Clitoral epidermoid inclusion cyst following female genital mutilation from rural Ethiopian: case report and review of literature

Abstract

Introduction and importance: The World Health Organization (WHO) defines female genital mutilation (FGM) as any procedure involving alteration or removal of the external female genitalia for non-medical reasons. Clitoral epidermoid inclusion cysts, although rare, are a recognized long-term complication of FGM. Presentation of case: A 25-year-old para 5 mother from Garbo, Somali Region, Ethiopia, presented in October 2024 with a complaint of progressively enlarging clitoral swelling for 2 years. Her medical history was notable for FGM performed at age 11 by a traditional healer. On physical exam, a 4 × 4 cm clitoral mass was noted, with mild tenderness to palpation. Histopathological analysis confirmed the diagnosis of clitoral epidermoid inclusion cyst, and surgical excision was carried out. The post-operative period was uncomplicated, with an excellent outcome. Clinical discussion: Benign and malignant tumors can affect the female genital tract. While cysts can arise from various locations, clitoral epidermoid inclusion cysts are a rare long-term complication of FGM. The WHO classifies FGM into four types based on anatomical changes, with type III representing the most severe form. The pathophysiology of cyst formation following FGM typically involves entrapment of keratinized epithelium and sebaceous glands within scar tissue. Diagnosis requires a thorough history and tissue examination, with treatment focused on careful surgical excision. Conclusion: Clitoral epidermoid inclusion cysts from FGM, though rare, have major health impacts. Even with declining FGM rates, the burden remains high in sub-Saharan Africa. Prevention and timely care are key to improving outcomes.