Periclitoral abscess is a rare entity, with publications limited to case reports. We present here a case of periclitoral abscess in a 17 year old patient, which was treated with incision and drainage. We also review all the similar cases that have been reported in the English literature until now.
Abscess of the periclitoral area is a rare gynecological condition with few cases reported; therefore, correlation with specific causes is difficult. A significant number of cases are patients who had been subjected to genital mutilation procedures of religious motives. In such cases, periclitoral abscess formation follows the development of postsurgical inclusion cysts, which get infected. Conversely, there are periclitoral abscess cases that occur spontaneously without any previous local surgery. Such spontaneous development is difficult to be associated with specific causes because these cases are rare. Therefore, available treatment options are based on personal experience and not on enough available evidence.
Case Report
A 17 year old patient (para 0; gravida 0) was referred, complaining of severe genital pain and swelling of 12 hours’ duration. She was afebrile and able to pass urine. Her past medical history was unremarkable. On examination, a prominent lump of 2 cm was noted arising from the prepuce ( Figure ). The lump was tender and fluctuant, suggestive of fluid collection. A concomitant swelling of the left labia minora was apparent, but the rest of the genital structures appeared normal. The abscess was incised and drained under local anesthesia. Cultures revealed coagulase positive Staphylococcus and Bacteroides species. The patient was discharged within the same day. No recurrence was recorded after 8 months of follow-up.
Comment
Excluding the reports in which a periclitoral abscess was the result of female clitoral mutilation (complicated circumcision of religious motives), in total 18 reports of spontaneous periclitoral abscesses have been published in the English medical literature, including the presented case ( Table ). In most of the reported cases, the etiology for the development of such spontaneous abscesses was unclear. A speculative pathogenetic mechanism could be a defect of the squamous stratified epithelium that permits the entrance of pathogens. Indeed, several microorganisms that cause purulent infections have been isolated in some of the published cases: coagulase-positive Staphylococcus , Streptococcus bovis , Diptheriae species , and Bacteroides species .
| Year | Author | Age, y | Size, cm | Features | Cultures | Treatment of first episode (history data) | Recurrence | Definitive management |
|---|---|---|---|---|---|---|---|---|
| 1957 | Palmer | 29 | 4 | Pilonidal a. | None reported | Spontaneous drainage | One within 1 y | Excision of cyst-track |
| 1962 | Betson et al | 29 | Pilonidal a. | None reported | Spontaneous drainage | One within 1 y | Excision of cyst-track | |
| 1972 | Radman and Bhagavan | 22 | 3 | Pilonidal a. | None reported | Incision | Multiple for 2 y | Excision of cyst-track |
| 1975 | Devroede et al | 28 | 1 | Crohn’s d. | Staphylococcus aureus , Staphylococcus epidermidis , Peptostreptococcus | Spontaneous drainage | No (follow-up 5 mo) | |
| 1980 | Reeves and Kaufman | 29 | 4 | Breast tissue | None reported | Incision | One after 8 d | Excision of mass |
| 1982 | Kent and Taxiarchis | 24 | 2 | Nonspecific | None reported | Incision | Multiple for 11 y | Conservative |
| 1982 | Kent and Taxiarchis | 23 | 2 | Nonspecific | None reported | Spontaneous drainage | Multiple for 6 y | Marsupialization |
| 1982 | Kent and Taxiarchis | 29 | 3 | Nonspecific | Bacteroides , Diptheroides | Spontaneous drainage | One after 10 y | Marsupialization |
| 1982 | Kent and Taxiarchis | 31 | Nonspecific | Coag-positive Staphylococcus | Incision | Multiple for 18 mo | Marsupialization | |
| 1983 | Sur | 41 | 3 | Nonspecific | Streptococcus bovis | Incision | One after 2 mo | Marsupialization |
| 1983 | Sur | 16 | 3 | Nonspecific | None identified | Incision | Two in 3 mo | Marsupialization |
| 1990 | Werker and Kon | 23 | 3 | Pilonidal a. | None reported | Local excision | Multiple in 1 y | Excision of cyst-track |
| 2003 | Chinnock | 41 | 5 | No biopsy | None reported | Conservative | No (follow-up not reported) | |
| 2004 | Lara-Torre et al | 11 | No biopsy | None reported | Spontaneous drainage | No (follow-up 6 mo) | ||
| 2007 | Mendilcioglu | 33 | 4 | No biopsy | None identified | Spontaneous drainage at age 12 | One after 21 y | Marsupialization |
| 2008 | Baker et al | 30 | 2 | Pilonidal a. | None reported | Incision | Multiple for 2 y | Excision of cyst-track |
| 2010 | Maor-Sagie et al | 8 | 1 | Pilonidal a. | None reported | Local excision | One within 3 mo | Excision of tract |
| 2011 | Current case | 17 | 2 | No biopsy | Coag-positive Staphylococcus | Incision | No (follow-up 8 mo) |
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