(137) Peri-clitoral Abscess: Case of the Hidden Hair

Abstract Introduction A 30 yo woman presented to our clinic after having seen 26 clinicians over a one-year period for a painful peri-clitoral abscess that filled with purulent drainage, spontaneously drained, and recurred over and over, with no readily apparent etiology. Antibiotics were unsuccessful in treating the abscess and no provider was comfortable managing the mass due to its proximity to the clitoris. Objective We describe the management of a woman with a recurrent peri-clitoral abscess formation in the prepuce unable to get successful treatment for a year. Methods The patient was examined under vulvoscopy and the peri-clitoral abscess, approximately 1 cm in diameter, was located anterior to the glans clitoris in the clitoral hood. (Figure 1) The region was tender to both palpation and cotton tip swab testing, retraction of the clitoral hood caused discomfort, and the clitoral glans could not be visualized due to adhesions and swelling. The patient was scheduled to undergo dorsal slit procedure with surgical exploration of the abscess. Results During surgery the clitoris could not be visualized due to adhesions. A dorsal slit procedure was performed revealing there was no apparent involvement of the clitoral glans with the abscess. A 2 cm oval area of preputial skin superior to the clitoris covering the peri-clitoral abscess was excised and the area vigorously irrigated. Probing the subcutaneous tissue in this area revealed an ingrown hair. (Figure 2) Upon removal of the hair and root, the area was again vigorously irrigated and a 2-layer closure was fashioned. (Figure 3) Three months post op, the patient remains pain free, with no recurrence of the abscess. A literature search was performed, resulting in 5 peer reviewed papers describing an ingrown hair as a frequent cause of a pilonidal sinus tract of the clitoris resulting in a peri-clitoral abscess. Conclusions Recurrent clitoral abscesses presenting as clitorodynia with purulent drainage from the prepuce can be caused by ingrown hairs. Exploration of the sinus tract and removal of the offending ingrown hair and root can result in cure. Having an abscess near the clitoris should not negate a surgical exploration to better understand the status of the clitoris and the basis of the peri-clitoral abscess. Disclosure No.