Clitoral Epidermal Inclusion Cyst Resection With Intraoperative Sensory Nerve Mapping Technique

Abstract

Background Despite the ever increasing popularity of labial and clitoral surgeries, the best practices and long term effects of reconstructive procedures in these regions remain unknown. This is particularly noteworthy since the presentation of nerve related symptoms may be delayed up to a year. Despite the convention that these surgical procedures are low risk, little is known about the best practices that may reduce the postoperative complications as a result of these reconstructive surgeries. We describe a preoperative sensory mapping technique in the context of a symptomatic inclusion cyst in the clitoral region. This technique delineates anatomical and functional regions innervated by the dorsal clitoral nerve while avoiding the vascular watershed area in the midline. Case A prototypical case of a patient with a clitoral mass will be discussed with clinical history and surgical approach. Prior to surgical excision, the dorsal clitoral nerve distribution was mapped in order to avoid a surgical incision in this sensual zone. Conclusions In our practice, preoperative sensory mapping is a clinically useful planning tool that requires minimal instrumentation and no additional operating time. Sensory mapping allows identification of the functional zone innervated by the dorsal clitoral nerve so that it can be avoided.

Epidermal Cyst of the Clitoris Mimicking Cliteromegaly: A Case Report and Review of the Literatüre

“…For this purpose, preoperative sensory mapping will be clinically useful. 16 Long-term effects of the reconstructive procedures in this area is yet to be unknown. Definitive diagnosis can be confirmed by histopathological demonstration.…”

Clitoral cyst in a bitch

“…6,12 Patients are often asymptomatic when an abnormality is initially identified, but develop pain if there is associated inflammation or infection, may develop urinary incontinence or may have difficulty ambulating. 4,14 A variety of surgical techniques have been identified for excision.…”

“…[15][16][17][18][19][20][21] Urinary incontinence in humans has been associated with disorders of sexual development, primarily in those with ambiguous female external genitalia. 4,14 The exposed clitoris, when enlarged, may cause mechanical interference with the urethra, and contribute to urinary incontinence. 4,14 Similar mechanical interference has been described in cases of vaginal cysts.…”

“…4,14 The exposed clitoris, when enlarged, may cause mechanical interference with the urethra, and contribute to urinary incontinence. 4,14 Similar mechanical interference has been described in cases of vaginal cysts. [22][23][24] In one dog that presented with an osclitoridis, there may have been derangements of normal urethral anatomy, including the urethra coursing through the hypertrophied clitoris.…”

“…3 The majority of vulvar and clitoral cysts are reported secondary to female genital mutilation, and although many patients are asymptomatic, when enlarged, these cysts may cause pain. [4][5][6] Clitoral cysts have not been reported in the veterinary literature. This case report details the diagnosis and treatment of a dog with an epithelial lined cyst arising from the clitoris.…”