Yes, let's unleash yet another thing to worry about: can your clitoris shrink?!
The clitoris is known as the pleasure center of the vulva, and clitoral stimulation is necessary for many people to reach orgasm, more than penetration alone. (Speaking of, here are our picks for the best clit stimulators on the market.)
However, there is a little-known condition lurking in the world and it has the power to shrink your clitoris and steal away pleasure. Let's talk about clitoral atrophy.
Despite the misconceptions swirling around it, clitoral atrophy cannot make your clitoris vanish entirely because most of the clit lies beneath the surface of your labia. It can, however, shrink over time and the head of the clitoris may retreat deep into its hood. But how and why does it happen? Here is everything we know.
Can your clitoris shrink? All about clitoral atrophy
“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 OB/GYN Dr. Sameena Rahman, clinical assistant professor of OB/GYN at the Northwestern Feinberg School of Medicine and founder of the Center for Gynecology and Cosmetics.
Its twisted sister, vaginal atrophy, is more well-known, typically showing up during estrogen changes brought on by menopause, and clitoral atrophy has similar triggers. However, its effects are felt primarily by the clitoris, not the surrounding vaginal tissue.
“A lack of estrogen and testosterone are the main causes of clitoral atrophy but this can happen in many stages of life,” explains Rahman. “Essentially, as you enter stages in life with a marked reduction in estrogen and testosterone, like menopause, it changes the vulva and vagina.”
A lack of estrogen decreases vascular flow and engorgement of the clitoris, which may cause shrinking. Unfortunately, the research is limited so there are no reliable figures for how many people are living with it.
“Most of the population impacted with clitoral atrophy are either those patients untreated in postmenopause, after the final cessation of menses and ovarian activity, and some who are nursing in the postpartum period,” adds Rahman. “A subset of patients on oral contraceptive pills may also notice a shrinking of the clitoris.”
What happens when you have clitoral atrophy?
The impact on sexuality can be significant, particularly if left untreated. Aside from the physical changes, the mental blocks thrown up by a change in sensation are difficult to manage.
“If the clitoris has diminished in size and with the lack of estrogen and testosterone, it is possible for there to be diminished blood flow that can eliminate or delay engorgement and impact pleasure altogether,” adds Rahman. “This can result in painful sex, loss of sex drive, and in worst-case scenarios, the disappearance of the clitoris entirely.”
Clitoral atrophy is treated with estrogen therapy—topical or internal hormone replacement therapy. More holistic methods include increasing cardiovascular exercise and regular clitoral stimulation.
So, is it true: if you don't use it, you lose it?
Claims that neglecting to stimulate your clitoris will result in shrinkage have circulated for decades, most likely stemming from a 1983 study published by the Jama Network. It associated lack of usage with a higher degree of vaginal atrophy, but the study only reviewed a small population of 52 postmenopausal patients.
“This is a correlation study, not a causation,” explains Rahman. “We simply do not have the research to state this with certainty and we need more research on the clitoris and on women’s health in general.”
Like with most medical mysteries, the answer is probably more complicated than simply not climaxing enough, but there could be a link.
“As with most things in sex med, it is likely multi-factorial,” continues Rahman. “Like any other muscles or organs, we have to utilize them and allow blood to flow to keep them vital.”
How to reignite your sex life after clitoral atrophy
Shame makes communicating any medical condition a challenge, but the stigma attached to gynecological conditions is an even larger obstacle to overcome. When you are ready to let go of the discomfort and engage with sex again, it starts with openness.
The foundation of all healthy relationships and great sex is communication. A prospective or current partner cannot support you through something that they do not know exists!
Lyndsey Murray, an AASECT certified sex therapist at Relationship Matters Therapy, recommends you keep your opener simple, outline what clitoral atrophy is, why you have it and the impact it has on your body.
“Individuals can also explain that blood flow to the clitoris is similar to blood flow to the tip of the penis, so this part of their body is not functioning the way it used to, but it doesn’t have to mean sex is off the table,” Murray adds. “Instead, you will find ways to work with this.”
There is no catch-all approach to sex with clitoral atrophy because everyone’s pleasure centers are unique to them. It may take some trial and error to concoct the perfect recipe. A key universal rule to abide by, however, is always use plenty of lubrication. (Here are all of your lube questions answered, BTW.)
Introduce sex toys into the bedroom, too. They can expand everyone’s sexual horizons and will allow you the opportunity to experiment with what feels best for you and your new clitoris.
“I would identify what discomfort comes with clitoral atrophy and then begin focusing on other pleasure points of the body that don’t involve parts that cause discomfort,” recommends Murray. “Overall, still have sex, have fun, feel pleasure, and don’t let a dysfunction keep you from the sex life you want.”
