狭窄患者术后性功能改善,但是性困扰水平没有显着降低。
结论：这项研究的结果将有助于临床医生集中治疗方法，并就阴蒂包茎的管理向患者提供建议。
■这是一项评估性功能术后结果的研究，苦恼,以及对患有严重CP的女性生殖器的满意度，使用经过验证的问卷。然而,患者数量少和缺乏适当的对照组是局限性.
结论：手术治疗阴蒂包茎可改善性功能，但是由于LS-一种常见的根本原因-本质上是慢性的，患者可能会复发。ChmelR,MNováčková,等待T,etal.阴蒂包茎：对女性性功能和手术治疗结果的影响。J性医学2019；16：257-266。
目的：我们旨在确定阴蒂包茎的病因，它对性功能的影响，手术治疗后的结果。
方法：在这项前瞻性队列研究中，我们观察了2014年9月至2016年9月3,650名性活跃的异性恋女性的阴蒂包茎的发生情况及相关变化,这些女性的平均年龄为34.8±14.9岁(20~45岁).最终,我们比较了9例严重阴蒂包茎患者在手术治疗后12个月的性功能和痛苦的变化以及对术后生殖器外观的满意度。
方法：使用修订的女性性困扰量表和女性性功能指数评估性功能，使用女性生殖器自我形象量表评估患者的生殖器自我形象；对所有患者进行妇科检查。
结果：在3,650例患者中有46例（1.3％）发现了各种形式的CP。在9例中发现了严重形式的CP，但只有2例合并阴道口狭窄。这9名患者接受了包皮环切术,其中2人接受了围手术。女性性功能障碍主要发生在患有LS和严重包茎的人群中。性功能,如女性性功能指数总分所示，术后12个月显著改善（17.9±0.9vs26.6±0.5；P<.001）。女性生殖器自我形象量表评估生殖器感知的评分在手术后明显高于接受阴蒂包皮环切术的女性(20±3.0vs12.3±3.3;P<.001)。女性性困扰量表修订后评分明显低于手术前（21.3±6.2vs33.8±6.9；P<.001）。2例CP伴阴道口狭窄患者术后性功能改善,但是性困扰水平没有显着降低。
结论：这项研究的结果将有助于临床医生集中治疗方法，并就阴蒂包茎的管理向患者提供建议。
■这是一项评估性功能术后结果的研究，苦恼,以及对患有严重CP的女性生殖器的满意度，使用经过验证的问卷。然而,患者数量少和缺乏适当的对照组是局限性.
结论：手术治疗阴蒂包茎可改善性功能，但是由于LS-一种常见的根本原因-本质上是慢性的，患者可能会复发。ChmelR,MNováčková,等待T,etal.阴蒂包茎：对女性性功能和手术治疗结果的影响。J性医学2019；16：257-266。
