What are the causes of vaginal cysts? How are they treated? Discover the answers to these and other crucial questions about this common gynecological condition.

Understanding Vaginal Cysts: Types, Causes, and Symptoms

The human body is a remarkable and complex structure, prone to various growths and abnormalities. Cysts, a type of fluid-filled sac, are one such common occurrence that can develop in many areas of the body, including the vagina. There are several different types of vaginal cysts, each with its own unique causes and characteristics.

Inclusion cysts are one of the most prevalent forms of vaginal cysts. These small, fluid-filled lumps typically form on the lower back of the vaginal wall, often as a result of trauma or damage to the vaginal lining, such as during childbirth or surgical procedures. Bartholin’s gland cysts, on the other hand, develop when the opening to the Bartholin’s glands, located on either side of the vaginal opening, becomes blocked, causing fluid to accumulate. Bacteria, including those that cause sexually transmitted infections, can also lead to the formation of Bartholin’s abscesses.

Another type of vaginal cyst, Gartner’s duct cysts, occurs when embryonic ducts that should have disappeared after birth fail to do so, leading to the formation of a cyst in the vaginal wall. Müllerian cysts, a common type of vaginal cyst, develop from remnants of the Müllerian ducts, which play a crucial role in the formation of the female reproductive system during embryonic development.

Symptoms and Diagnosis of Vaginal Cysts

Many vaginal cysts do not cause any noticeable symptoms, and they are often discovered during a routine gynecological examination. However, larger cysts, particularly Bartholin’s gland cysts, can sometimes lead to discomfort, especially during walking, sexual intercourse, or tampon insertion. Infected cysts can also cause pain and the formation of a pus-filled abscess.

To diagnose a vaginal cyst, your healthcare provider may perform a physical examination, during which they will feel for any lumps or growths along the vaginal wall or on the vulva. In some cases, they may recommend imaging tests, such as ultrasound or magnetic resonance imaging (MRI), to get a better understanding of the cyst’s size, location, and characteristics. A biopsy, where a small sample of the cyst is removed and examined under a microscope, may also be necessary to rule out the possibility of cancer.

Treatment Options for Vaginal Cysts

In many cases, vaginal cysts do not require any treatment, as they are often harmless and do not cause any symptoms. Your healthcare provider may simply choose to monitor the cyst during routine check-ups to ensure it does not grow or cause any problems.

If a vaginal cyst is causing discomfort or becomes infected, there are several treatment options available. Warm sitz baths, taken several times a day for a few days, can help relieve any discomfort. Antibiotics may be prescribed to treat an infection. For larger, fluid-filled cysts, such as Bartholin’s gland cysts, your healthcare provider may drain the cyst and insert a small tube called a catheter to keep it open and allow for continued drainage and healing.

In some cases, particularly for recurrent or large cysts, your healthcare provider may recommend a surgical procedure to remove the entire cyst. This is more common for women over the age of 40, as there is a slightly increased risk of the cyst being cancerous. After successful surgical removal, vaginal cysts typically do not recur.

Preventing Vaginal Cysts

While there is no surefire way to prevent the formation of vaginal cysts, there are a few steps you can take to reduce your risk:

• Maintain good hygiene and avoid irritating the vaginal area.
• Seek prompt treatment for any vaginal infections or sexually transmitted diseases.
• Avoid any unnecessary trauma or damage to the vaginal area, such as during childbirth or surgical procedures.

By understanding the different types of vaginal cysts, their causes, and the available treatment options, you can be better prepared to address any issues that may arise and maintain a healthy, comfortable vaginal environment.

When to Seek Medical Attention

If you notice any new lumps, bumps, or growths in the vaginal area, it’s important to seek medical attention, even if they are not causing any discomfort. Your healthcare provider can properly evaluate the growth and determine the appropriate course of action.

Additionally, if you experience any sudden or persistent pain, discomfort, or signs of infection, such as redness, swelling, or discharge, in the vaginal area, it’s crucial to schedule an appointment with your healthcare provider right away. Prompt treatment can help prevent complications and ensure the best possible outcome.

Conclusion

Vaginal cysts, while common, can be a source of concern and discomfort for many women. By understanding the different types of cysts, their causes, and the available treatment options, you can be better equipped to manage this condition and maintain your overall vaginal health. Remember to communicate openly with your healthcare provider and seek prompt medical attention if you notice any changes or concerns in the vaginal area.

Vaginal Cysts: Causes, Symptoms, and Treatments

The human body isn’t perfectly smooth. It’s prone to developing various lumps and bumps. Cysts are just one type of growth many people get. These sac-like lumps are filled with fluid, air, or other materials. They’re not usually harmful or painful.

Some cysts are so small that they can’t be seen with the naked eye. Others can grow to the size of an orange.

You can find cysts just about anywhere on the body, including the vagina. A vaginal cyst is usually located on or under the lining of the vagina.

