背景：角蛋白珍珠是在鳞状细胞同心层内的中央角化灶，可在阴蒂包皮下形成并引起疼痛（阴蒂痛）；办公室中去除角蛋白珍珠可减少阴蒂疼痛并改善性功能。
目的：本研究旨在调查部分阴蒂包茎和角蛋白珍珠的女性在办公室使用角蛋白珍珠切除术（LCA-KPE）治疗阴蒂粘连前后的阴蒂疼痛和性功能。
方法：一项介入前研究评估了在2017年1月至2023年2月期间在2个专治外阴疼痛的大都市妇科诊所接受LCA-KPE的患者。通过回顾性图表审查发现的角蛋白珍珠和部分阴蒂包茎的患者被要求完成术后问卷调查，并提供对阴蒂不适的主观反应。性功能,性困扰,以及他们在办公室LCA-KPE的经验。采用配对t检验进行双变量分析以确定LCA-KPE的效果。定性数据分析采用主题编码。
结果：使用11点疼痛视觉模拟量表来确定手术前后阴蒂不适和性高潮困难。使用女性性功能指数（FSFI）和修订的女性性困扰量表测量女性性功能障碍。
结果：74例符合纳入标准的患者中，共有32例完成了术后调查（43％的反应率）。受访者的平均阴蒂疼痛基线为6.91，LCA-KPE后为2.50（P<.001）。平均性高潮难度从基线时的5.45显著降低至LCA-KPE后的3.13(P<.001)。参与者在治疗后的平均FSFI总分为17.68，而平均总基线FSFI为12.12（P=0.017）。随访时疼痛的平均FSFI评分为2.43，而基线为1.37（P=0.049）。术前与术后女性性困扰量表修订后的平均评分没有显着差异（P=0.27）。定性主题将该过程描述为痛苦但值得，77%的参与者报告总体体验为积极的。总体复发率为28%，中位数为2次重复程序。
结论：认识到角蛋白珍珠是阴蒂疼痛的结构性原因并提供办公室治疗是解决阴蒂痛和改善性功能的重要工具。
■这是迄今为止最大的记录事件的研究，确定相关的疼痛状况，并评估阴蒂角蛋白珍珠的程序性结果。这项研究受到相对较小样本量的限制。
结论：办公室LCA-KPE可显著减少阴蒂不适和性高潮困难。
BACKGROUND: Keratin pearls are foci of central keratinization within concentric layers of squamous cells that can form under the clitoral prepuce and cause pain (clitorodynia); in-office removal of keratin pearls may reduce clitoral pain and improve sexual function.
OBJECTIVE: This
study aims to investigate clitoral pain and sexual function in women with partial clitoral phimosis and keratin pearls before and after in-office lysis of clitoral adhesions with keratin pearl excision (LCA-KPE).
METHODS: A pre-post interventional
study evaluated patients who underwent LCA-KPE between January 2017 and February 2023 in 2 metropolitan gynecology clinics specializing in vulvar pain. Patients presenting with keratin pearls and partial clitoral phimosis identified through retrospective chart review were asked to complete postprocedure questionnaires and provide subjective responses on clitoral discomfort, sexual function, sexual distress, and their experience with in-office LCA-KPE. Bivariate analyses with paired t tests were conducted to determine the effect of LCA-KPE. Qualitative data were analyzed with thematic coding.
RESULTS: An 11-point pain visual analog scale was utilized to determine pre- and postprocedure clitoral discomfort and difficulty with orgasm. Female sexual dysfunction was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised.
RESULTS: A total of 32 of 74 patients who met inclusion criteria completed postprocedure surveys (43% response rate). Mean clitoral pain for respondents was 6.91 at baseline and 2.50 after LCA-KPE (P < .001). Mean difficulty with orgasm was significantly decreased from 5.45 at baseline to 3.13 after LCA-KPE (P < .001). Participants had a mean FSFI total score of 17.68 after treatment compared with a mean total baseline FSFI of 12.12 (P = .017). The mean FSFI score for pain was 2.43 at follow-up compared with 1.37 at baseline (P = .049). There was no significant difference in the mean Female Sexual Distress Scale-Revised score before vs after the procedure (P = .27). Qualitative themes described the procedure as painful but worthwhile, with 77% of participants reporting the overall experience as positive. Recurrence rate overall was 28%, with a median of 2 repeat procedures.
CONCLUSIONS: Recognizing keratin pearls as a structural cause of clitoral pain and offering in-office treatment is an important tool in addressing clitorodynia and improving sexual function.
UNASSIGNED: This is the largest
study to date documenting the occurrence, identifying associated pain conditions, and evaluating procedural outcomes for clitoral keratin pearls. This
study was limited by a relatively small sample size.
CONCLUSIONS: In-office LCA-KPE significantly reduced clitoral discomfort and difficulty with orgasm.
