Clitoral Atrophy: Can Your Clitoris Really Shrink?

If you aren't feeling sexual arousal like you used to, it might not be low libido, but it could be clitoral atrophy.

Clitoral atrophy is a pleasure-stealing—and vastly under-researched—condition looming over people with vaginas.

What is clitoral atrophy and how does it present?

You may have heard of vaginal atrophy. This health condition causes vaginal dryness and thinning and, according to the Mayo Clinic. These vaginal tissue changes happen most often due to estrogen changes associated with menopause.

Clitoral atrophy is different. It can affect anyone at any age and cause sexual dysfunction.

"Clitoral atrophy is a type of degeneration or wasting away of the clitoris causing thinning or shrinking that leads to a reduction in sensitivity and sexual function," said Sameena Rahman, M.D., an OB-GYN in Chicago and founder of the Center for Gynecology and Cosmetics. "Clitoral atrophy may be considered part of the constellation of symptoms patients have with genitourinary syndrome of menopause."

During the menopausal process, hormones decline and bladder, vaginal and vulval tissues can change, Rahman explained.

"The lack of estrogen can lead to a decrease in vascular flow and decrease engorgement of the clitoris, which can lead to delayed reaction time, absence or delay of arousal or orgasm," Rahman said. "The lips of the vagina, vulva, will shrink in size and so can the clitoris."

Menopause is not the only cause of clitoral atrophy, however, it can affect anyone. 

The causes of clitoral atrophy include:

• Lichen sclerosus
• Hysterectomy
• Lack of blood flow
• Menopause
• Hormonal birth control

"Using hormonal birth control can also cause estrogen levels to decrease," added Amir Marashi, M.D., a gynecologist and pelvic pain and endometriosis expert in New York City. "Clitoral atrophy can also develop if the clitoris is not stimulated enough; the definition of 'enough' can vary widely from woman to woman. Clitoral atrophy is associated with low libido, decreased lubrication, decreased pleasure and less chance of orgasm."

The condition can also trigger painful intercourse in sexually active people, and a loss of sex drive. In some cases, the clitoris can become buried under the clitoral hood as though it has disappeared.

What does clitoral atrophy feel like?

New York-based teacher and musician Marie Schultz's experiences with clitoral atrophy started when she began taking low-dose oral contraceptives at age 15, resulting in testosterone and estrogen deficiency.

"I developed urogenital syndrome of menopause by age 30, with vulvar atrophy and urinary tract issues like a menopausal woman," she said. "I was diagnosed with interstitial cystitis/painful bladder syndrome at age 22 due to this, and vulvar vestibulodynia a few years later."

After improving her symptoms by quitting the pill and using topical estrogen on her vulva vestibule, Schultz struggled to get additional help or a consistent treatment plan.

"Not being allowed to see a gynecologist for months drove me to seek care from a private vulvovaginal specialist in another city," she continued. "This doctor diagnosed me with clitoral atrophy, as well as hormonally mediated vestibulodynia. He said my clitoris should be about the size of a Q-tip and that due to the years of low testosterone from the pill, it was about half the size it should be."

Combined with other medical issues and facing a series of misdiagnoses and poor handling of care, Schultz quickly lost faith in her medical teams and the condition took a significant mental toll.

"All chronic pain and invisible medical issues are tough to live with, but clitoral issues are the hardest I've ever experienced because I've lost my sexuality in addition to becoming disabled," she said.

Despite the mental and physical burden of managing the condition, Schultz is using her experiences to raise awareness of this little-known condition.

"I'm grateful for the opportunity to use my experiences to hopefully prevent stories like mine from happening to anyone else," Schultz explained. "Feeling like I might be able to raise awareness on the lack of medical knowledge and concern in this part of the body gives me a purpose as I wait and wait and wait for this to heal."

How are you diagnosed with clitoral atrophy?

"Many people think the glans is the entire clitoris since that's the only part of the clitoris that can be seen," Marashi said. "The clitoris extends beneath the skin's surface: the clitoral bulbs and crura make up the bulk of the organ and fill with blood during arousal. Since the size of the clitoris can vary, the best person to gauge whether there is clitoral atrophy is the one who sees it most often."

While there is no formal process for diagnosing clitoral atrophy, doctors should ask to examine the clitoris and may order a blood test to monitor hormone levels.

Is there treatment for clitoral atrophy?

Once diagnosed, treatments to restore sensation vary depending on the underlying cause.

Some holistic options include

• Regular clitoral stimulation
• Using sexual stimulants during intercourse to help enhance clitoral sensations
• Cardiovascular exercise to stimulate blood flow

Medical treatments include estrogen therapy—topical or internal hormone replacement  therapy treatment—and some people believe topical testosterone treatment could restore sensitivity. However, there is no robust scientific research to support this view.

How can you prevent clitoral atrophy?

There is no guaranteed method of preventing clitoral atrophy, but there are a couple of methods that can help, Rahman explained.

"Prevention is mainly through awareness of changes that may occur with the above conditions, examining yourself routinely," she said. Knowing how your body operates in general can help you better realize when something seems off. 

"Depending on underlying issues, some options are stimulating the clitoris regularly through regular masturbation or intercourse, [which] helps promote and maintain blood flow to the clitoris," Rahman said. 

Breaking down medical barriers

Above all, improving awareness of clitoral atrophy is crucial for reducing its impact on people with vaginas. Shattering any shame people have around talking about intimate body parts is one step, however, doctors also have a responsibility to improve their approach.

If you have any concerns about your clitoral health, advocate for yourself fiercely. Insist that doctors examine your clitoris, vulva and vagina to diagnose any issues. Pay attention to your sexual health and do not delay seeking a second opinion.

The bottom line

Although we now know the clitoris has more than 10,000 ultrasensitive nerve endings, this delicate organ is vulnerable to a loss of sensation. Sometimes, for reasons varying from disuse to hormonal changes, the clitoris stops responding to stimulation and starts to shrink.

Due to a lack of concrete research, there are no reliable figures to accurately indicate the prevalence of clitoral atrophy. However, considering the lack of research conducted on all gynecological conditions, it is likely that clitoral atrophy is affecting the lives of far more people than we realize.

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