There are several different types of vaginal cysts:

• Inclusion cysts are one of the most common types of vaginal cysts. They are usually very small and located in the lower back of the vaginal wall.
• Bartholin’s gland cysts are fluid-filled cysts that form on the Bartholin’s glands. These glands sit on either side of the opening to the vagina and produce the fluid that lubricates the vaginal lips (labia).
• Gartner’s duct cysts occur when ducts in a developing embryo don’t disappear as they are supposed to after the baby is born. These remaining ducts can form vaginal cysts later in life.
• Müllerian cysts are another common type of vaginal cyst that form from structures left behind when a baby develops. These cysts can grow anywhere on the vaginal walls and they often contain mucus.

Vaginal Cyst Causes

Vaginal cysts usually form when a gland or duct becomes clogged, causing liquid or another material to collect inside. The cause of a vaginal cyst depends on its type.

Inclusion cysts are caused by trauma to the vaginal walls. For example, women may get an inclusion cyst after they have an episiotomy (a surgical cut used to enlarge the vaginal opening during childbirth) or when they have surgery that damages the lining of the vagina.

Bartholin’s gland cysts are caused when the opening to the Bartholin’s gland becomes blocked — such as by a flap of skin — creating a fluid-filled growth. An abscess can result from a number of bacteria including those that cause sexually transmitted diseases such as gonorrhea or chlamydia. Bacteria normally found in the intestinal tract, such as E. coli, can also lead to Bartholin’s abscesses.

Vaginal Cyst Symptoms

Vaginal cysts usually don’t cause symptoms. If you have one of these cysts, you might feel a small lump along the vaginal wall or on the lips. Often, your gynecologist will discover the lump during your annual exam. The cyst might stay the same size or grow larger.

The cyst shouldn’t be painful. However, some larger cysts — especially Bartholin’s gland cysts — can cause discomfort when you walk, have sex, or insert a tampon.

Cysts are more likely to cause pain when they get infected. Vaginal cysts can become infected by the normal bacteria found on the skin or by a sexually transmitted infection. Infected vaginal cysts can form an abscess — a pus-filled lump that can be very painful.

Vaginal Cyst Treatments

Vaginal cysts usually don’t need to be treated. Often they will remain small and not cause any problems. Your health care provider may just want to monitor the cyst’s growth during routine exams.

You might need to have a biopsy of the cyst to rule out cancer. During a biopsy, your health care provider removes a piece of tissue from the cyst. That piece of tissue is examined under a microscope to see if it is cancerous.

To relieve any discomfort you’re having from a vaginal cyst, sit in a bathtub filled with a few inches of warm water (called a sitz bath) several times a day for three or four days.

To treat an infected vaginal cyst, you may need to take antibiotics.

If a vaginal cyst is large and filled with fluid (like a Bartholin’s cyst), your health care provider can drain it and may insert a small tube called a catheter to keep it open so it can drain more and allow it to heal better.”. You will have to keep the catheter in place for about four to six weeks. You could also have a procedure called marsupialization in which a small incision is made in the cyst to drain the fluid and then the edges of the incision are sutured to the sides of the incision.

It’s also possible to have surgery to remove the entire cyst if you’re very uncomfortable or the cyst keeps returning. Some health care providers recommend that women over age 40 have surgery to remove certain types of vaginal cysts because of the possibility they might be cancerous. This type of cyst usually doesn’t come back after surgery.

Simple Operations of the Vulva

INTRODUCTION

Numerous procedures available to the gynecologist for diagnosis and management of vulvar processes are adequately and appropriately addressed in a clinic or ambulatory care setting. The choice of an office versus an ambulatory operating room facility is generally based on the degree of surgical dissection required, the availability of appropriate instrumentation, and the level of anesthesia necessary for adequate patient comfort. The surgical procedures presented in this chapter are grouped by disease processes, as this grouping best explains their appropriate use in the clinical setting.

INFECTIOUS PROCESSES

Infections of the vulva are commonly due to bacteria that inhabit the skin, causing diseases such as carbuncles, furuncles, pyodermatitis, erysipelas, and impetigo. These infections are generally unimicrobial. They may be treated with topical or systemic antibiotics, depending on the seriousness of the infection. Incision and drainage may be required for localized abscesses from these infections. Carbuncles and furuncles are circumscribed areas of inflammation of the skin and deeper tissues, with furuncles specifically beginning in a hair follicle or follicular gland. Staphylococcus is the in situ organism. Application of moist heat is recommended until the abscess points, allowing incision and drainage. Predisposing factors include diabetes or systemic conditions resulting in an underlying decreased immune response. Shaving across the delicate skin of the vulvar area, crural fold, or mons could also incite or spread such a process by breaking the skin, thus allowing access of staphylococci into the deeper tissue.

