A Novel Method to Treat Primary Anorgasmia : Vestibuloplasty : A Case Report Omer

C l i n M e d International Library Citation: Karatas OF, Gumus II, Bayrak O, Yildirim ME, Badem H, et al. (2016) A Novel Method to Treat Primary Anorgasmia: Vestibuloplasty: A Case Report. Int J Womens Health Wellness 2:011 Received: December 28, 2015: Accepted: January 23, 2016: Published: January 26, 2016 Copyright: © 2016 Karatas OF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Karatas et al. Int J Womens Health Wellness 2016, 2:011 Volume 2 | Issue 1 ISSN: 2474-1353


Introduction
In women, orgasm is defined as giving a feeling of happiness and fulfillment after sexual stimulation which is decreasing of vasocongestion; rhythmic contractions of uterus, anus and vagina muscles surrounding the pelvic region, also defined as a state of short term intense pleasure.Sexuality takes an important role and has an impact on the quality of life of the couples [1].Sexual function in women affected by psychological, environmental and physiologic (hormonal, vascular, neurologic and anatomic) factors [2].Recent literature indicates that 40-45% of woman experienced at least one sexual dysfunction [3].
The clitoris plays an important role at the primary erogenous response by the disciplines of embryology, anatomy and physiology [4].Glans and the body of the clitoris are visible in normal, but in some cases a skin, likely the prepuce in men, covers the clitoris [4].Some women may reflect this situation as a reason of anorgasmia.We represent a case aiming to assess the various reasons of women anorgasmia discussing with the current literature.

Case
A 35 year old woman, married for ten years and having 2 children with vaginal delivery admitted to obstetrics and gynecology clinic with primary anorgasmia from the beginning of her marriage.She had a regular sexual life with her husband (at least twice a month), but she had never experienced an orgasm during her marriage.She had graduated from university and has a normal socioeconomic status.She had not experienced any sexual intercourse before her marriage.During her marriage she had no argument with her husband about this situation.Urology consultation was obtained after the vaginal examination.Patient was evaluated with urogynecologic examination and Female Sexual Function Index (FSFI).At the and the roots of clitoris are located in contact with the ischiopubic ramus [4].Embryologic, anatomic and physiologic findings showed that clitoris plays an important role in female orgasm [4].According to some authors, it is one of the erectile tissues in woman and could be named as female penis [4].The glans and the body of the clitoris are visible but sometimes they can be covered by a prepuce like skin [4].So that, women, like in our case, could not have a satisfactory orgasm because absence stimulation of clitoris.Orgasm is known to develop on the ground of peripheral sexual stimulation, as a result of physiological changes in cerebral neural activity.Neuroanatomical studies have shown that pudendal nerve branches innervating the clitoris that include the clitoral corpus cavernous nerve, the peripheral nerve and the dorsal nerve of clitoris, which is likely that this fine innervation of the clitoris and external genitalia transmits the sensorial stimulation that influences the vasocongestive events of clitoral sexual arousal [7].
First line we suggested "Coital Alignment" technique as behavioral therapy that was hypothesized with high frequency of female orgasm and partner simultaneity [8].For women, sildenafil initially was used "off label" as a primary treatment for female sexual dysfunction (FSD) since 1998 [9].After failure of behavioral therapy we suggested sildenafil 25 mg and tibolon 2.5 mg for daily for a month but, she had showed no response to sildenafil.We also recommended a vacuum erection device which increases blood flow to the clitoris has been approved by the US Food and Drug Administration (FDA) for a month.Mechanical devices may work through vibratory stimulation or by causing clitoral vascular engorgement using a vacuum system [10].She did not show any response to all these therapies and there were no increase at the FSFI scores in three month period.We excised a half of the prepuce in order to expose the glans clitoris.Sexual satisfaction and FSFI scores were started to increase at second month after the operation.Sexual satisfaction still remained at the same level at the two years of follow-up.This delay at satisfaction may be due the late onset of sexual intercourse after operation.
Anatomical or physiological factors inhibiting the arousal of clitoris are adversely affecting the clitoris to achieve orgasm.In cases where other treatment methods have failed at women with primary anorgasmia, clitoris examination should be performed.Vestibuloplasty could provide a treatment success increasing the sensitivity of clitoris in anorgasmia at appropriate patients.This is the first report about excision of the clitoral skin in order to expose the glans clitoris to increase the sexual satisfaction in women.