Keratin Pearls: Clitoral Pain Explained

Keratin pearls are a tiny piece of keratin surrounded by layers of squamous cells, that form a round ‘pearl’. The central piece of keratin – a dead skin cell – is the central point for the cells to collect around, forming a ball.

These tiny little vulval irritants can occur at any age, and are related to the production and drainage of smegma and sloughed off skin cells.

Keratin pearls can be several millimetres in diameter and can cause clitoral irritation and hypersensitivity – think of a grain of sand in the eye, and you have the idea¹. The result can be intense, unrelenting pain in the clitoral area, and the debris may result in infection.

Keratin pearls are considered as a cause of or related to female sexual dysfunction, clitorodynia², labial adhesions and persistent genital arousal disorder (PGAD).

Treatment of clitoral or vulvar keratin pearls

The main treatment for keratin pearls is removal of the accumulated debris, removing the source of the irritation³. The removal may need to be performed by a vulvovaginal specialist dermatologist or gynaecologist.

Depending on the presentation of the local tissue of the clitoral area, to prevent repeat occurences, further treatment may be required to open the enclosed area that is trapping the keratin pearls. This type of surgical intervention for keratin pearls or smegmatic pseudocysts is on a case by case basis, determined by the doctor.

When keratin pearls are associated with clitoral or labial adhesions, oestrogen cream has been used as a non-invasive treatment for the adhesions, which then allows the cells and smegma to be freely washed away during the course of normal bathing.