Hidradenitis Suppurativa

Hidradenitis suppurativa is a disease process that originates in the apocrine sweat glands, and is initiated by closure of the duct or pore, preventing normal expulsion of the gland contents. It is commonly a complex polymicrobial infection, having been colonized with bacteria from the skin, vaginal flora, and anorectal area. Abscessed glands may rupture at or below the skin surface, infecting the surrounding tissue and forming fistulae to other apocrine glands. Bhatia and associates¹ recommended that the diagnosis be confirmed by biopsy. Simple incision and drainage is not effective. Antibiotic regimens providing activity against anaerobes and facultative anaerobes may produce some response. Antibiotic treatment, however, seldom provides a cure for this infection. Early disease may be cyclic, corresponding to the secretory activity of the apocrine glands during the progestational phase of the menstrual cycle. This activity may be modified with oral contraceptive pills. Remission has been achieved in 50% of patients treated with isotretinoin (Accutane).² This medication should be used with caution, however, in women of reproductive age because it is a powerful teratogen. Strong consideration should therefore be given to early, aggressive, wide excision of the infected skin. A probe is inserted into the infected sinus and the tract unroofed to delineate the involved areas for excision. The excision should include a margin of noninfected tissue and the underlying subcutaneous tissue without fascia. The incision may be closed primarily or allowed to heal by secondary intention. If large areas are involved, a skin graft may be required. It is imperative that all infected tissue be removed to decrease the risk of recurrence.

Crohn’s Disease

Crohn’s disease should be in the differential for any vulvar inflammatory process with an associated draining tract. Biopsy of the affected tissue on the perineum will reveal the presence of noncaseating granulomas characteristic of Crohn’s disease. Further bowel studies as well as a fistulogram may be employed to confirm the diagnosis. Excision of a draining sinus tract produced by Crohn’s disease may result in further deterioration of the tissue. Therefore, the preferred treatment is prednisone and metronidazole for 4 to 6 weeks. Surgical excision or incision of the tract may be effective after appropriate medical management.

Necrotizing Fasciitis

The potential for necrotizing fasciitis of the vulva should be entertained in any patient who has not responded to initial therapy for inflammatory vulvar processes, and especially in patients with a decreased immune response, as is seen in diabetes. The infection extends down to the level of fascia, with biopsy of the fascia being diagnostic. The underlying fascial necrosis generally exceeds the boundaries of the visible skin infection. Broad-spectrum antibiotics and aggressive surgical excision are required for therapy.³ Debridement should be continued until viable, well-vascularized tissue margins are identified. Control of diabetes is necessary, if present. Hyperbaric oxygen therapy has been shown to improve tissue healing.

Viral Infections

Molluscum contagiosum is a member of the pox virus family and presents on the vulva as multiple, small, umbilicated lesions. The treatment of choice is evacuation of the umbilicated lesions, commonly with a dermal curette, followed by chemical cauterization of the base.

Condylomata acuminata is one of the manifestations of human papillomavirus (HPV) infections in the lower genital tract. Clinical infection is usually apparent in approximately 3 months, although the incubation period may range from several weeks to 8 months. More than 60 subtypes of HPV have been identified. HPV-6, -11, -16, -18, and -31 account for most genital tract infections. Histopathologic and virologic evaluation of vulvar lesions has demonstrated HPV-6 and -11 to be associated with the majority of exophytic condylomata. These two types are also common in flat cervical condylomata and low-grade cervical dysplasia. Reid and associates⁴ found HPV-16 and -18 to be commonly associated with high-grade dysplasia and invasive carcinomas. HPV-16 and -18 are infrequently identified in benign lesions. As condylomata acuminata identified on the vulva may be associated with cervical, vaginal, or perianal HPV infection, a careful clinical evaluation including cytology and colposcopy as indicated is appropriate in all patients who present with vulvar warts. This not only aids in defining the extent of condylomatous change, but also permits appropriate therapy to include any involved areas.

Condylomata acuminata generally present as small and usually multifocal lesions. The first line of therapy involves a local application of 25% podophyllin solution or 90% trichloroacetic acid. Podophyllin may be applied to the lesions without anesthesia in the office setting. A burning sensation occurs as the podophyllin is left on the lesion and gradually increases over time. The recommendation is to allow this solution to remain on the lesions for 4 to 6 hours after application, at which time it may be removed by bathing. Its use is restricted to nonpregnant patients and to the vulva. It should not be applied within the vagina because of increased absorption and potential neurotoxicity. Bichloroacetic or trichloroacetic acid has the advantage of being applicable for vaginal use as well as during pregnancy. It may produce a burning sensation initially, but this actually resolves over time and requires no rinsing solution. A disadvantage to both of these methods is that they commonly require multiple applications for adequate therapy.

