Tag Archives: Vulvar diseases

Pathological processes of the VULVA.

Clitoral keloids after female genital mutilation/cutting.

FREETurk J Obstet Gynecol. 2016 Sep;13(3):154-157. doi: 10.4274/tjod.32067. Epub 2016 Sep 15.

Clitoral keloids after female genital mutilation/cutting.

Birge Ö, Akbaş M, Özbey EG, Adıyeke M.

ABSTRACT

We aimed to describe the presentation of long-term complications of female genital mutilation/cutting and the surgical management of clitoral keloids secondary to female genital mutilation/cutting. Twenty-seven women who underwent surgery because of clitoral keloid between May 2014 and September 2015 in Sudan Nyala Turkish Hospital were evaluated in this retrospective descriptive case series study. The prevalence of type 1, type 2, and type 3 female genital mutilation/cutting were 3.7%, 22.2%, and 74.1%, respectively (type 1: 1/27, type 2: 6/27, and type 3: 20/27). All patients had long-term health problems (dysuria, chronic pelvic pain, vaginal discharge, and chronic pruritus) and sexual dysfunction. Keloids were removed by surgical excision. There were no postoperative complications in any patient. Although clitoral keloid lesions can be seen after any type of female genital mutilation/cutting, they usually develop after type 3 female genital mutilation/cutting. Most of these keloids were noticed after menarche. Keloids can be removed by surgical excision and this procedure can alleviate some long-term morbidities of female genital mutilation/cutting.

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Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City.

Afr J Reprod Health. 2009 Mar;13(1):17-25. FREE

Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City.

Osifo DO, Evbuomwan I.

Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. Leadekso@yahoo.com

ABSTRACT

This prospective study on female genital mutilation among Edo people was based on female children and parents who presented on account of it at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2002 and December 2007. During the period, 51 female children aged 10 days and 18 years presented with complications following genital mutilation. Twenty-nine were brought by their parents for mutilation while 67 parents interviewed believed strongly on female genital mutilation with 47 mothers mutilated. Religio-cultural and superstitious beliefs were the main indications and the type of mutilation ranged from excision of clitoridal tip in 10 (19.6%) children to complete excision of the clitoris, labia minora and inner layer of majora in 7 (13.7%). Complications ranged from clitoridal cyst formation in 21 (41.2%) to life threatening infections with one mortality due to tetanus infection.

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[Diagnostic image. A woman with a vulvar swelling]

Ned Tijdschr Geneeskd. 2009;153:A115.

[Diagnostic image. A woman with a vulvar swelling]. [Article in Dutch]

Lashley LE, Feitsma HA.

Leids Universitair Medisch Centrum, afd. Gynaecologie, Leiden, The Netherlands. lisalashley@hotmail.com

A 25-year-old woman presented with a tumour above the labia minora, due to an epidermal cyst.

There is no link to view this article online.

Epidermal clitoral inclusion cysts: not a rare complication of female genital mutilation.

FREEHum Reprod. 2010 Jul;25(7):1672-4. doi: 10.1093/humrep/deq126. Epub 2010 May 22.

Epidermal clitoral inclusion cysts: not a rare complication of female genital mutilation.

Rouzi AA.

Department of Obstetrics and Gynecology, King Abdulaziz University, PO Box 80215, Jeddah 21589, Saudi Arabia. aarouzi@gmail.com

BACKGROUND: Although female genital mutilation (FGM) does not feature in Judeo-Christian populations, it is estimated that, 100-140 million women in the world have undergone some form of FGM. Given the increasing diversity of the western populations, a review of specific complications of FGM is of paramount importance to practicing clinicians. The objective of this study is to report a case series of epidermal clitoral inclusion cysts after FGM in a Muslim population primarily from the Middle East. METHODS: Between January 1998 and July 2009, 32 females underwent surgical removal of epidermal clitoral inclusion cysts in a tertiary referral university hospital. Data regarding age, clinical presentation, operation time, estimated blood loss, presence of intraoperative and post-operative complications, duration of admission to the hospital and long-term follow-up were extracted from the records. RESULTS: There were 15 women (46.9%) with a definitive history of FGM, 14 (43.8%) did not know whether they had FGM or not and 3 (9.3%) had no history of FGM and were excluded from the analysis. The mean age of subjects was 28.1 years (range 5-91 years). All presented with increasing clitoral mass over a mean duration of 5.2 +/- 4.1 years. The mean diameter of the cyst was 4.2 +/- 2 cm. Regarding treatment, 28 subjects underwent surgical excision, and one underwent incision and drainage of a clitoral abscess. No short- or long-term complications occurred. CONCLUSIONS: Clitoral cysts appear to be a more common complication of FGM than previously thought. Publication of studies that highlight the medical complications of FGM should be encouraged to advocate abandonment of the procedure.

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[Three cases of epidermal cyst of vulva following female genital mutilation]

Gynecol Obstet Fertil. December 2002 30(12): 958–960

Trois cas de kystes épidermiques de la vulve après mutilations génitales féminines

[Three cases of epidermal cyst of vulva following female genital mutilation] [Article in French]

Moreira P.M., Moreira I.V., Faye E.H.O, Cisse L, Mendes V, Diadhiou F

ABSTRACT

We report three cases of tumors of the vulva following an Excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

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Late complications of childhood female genital mutilation.

J Obstet Gynaecol Can. 2010 Jun;32(6):587-9.

Late complications of childhood female genital mutilation.

Hamoudi A, Shier M.

Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.

