Paraclitoral cystic lesions after female genital mutilation: a clinicopathologic evaluation from Mogadishu

BACKGROUND: Female genital mutilation/cutting (FGM/C) is associated with long-term gynecologic complications, including delayed paraclitoral cystic lesions. However, the clinicopathologic spectrum and postoperative outcomes of these lesions remain insufficiently characterized, particularly in high-prevalence settings. METHODS: This single-center retrospective clinicopathologic study included women with a history of FGM/C who underwent surgical excision of paraclitoral lesions between January 2017 and March 2025. Clinical presentation, surgical management, histopathological findings, and postoperative outcomes were analyzed. Comparative analyses were performed between epidermoid and non-epidermoid lesions. RESULTS: A total of 146 patients were included. The mean age was 28.9 ± 13.2 years. The most common presenting symptom was pain (58.9%), and pain was present in 86.3% overall. Histopathology revealed predominantly epidermoid cysts (84.2%), followed by traumatic neuroma (8.9%) and other benign lesions. Parity was significantly associated with histopathologic subtype (p = 0.020), with non-epidermoid lesions more common in women with parity > 3. All patients underwent complete en bloc excision, and no intraoperative complications were documented in the available operative records. Among patients with available follow-up, postoperative pain improvement was documented in 89.7%, and no recurrence was documented among patients with available 6-month follow-up. CONCLUSION: Paraclitoral lesions following FGM/C are predominantly epidermoid cysts but may also include other pathologies, such as traumatic neuroma. Surgical excision was associated with favorable early documented outcomes among patients with available follow-up; however, interpretation of functional recovery and recurrence remains limited by nonstandardized retrospective outcome assessment and incomplete follow-up. These findings contribute additional clinicopathologic data to a limited evidence base and highlight the need for prospective studies with standardized follow-up.