Vulvar and perianal condylomata may become particularly massive secondary to lack of therapy, immunosuppression, and occasionally pregnancy. Surgical therapy is appropriate for extensive volume of disease, multicentric disease associated with intraepithelial neoplasia, and in immunocompromised hosts. Biopsy should be used liberally in condylomata that are refractory to topical treatment or have an atypical appearance. Laser ablation therapy has been shown to be very effective in removing bulk, multicentric, or resistant condylomata. Further biopsies may be obtained at the same time. Recurrence rates range from 25% to 50%. Close follow-up may allow early treatment of small recurrent lesions.

General anesthesia is generally preferred for laser ablation therapy. Lesions should be vaporized no deeper than the level of the surrounding skin surface, using only a depth of the first surgical plane as defined by Reid and co-workers.⁵ I generally employ a power of 20 W with a spot diameter of 1.5 to 2 mm, giving a power density of 500 to 800 W/cm² for vaporization. Sites of vaporization are wiped with moistened gauze sponges to remove debris, cool the tissue, and permit accurate assessment of the depth of vaporization and the amount of remaining lesion. A brush technique is employed for the epithelium surrounding the lesions. The power is reduced to 10 W with a spot size of 2 mm to maintain a power density of 250 W/cm². This superficially denudes the adjacent epidermis, as HPV has been demonstrated in the tissue proximal to the actual condyloma. ⁶ Treatment of the subclinical infection is believed to prevent the reactivation of latent virus in the adjacent tissue, which may otherwise manifest as clinical infection after laser therapy.

Healing should be complete in 2 to 4 weeks. Local care includes sitz baths, followed by drying with the air setting of a blow dryer and application of silver sulfadiazine (Silvadene) cream. Narcotic analgesics are frequently required and are appropriate during the early healing process. Patients with known immunosuppression, particularly those with recalcitrant condyloma, may be treated after therapy or at the time of early recurrences with natural interferon alfa.⁷ This medication is not commonly used as initial therapy because of the requirement of regional injections 2 to 3 times per week with associative flu-like symptoms. Topical application of fluorouracil cream (Efudex) 5% has also been used to treat genital warts, but it is particularly caustic in the vulvar area and is generally limited to vaginal use.

Cryotherapy to the vulva has mostly been abandoned. Not only does it often require general anesthesia, but the depth of tissue destruction is difficult to assess, thereby making it less popular than more precise methods outlined above. Electrocautery with a loop has been found to be effective particularly with extensive lesions, but again general anesthesia is generally required, and the depth of penetration is not as precise as with laser therapy. However, this method can be combined with laser therapy: larger lesions can be removed superficially with the loop, leaving the resultant base of the lesion amenable to laser therapy.

DERMATOLOGIC CONDITIONS

Dermatologic conditions of the vulva are responsible for a large number of gynecologic office visits. The vulvar skin is a frequent site of contact dermatitis produced by both primary irritants and allergic phenomena. The vulvar area may be irritated by local cosmetic or therapeutic agents, as well as by biological fluids such as urine or feces in cases of incontinence or difficult hygiene. Generalized skin conditions such as psoriasis, seborrheic dermatitis, and lichen planus may also have manifestations in the vulva and may be confused with other etiologies, such as candidiasis. These skin conditions may have a slightly different appearance on the vulva than in other areas of the body because of the moisture present. Steroid preparations are commonly used for these dermatologic conditions. In contact dermatitis the offending substance, if identified, is removed. Biopsy is recommended in any of these circumstances if the course is chronic or the precise etiology unclear.

Biopsy of the vulvar skin is usually obtained with a Keyes biopsy punch. A simple alcohol preparation is sufficient with infiltration of local anesthetic, usually 1% lidocaine injected subepidermally with a 25-gauge needle. The addition of epinephrine promotes vasoconstriction and prolongs the anesthetic effect. The Keyes punch is available in diameters ranging from 2 to 5 mm, with 4- and 5-mm diameters most commonly employed for vulvar use. The site selected for biopsy should include tissue representative of the lesion or area of abnormality, but not necessarily the most central inflamed or necrotic area, which may give minimal tissue diagnosis because of the inflammation present. Therefore, the site picked is often at the periphery and may even include an edge of the lesion as it approaches the normal tissue. The cutting edge of the punch is applied to the surface (Fig. 1). With light pressure, the punch is rotated clockwise and counter clockwise, essentially drilling a hole through the full thickness of the skin. The specimen is then elevated with forceps and removed sharply from the underlying subcutaneous tissue. Hemostasis may be controlled with application of a silver nitrate stick to the site. Direct pressure may also be employed. Occasionally a suture of 3.0 chromic is required.

Intractable Pruritus

Some patients with benign dermatologic conditions have chronic pruritus that is not amenable to topical agents. This may be due to the inability of these drugs to penetrate the thickened, hyperkeratotic surface of the skin. In these instances a steroid injection into the subepithelial dermis may be appropriate. An injection of 20 to 30 mg (10 mg/mL) of triamcinolone acetonide (Kenalog) to a localized area is effective. The injected solution should be rubbed thoroughly into the tissue. Relief of symptoms may occur within 48 hours. Remissions may last for 4 to 6 months. Injections can be repeated for recurrent symptoms.

