From the Guidelines
The treatment of a clitoris pseudocyst typically involves surgical intervention, and patients should be reviewed with a gynaecologist with a special interest in vulval disease, where division of adhesions may be needed if symptomatic or recurrently infected. When considering treatment options, it's essential to prioritize the patient's quality of life, morbidity, and mortality. According to the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1, pseudocyst of the clitoris is occasionally caused by clitoral hood adhesions sealing over the clitoris, leading to keratinous debris buildup underneath, forming a painful pseudocyst. Some key points to consider in the treatment of pseudocyst of the clitoris include:
- Review with a gynaecologist with a special interest in vulval disease
- Division of adhesions may be needed if symptomatic or recurrently infected
- The goal of treatment is to alleviate symptoms, prevent recurrence, and improve the patient's quality of life. It's also important to note that while other studies, such as the 2002 and 2010 guidelines 1, suggest subtotal or total circumcision as a treatment option, the most recent and highest-quality study, the 2018 guidelines 1, recommends a more conservative approach, prioritizing review with a specialist and division of adhesions as needed. In terms of specific treatment, the 2018 guidelines do not provide detailed information on surgical techniques or post-operative care, but it's essential to prioritize the patient's comfort, preserve clitoral sensation and function, and prevent potential complications. Overall, the treatment of pseudocyst of the clitoris should be individualized, taking into account the patient's specific needs and circumstances, and prioritizing their quality of life, morbidity, and mortality.
From the Research
Treatment Options for Pseudocyst of Clitoris
- Surgical removal of the cyst is the preferred treatment, associated with excellent postoperative results 2
- A minimal surgery approach, such as manual retraction of the synarchies without making an incision, can be a gentle and effective surgical management of preputial fusion, which may cause a periclitoral pseudocyst 3
- Topical agents and manual retraction of the prepuce can be used for conservative management or postprocedural care, but the efficacy of these interventions has not been investigated 4
- Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm associated with clitoral adhesion, which can cause pseudocysts 4
Diagnostic Approaches
- Clinical examination and instrumental techniques, such as Magnetic Resonance (MR) imaging, can be useful tools for diagnosis 2, 5
- The use of an alternative coil during MR imaging, such as a small flex coil, can improve visualization of the anatomy and guide surgical management 5
Considerations for Management
- It is essential to differentiate between acute and chronic pseudocysts, as well as cystic neoplasias, for proper management 6
- Conservative treatment should always be considered the first option, and intervention should only be performed if necessary 6
- Follow-up is needed to diagnose possible recurrences after treatment 2