What is the treatment for multiple inclusion cysts in the genital area?

Treatment of Multiple Inclusion Cysts in the Genital Area

Surgical excision is the treatment of choice for genital inclusion cysts that cause discomfort, show growth during follow-up, or have suspicious features. 1 Complete surgical excision provides definitive histopathological diagnosis and prevents future complications.

Diagnostic Evaluation

Before proceeding with treatment, proper evaluation is essential:

• Transvaginal ultrasound combined with transabdominal ultrasound is the first-line imaging study for evaluating cystic lesions in the genital area 2, 1
• Include Doppler color evaluation to assess vascularity of any solid components 1
• For indeterminate masses, MRI with contrast may provide superior characterization 1

Treatment Algorithm for Genital Inclusion Cysts

1. Conservative Management

• Small, asymptomatic cysts (<3 cm) may be monitored without intervention 1
• Follow-up ultrasound in 8-12 weeks for cysts >3 cm but <10 cm 1

2. Surgical Management

• Indications for surgical excision:

  • Cysts causing discomfort or difficulty with daily activities
  • Cysts showing growth during follow-up
  • Cysts with suspicious features
  • Cysts causing urinary obstruction or sexual dysfunction 3

• Surgical technique:

  • Make a vertical incision in the skin
  • Carefully dissect and excise the cyst
  • Remove excessive skin if necessary
  • Reapproximate skin edges 4
  • Pay particular attention to preserve surrounding normal tissue 4

• Special considerations:

  • For clitoral inclusion cysts, careful dissection is required to preserve remaining clitoral tissue 4
  • Complete excision is important to prevent recurrence 5

Outcomes and Follow-up

• Most patients can be discharged within 1-2 days after surgery 4
• Surgical management is generally effective with no documented risk of recurrence when complete excision is performed 5
• Follow-up should include assessment for:
  • Resolution of symptoms
  • Wound healing
  • Sexual function
  • Emotional well-being 5

Important Caveats

• Genital inclusion cysts can sometimes be misdiagnosed as other conditions, including malignancy 6
• In cases with history of female genital mutilation (FGM), these cysts represent a common late complication that may appear decades after the procedure 3, 4, 5, 6
• Inclusion cysts can also occur as a complication of other genital surgeries, as documented in cases of penile girth enhancement procedures 7
• Careful histopathological examination of excised tissue is essential to confirm diagnosis and rule out malignancy

The surgical approach should be tailored to the specific location and size of the cysts while prioritizing preservation of normal anatomy and function. Complete excision offers the best outcomes in terms of symptom resolution and prevention of recurrence.