Local alcohol injections have also been employed, but require a general anesthetic. The entire vulvar area is marked off in a grid of 1-cm squares (Fig. 2). Absolute ethyl alcohol, 0.1 to 0.2 mL, is then injected into the subcutaneous tissue with a 25-gauge needle at each intersection of the lines, beginning at the lowest level of the grid. ⁸ Care must be taken to avoid injection into the epithelium or into the deep subcutaneous tissue to avoid tissue necrosis and sloughing. Thin folds of the labia minora should be injected only at the bases. All areas should be fully massaged to facilitate even distribution. Localized edema is noted rapidly and is present for 2 to 3 weeks. Recurrent symptoms may require additional treatment. Most patients get at least enough relief so that their symptoms may be controlled with topical agents.

The Mering procedure may be employed if all other measures have failed to produce relief of symptoms.⁹ It involves blunt dissection through the subcutaneous tissue of the vulva to interrupt the branches of the ilioinguinal and genitofemoral nerves. The procedure requires a general or regional anesthetic. Incisions are made at the lateral margins of the labia majora, extending to the level of the clitoris superiorly and the anal orifice inferiorly (Fig. 3). The dissection is continued to the level of the fascia. The nerves in the adjacent tissue are disrupted bluntly, allowing the fingers in each incision to meet in the midline above and below the clitoris; blunt dissection proceeds posteriorly to meet in the perineum, and even around the rectum if symptoms are present in this area. This perianal disruption will also affect branches of the pudendal nerve. Hematoma formation and cellulitis are potential complications. A small drain is therefore placed in the most dependent portion of the incision. Both the underlying tissue and the skin edges are closed with absorbable suture. It is recommended that this area be treated with direct pressure for 24 hours, followed by ice packs.

Vulvar Vestibulitis

Vulvar vestibulitis is the most prevalent of the vulvar pain syndromes, or vulvodynia. It is a chronic condition for which no single etiology has been identified. It is characterized by inflammation localized to the vulvar vestibule, with dyspareunia as the most common complaint. The technique described for diagnosis includes probing the vestibule with a cotton-tipped applicator to map the area of burning and pain, which is often exquisite, thus mimicking the patient’s symptoms. The area involved is nonkeratinized squamous epithelium containing mucous-secreting minor vestibular glands. These glands supply lubrication for coitus and may become inflamed due to edema, trauma, or infection. The examination reveals areas of bright erythema consistent with focal inflammation. Biopsy often shows a chronic inflammatory infiltrate with plasma cells. HPV has been demonstrated in some lesions by DNA hybridization techniques.¹⁰

Therapy has been directed toward treating any underlying infectious or dermatologic etiologies that may be aggravating these symptoms, as well as toward the use of topical anesthetic solutions or gels applied to the affected areas before coitus. Other therapies that have been reported as having some success in small series include acyclovir given over a 3-month period,¹¹ intradermal injection of interferon alfa three times per week for 4 weeks,¹² and low-dose 5-fluorouracil.¹³ Laser ablation has been successful in some cases.¹⁴ Surgical excision is considered for women whose symptoms have persisted for more than 6 months despite use of the therapies already mentioned. With vulvar vestibulectomy, 60% to 80% of women report significant pain relief. In performing the vestibulectomy with perineoplasty, the specific area of pain should be carefully delineated with a marking pen immediately before the administration of any anesthetic. The full epithelial thickness should be excised with inclusion of the adjacent hymen (Fig. 4). The posterior vaginal wall should be separated from the underlying tissue for 2 to 3 cm above the hymenal ring so that it may be pulled down and out to close the defect created. This vaginal mucosa is attached to the perineum with a mattress closure of interrupted absorbable suture.

CYSTS OF THE VULVA

Bartholin’s Duct Cyst

The most common large cyst of the vulva is a cystic dilation that results from an obstructed Bartholin’s duct. The underlying gland continues to produce secretions. In asymptomatic women less than 40 years of age, no treatment may be required. To exclude malignancy in women above the age of 40, excision of the cyst and the underlying gland is recommended. Adenocarcinoma may be found in the gland, as well as transitional or squamous cell carcinoma in the duct. A Bartholin’s abscess may present acutely with localized tenderness and surrounding induration or erythema. Incision and drainage is recommended with immediate improvement of symptoms. This may be performed with a local anesthetic. A small stab wound is made through the vestibular mucosa as close as possible to the hymeneal ring and into the cyst or abscess in an area that appears closest to the mucosal surface. Internal loculations should be disrupted with a straight hemostat, and the extent of the cyst explored. After exploration, the cavity should be rinsed thoroughly. At this point it is necessary to place a wick with packing into the gland, or preferably a Word catheter. ¹⁵ This catheter is similar to a small pediatric catheter with an inflatable balloon to maintain its position within the cavity (Fig. 5). Normal saline should be used to inflate the bulb, as an air inflation may result in premature deflation. The end of the catheter can be tucked within the vagina for comfort. This catheter should remain in place for 3 to 4 weeks to ensure reepithelialization, thereby creating a new duct opening. Without this epithelialized tract, secretions due to the underlying functional gland tissue can reaccumulate, resulting in an unacceptably high recurrence rate. Bacteria present within Bartholin’s abscess include normal vaginal flora, Escherichia coli, and occasionally Chlamydia and Neisseria. Appropriate cultures should be obtained. Women should be placed on metronidazole and penicillin for the next 7 days if there is any evidence of surrounding cellulitis. Diabetic women should return within 24 hours for reevaluation to ensure that they are responding adequately.

