A preventable burden: Clitoral epidermal inclusion cysts following female genital mutilation from resource limiting settings - A case series and literature review.

Introduction and importance: The female external genitalia can be affected by various tumors, benign and malignant, including those of the clitoris. Clitoral epidermoid cysts are a rare late complication associated with female genital mutilation (FGM). FGM, as defined by the WHO, is a human rights violation performed for non-medical reasons. Despite efforts to eradicate FGM, it remains prevalent in parts of sub-Saharan Africa and other regions, impacting an estimated 100 million women globally.

Case presentation: Three women from Garbo, Somali region, Ethiopia (A 36-year-old para 8 presenting with a 12-year history of progressive vulvar swelling after undergoing FGM at age 6, An 18-year-old nulligravida presenting with a 5-year history of progressively enlarging vulvar swelling after undergoing FGM at age 5 years and A 28-year-old para 5 mother with history of 9 years vulvar swelling) presented from rural Ethiopia. Physical exam revealed varying sizes of clitoral masses in all patients, with normal other findings. Biopsy suggested clitoral epidermoid cysts. They were managed with surgical removal and reconstruction.

Case discussion: Clitoral epidermoid inclusion cysts, rare benign masses typically found elsewhere on the body, can present as swelling requiring differentiation from clitoromegaly. While often associated with trauma, they can arise as a long-term complication of Female Genital Mutilation. Diagnosis involves clinical and histologic examination. Management of clitoral cysts involves enucleation and reconstruction, as exemplified in this case. Post-operative care addresses potential complications like sexual dysfunction, cosmetic issues, UTIs, obstetric sequelae, psychological concerns, and recurrence, none of which were reported by the patient at follow-up.

Conclusion: Clitoral epidermoid inclusion cysts are rare complications of trauma, including FGM, which remains a challenge in low-income countries following FGM. Prevention and surgical management are key to improving outcomes and quality of life.