A narrative review on the practice of genital mutilation among Arab adolescent females and a case report on a large clitoral epidermal inclusion cyst.

Abstract

Introduction and importance: Female circumcision, also known as female genital mutilation/cutting (FGM/C), is a common practice in many Arab countries, including Egypt. One potential complication of FGM/C is the development of a clitoral epidermal inclusion cyst, which occurs when keratinized epithelial cells and sebaceous glands become incorporated into the circumcision scar line in the clitoral or labial area. The objective of this study is to present a rare case of a large clitoral epidermal inclusion cyst following FGM/C and to review the current practice of FGM/C in the Arab world, including Egypt, Sudan, and Saudi Arabia. A retrospective review of medical records for a single rare case and a literature search on PubMed were conducted to gather information on FGM/C in Egypt and the Arab region.

Case presentation: A newly married 19-year-old Egyptian adolescent female presented with a large (∼5 × 5 cm) painless clitoral swelling, 11 years after undergoing FGM/C. A complete history, perineal examination, and ultrasonography suggested a clitoral swelling, with the top differential diagnosis being an "epidermal inclusion cyst". During surgery, a cystic swelling was dissected and enucleated with the capsule intact.

Clinical discussion: Histopathology of the specimen confirmed the presence of an epidermal inclusion cyst, most likely related to the previous FGM/C during her childhood. Clitoral epidermal inclusion cysts can arise many years after FGM/C.

Conclusion: Surgical intervention is successful in treating this rare and longterm post-circumcision complication. The practice of FGM/C remains prevalent among adolescent females in Egypt and many other Arab countries.