A recurrent or symptomatic but uninfected Bartholin’s duct cyst may be addressed with surgical marsupialization. This technique is preferred to direct excision for recurrent cysts to maintain the functioning gland and to avoid the somewhat extensive dissection in this highly vascular area, which can result in scarring and vulvar pain. Surgical marsupialization involves directly approximating the ductal epithelium of the cyst or abscess to the overlying introital epithelium. Local infiltration of an anesthetic or a unilateral pudendal block are appropriate options for this procedure. Rarely is a general anesthetic necessary. A vertical ellipse of vestibular epithelium is excised from the center of the cyst, just outside the hymeneal ring (Fig. 6). The excision should be as wide as possible because the stoma will become smaller as it heals. The cyst wall is opened and the internal contents are drained and rinsed, as previously described. The lining of the cyst is everted and sutured directly to the vestibular mucosa with interrupted sutures of 2.0 delayed absorbable material. Antibiotics are not generally required. For patient comfort and healing, warm sitz baths twice daily are recommended for the week after surgery. The risk of recurrence after marsupialization is 10% to 15%.

Excision of a Bartholin’s duct cyst is reserved for cases that have persistently recurred despite other measures, or for cases involving women older than 40 in whom a rare carcinoma may be detected. An elliptical incision is made in the vestibular mucosa adjacent to the hymenal ring immediately overlying the cyst (Fig. 7). Excising a small elliptical portion of the mucosa allows adequate exposure. The mucosal edges may be grasped with Allis forceps for traction. Blunt dissection may be possible; however, cyst formation is often preceded by inflammation, which causes adherence of the wall to the surrounding tissue. Tenotomy scissors are excellent for sharp dissection. A small gauze or the handle of the scalpel is used for blunt dissection. It is not unusual for the cyst to be larger and deeper within the tissue than originally suspected. If the cyst approaches the rectum, a finger inserted into the rectum during this dissection may help in distinguishing the cyst boundaries. The base of the cyst is a common place to encounter bleeding because of the venous channels of the vestibular bulb and underlying glandular tissue. Dissection across this area may be best handled with small Burlisher clamps with pedicles that are cut and tied individually for complete removal of the duct and gland if possible. The entire cavity is then obliterated with a small delayed absorbable suture material. Any direct areas of bleeding should be addressed, as a hematoma in this area may be particularly painful, can dissect into adjacent tissues, and potentially become infected. The vestibular mucosa is approximated with a continuous suture of 2.0 delayed absorbable material. If a hematoma of the labia develops after surgery, bed rest with ice packs and a pressure dressing is recommended, as reexploration of the surgical site often leads to no visible single source of bleeding. Although the blood will reabsorb with time, the hematoma may also liquefy in 4 to 5 days, allowing adequate drainage and evacuation.

Hydrocele (Canal Of Nuck)

A hydrocele represents the dilatation of the peritoneum that accompanies the round ligament and extends from the inguinal canal into the vulva. It usually presents in the labia majora adjacent to the labia minora. It may be confused with a Bartholin’s duct cyst. Dilatation in the inguinal canal is known as a cyst of the canal of Nuck. In rare instances a loop of intestine is found to follow this pathway to the vulva. Surgical therapy involves incision of the skin to expose the hernia sac, which is then opened and dissected free. After complete excision of the peritoneal lining, the external inguinal ring is closed along with the adjacent subcutaneous tissue.

Paraurethral And Skene’s Glands

Paraurethral and Skene’s glands may present with cystic dilatation immediately adjacent to the urethra. These cysts are most commonly lateral or posterolateral in location. A direct connection to the urethra may be identified with urethroscopy or with direct palpation producing a urethral discharge. It is not recommended that these cysts be primarily incised and drained, because such drainage may produce a fistulous tract from the urethra to the vestibule or perineum. Treatment of symptomatic cystic areas consists of incising the mucosa immediately over the cystic structure, but directed away from the urethral meatus. A Foley catheter may be inserted into the urethra to identify its location throughout the dissection. The cystic structure is then dissected, generally with a combination of blunt and sharp dissection, with careful attention to the dissection along the side that borders the urethra. Hemostasis should be meticulous, and the defect thus created closed with interrupted 3.0 absorbable suture. Retention of the Foley in the urethra throughout the closure ensures that the urethral mucosa is not incorporated into this closure. The overlying epithelium is then reapproximated with continuous 2.0 absorbable suture. The Foley catheter may be removed at this point. Spontaneous voiding is generally resumed immediately.

