Definition and Classification of Clitoral Phimosis and Adhesions: An International Delphi Study.

Abstract

The objective of this study is to develop accepted definitions and grading scales for clitoral phimosis and clitoral adhesions. Using a Delphi model of international vulvar experts, we attempt to reach consensus on definitions and factors included in grading scales. This was done through electronic surveys to accommodate the global reach. Physicians with significant clinical and/or research experience in vulvar dermatoses. Content experts were included from the fields of Dermatology, Gynaecology, and Urology. International content experts were invited to respond to two surveys on clitoral phimosis and clitoral adhesions. Individuals were deemed experts due to publications, international and national speaking engagements, and teaching on the topic of vulvar dermatoses. They were asked whether there is a need for definitions, the wording of definitions, and the variables that should constitute a future classification. A priori, we decided that a mean score of 7 out of 10 (70%) would constitute a consensus. The following statements gained consensus: (1) there is a need for a definition of clitoral phimosis and clitoral adhesions, (2) clitoral phimosis is defined as the inability to retract the clitoral prepuce to expose the entire glans, (3) clitoral adhesion is defined as the tethering of the clitoral prepuce (clitoral hood) to the glans clitoris, (4) the prepuce (90%) and the size of the glans (70%) should be considered in a classification, and (5) the degree of phimosis should be described as mild, moderate, or severe and whether or not the prepuce is retractable. Unifying communication on clitoral phimosis and adhesions could help improve research and clinical management.