BACKGROUND: Canada’s immigrants are increasingly from non-English-speaking countries with different medical issues. Female genital mutilation (FGM) is a procedure performed for non-medical reasons that is not traditionally encountered in Canada and that has serious health implications for women.
CASE: A 36-year-old woman, who underwent FGM at the age of four, presented to our colposcopy unit with increasing swelling of the vulva. Examination revealed a large cystic mass in the midline of the vulva, and MRI identified two well-defined cystic lesions. The mass was excised, and histologic examination confirmed an epidermal inclusion cyst.
CONCLUSION: An epidermal inclusion cyst can develop as a long-term consequence of
FGM. Although it grows slowly and usually without symptoms, it may require excision because of inflammation, secondary infection, or, in rare cases, malignancy developing within the cyst.

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Baaij M, Kagie MJ; Female circumcision; histories of 3 patients

Ned Tijdschr Geneeskd. 1999 Aug 21;143(34):1721-4.

[Female circumcision; histories of 3 patients]. [Article in Dutch]

Baaij M, Kagie MJ.

Medisch Centrum Haaglanden, locatie Westeinde, Den Haag.

Comment in Ned Tijdschr Geneeskd. 2000 Jan 8;144(2):95-6.

ABSTRACT

Three Somali women presented with problems of the infibulation they had undergone when they were girls. The first one was 22 years old and had problems with coition, the second one was 21 years old and had problems with parturition, the third one was 28 years old and had an epidermal cyst near the ventral commissure of the vulva. Infibulation is a form of female circumcision, in which the clitoris, labia minora and labia majora are removed and the ostium vaginae is reduced to less than a centimeter. In the Netherlands the Ministry of Health, Wellbeing and Sport and the Association of Obstetricians and Gynaecologists have declared themselves opponents to female genital mutilation carried out by Dutch physicians. The association decided also to not carry out reinfibulation, e.g. after parturition.

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Post genital mutilation giant clitoral epidermoid inclusion cyst in Benin City, Nigeria.

J Pediatr Adolesc Gynecol. 2010 Dec;23(6):336-40. Epub 2010 Aug 4.

Post genital mutilation giant clitoral epidermoid inclusion cyst in Benin City, Nigeria.

Osifo OD.

Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. Leadekso@yahoo.com

OBJECTIVE: To report overall occurrence, and the mode of presentation and management of girls with post genital mutilation giant clitoral epidermoid inclusion cyst in an African subregion.
METHODS: This is a prospective experience with female patients who presented at two centers in Benin City, Nigeria, between January 2005 and December 2009 with clitoral epidermoid inclusion cyst following underground traditional female genital mutilation performed on neonates.
RESULTS: In total, 37 patients were seen with clitoral epidermoid inclusion cyst, 15 (40.5%) were post pubertal girls who could no longer cope with giant cyst that measured more than 3.5 × 6.5 cm in size at an average age of 17 (range 14-21) years. Ignorance, financial constraints, and the fear of possible prosecution by anti-female genital mutilation agencies were reasons for late presentation. Consequently, rapid increase in size of all cysts (100%), mass effect producing dragging discomfort in the vulva of 14 (93.3%) girls, social stigmatization of 12 (80%) girls by peers and spouses, sexual difficulty experienced by 10 (66.7%), and irritating bulge in the perineum of 10 (66.7%) girls, were the most common indications for surgical consultation. Outcomes of cystectomy that included total clitoridectomy performed on on an outpatient basis mainly with local anesthesia were encouraging with no incidence of recurrence recorded on 1-4 years postoperative follow-up.
CONCLUSION: Late presentation of girls with giant post genital mutilation clitoral epidermoid inclusion cysts was common. More campaigns against female genital mutilation and government policy aimed at encouraging patients with
complications to seek early medical attention, and free treatment for those who present early are advocated.

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A case of vulval swelling secondary to female circumcision posing a diagnostic dilemma.

Int J Surg Case Rep. 2012;3(9):431-4. Epub 2012 May 24.

A case of vulval swelling secondary to female circumcision posing a diagnostic dilemma.

Amu OC, Udeh EI, Ugochukwu AI, Madu C, Nzegwu MA.

Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria.

INTRODUCTION: The practice of FGM is most prevalent in the African countries such as Nigeria, Ethiopia, Sudan, Egypt, and some area of the Middle East. It is not restricted to any ethnic, religious or socioeconomic class. There are many reasons for perpetuation of this practice; the most common are cultural and religious beliefs. The aim of this paper is to highlight the diagnostic dilemma associated with this type of case and the psychological trauma of a patient following her unfortunate genital mutilations.

PRESENTATION OF CASE: We present the case of epidermal inclusion dermoid cyst in an 18-year-old teenage girl referred to us from the gynecologist as a case of hydrocoele of the canal of Nuck involving the left labia majora. Patient was previously seen by general practitioner who diagnosed a left Bartholins cyst. Excision of the mass, revealed a well encapsulated cystic mass containing serous fluid with no extension to the inguinal area, measured 10cm×8cm. Histology showed epidermoid inclusion dermoid cyst probably related to circumcision (female genital mutilation).

DISCUSSION: Implantation dermoid cyst though a recognized complication of FGM is rare in our environment and a high index of suspicion is required any time a girl presents with a vulval swelling. Cosmesis still remains the watchword to assuage the psychological impact on the patient.

CONCLUSION: There is need for more public health campaigns to educate communities about the harms of circumcision with the goal of eradicating the practice.

This article can be accessed in this LINK