Distal Diverticulum

A distal diverticulum may be encountered in the midline immediately beneath the urethral meatus and present as a cystic structure at the introitus. Its tract into the urethra may be identified with urethroscopy, transvaginal sonography, voiding cystourethrography, or double balloon urethrography. Lee stated that 15% occurred in this distal location.¹⁶ The dissection at this point may be approached by the classic method of opening the anterior vaginal wall, mobilization of the underlying pubocervical fascia, and meticulous sharp dissection of the diverticular sac with transection across the neck of the diverticulum. At this point, the urethra is closed in a linear fashion over a urethral catheter with interrupted 4.0 delayed absorbable suture. The pubocervical fascia is then closed in a pants-over-vests fashion with 3.0 delayed absorbable suture followed by closure of the vaginal wall with 3.0 delayed absorbable suture. Hemostasis is meticulously maintained throughout this procedure. The urethral catheter is usually maintained for approximately 5 to 7 postoperative days. This discussion presents the basic components of the surgical technique used for a distal diverticulum, but does not address multiple tract openings or diverticula in the middle or upper third of the urethra, which require further attention to support the urethrovesical junction.

In contrast to this classic dissection and closure, another alternative that is applicable to patients with a distal diverticulum is that reported by Spence and Duckett.¹⁷ This procedure involves placing one blade of the scissors in the urethra and the other blade in the vagina at or under the diverticular sac to essentially create a common opening for the urethra which includes the sac epithelium. Hemostasis is maintained on the right and left lateral margins thus exposed with 3.0 or 4.0 delayed absorbable suture. This procedure may afford some benefits when a diverticulum is extremely distal and when a short surgical procedure is believed to be advantageous. It should be noted, however, that this may shorten the functional component of the urethra and could be a risk factor for incontinence.

ABNORMALITIES OF THE URETHRA

Urethral Caruncle

A urethral caruncle is a small, fleshly outgrowth usually at the posterior surface of the urethra. It is generally soft, smooth, and bright red, and may be somewhat friable. It is most common in postmenopausal women and its differential diagnosis includes primary carcinoma of the urethra and prolapse of the urethral mucosa. In a series of 394 women with urethral tumors reported by Marshall and colleagues,¹⁸ the diagnosis of urethral caruncle was made in 376 of the women and urethral carcinoma in 9 women. The diagnosis is established by biopsy under local anesthesia. Small, asymptomatic caruncles may not require treatment. Initial therapy is oral or topical estrogen and avoidance of any associated irritation. For large or symptomatic caruncles that do not respond to these conservative measures, further options include laser therapy, fulguration, or operative excision. A Foley catheter is generally required for 48 to 72 hours after a destructive or surgical procedure.

Prolapse Of The Urethra

Prolapse of the urethra is a condition that may exist in premenopausal and postmenopausal women. It may require no treatment if asymptomatic. Therapy of a prolapsed urethra includes hot sitz baths and antibiotics to reduce inflammation and infection. In rare cases, it may be necessary to excise the redundant mucosa. The surgical procedure in cases where this is felt to be pertinent involves excising the redundant circular mucosal tissue with reapproximation of the urethral edge to the circumferential vulvar skin using a series of 3.0 interrupted suture (Fig. 8).

CONDITIONS OBSTRUCTING THE INTROITUS

Surgery Of The Hymen

In cases of imperforate hymen, a small pin-size hole is often identifiable, which allows probing to ensure the presence of the underlying vagina. In these cases, a cruciate incision may be made and the hymen excised in quadrants (Fig. 9). The circumferential vaginal edge thus produced is sutured to the vestibule with interrupted sutures. A hymenotomy may also be performed in cases where the vaginal opening is clearly visible, but functionally obstructed secondary to the presence and rigidity of the hymen. Incisions at 4 and 8 o’clock allow increased vaginal diameter. The patient must maintain this opening during the healing phase.

Nichols also describes patients with recurrent postcoital cystitis who may have thickened lateral bands connecting the urethral meatus to the hymenal margin.¹⁹ In this case, urethrolysis can be curative. The procedure involves a crush injury with forceps at the site of hymenal attachment to the urethra, which is at approximately 11 and 1 o’clock on the hymenal ring (Fig. 10). An incision is made through the crush material. A running locked suture is then placed along the cut edge of the incision, allowing a flap release of the urethra from this hymenal ring tension.

Labial Agglutination

Labial agglutination is seen in prepubertal females who have had a localized infection or inflammation, resulting in subsequent adherence of the labial tissues. Initial therapy is directed at improving the local environment and reducing the inflammation or infection, followed by topical estrogen therapy. Most cases will respond adequately to these measures. Separation will often occur spontaneously at menarche. Therefore surgical separation should be delayed if possible. Because of the potential traumatic impact, both physical and mental, of manual separation of the labia in the office, general anesthesia is recommended in cases where surgical therapy is considered. These cases are most commonly related to difficulty with urination. With the patient under general anesthesia and the area adequately exposed, a very thin white line of agglutination can be seen. This line can easily be separated with a combination of blunt and sharp dissection. Hemostasis is rarely a factor and may simply be controlled with cautery and occasionally a small suture. It is imperative that during the postoperative healing phase these tissues remain separated to prevent recurrence. Silvadene cream to the perineum, along with topical estrogen in limited amounts, is helpful for this purpose.

Introital Stenosis

A stenotic introitus may at times be treated with vaginal dilators and the addition of estrogen in postmenopausal women. Surgical therapy may be employed to increase the caliber of the introitus and to release submucosal fibrotic tissue. A midline incision may be made in the perineal body skin and extended just past the hymenal ring (Fig. 11). The underlying fibrosis is incised. The perineal epithelium and vaginal mucosa are undermined to produce mobility of the tissue. The incision is then closed transversely using interrupted mattress sutures.

In cases where a simple perineotomy is not effective, a Z-plasty may be curative, as described by Nichols and Randall.²⁰ A Z-shaped incision is made right posterolaterally and left posterolaterally just at the introitus (Fig. 12). The full-thickness flaps are undermined, rotated and sewn into place.

SOLID TUMORS OF THE VULVAR

Fibromas

Fibromas are the most common benign solid tumor of the vulva and are of mesenchymal origin. The most common location on the vulva is in the labia majora. Treatment is by excision for symptoms or for continued growth.

Lipoma

Lipomas are slow-growing tumors of fat cell origin. As with fibromas, they frequently occur within the labia majora. Although small tumors may be monitored expectantly, larger or faster-growing tumors are usually removed for diagnosis.

Hidradenoma

A hidradenoma is a rare, benign, usually small vulvar tumor that originates from apocrine sweat glands. The location is generally the inner surface of the labia majora and the perineum. Hidradenomas may be cystic or solid. Excisional biopsy is the treatment of choice.

Excision of tumors within the subcutaneous or fibrous tissue of the vulva are usually addressed with an incision line that matches the contour of the labia or the introitus (Fig. 13). A Foley catheter placed in the urethra is particularly beneficial if there is any displacement of the urethra or urethral meatus. If the size of the mass has produced an apparent redundancy of the overlying skin, an elliptical incision with partial removal of this excess skin is advantageous. The skin edges are then grasped with Allis forceps. The underlying mass is identified and removed with sharp dissection. During the dissection an area with the tumor’s blood supply may be best approached with a Burlisher, followed by transection and individual ligation with 3.0 absorbable suture. The subcutaneous tissue is closed with 3.0 absorbable suture, and the skin edges are closed with interrupted 2.0 absorbable sutures.

VASCULAR ABNORMALITIES

Varices

Varices are common on the vulva and are related to the pudendal veins. They can involve tributaries of the hypogastric vein with varicosities extending through the gluteal vessels over the buttocks. Treatment depends on size as well as symptoms, particularly discomfort after exercise or long periods of standing due to engorgement. In these occasions ligation with excision of the segment of vulvar skin that contains the varices is a treatment option.

Hemangioma

Hemangiomas are malformations of blood vessels and may occur on the vulva. Strawberry hemangiomas are congenital defects discovered in young children. Most vulvar hemangiomas discovered in neonates and children remain stable or regress in size. Cherry angiomas normally arise on the labia majora of postmenopausal women. They are often less than 3 mm in diameter, multiple, and red-brown to dark blue. Angiokeratomas are approximately twice the size of cherry angiomas. They may demonstrate rapid growth and a tendency to bleed with strenuous exercise. Their color is blue to purple, and the differential diagnosis includes Kaposi’s sarcoma and angiosarcoma. Pyogenic granulomas represent an overgrowth of inflamed granulation tissue. The differential diagnosis includes malignant melanoma, basal cell carcinoma, vulvar condyloma, or nevus. Congenital hemangiomas rarely require treatment, whereas a biopsy specimen should be taken in an adult with an abrupt appearance of a pigmented lesion. Excisional biopsy may be diagnostic and therapeutic with smaller lesions. Large lesions may be difficult to remove. In these cases ligation of larger vessels may be beneficial if persistent bleeding is a problem.

TRAUMA

Hematomas

The vulva is richly supplied with vascular anastomotic channels, which make treatment of hemorrhage with compression or ligation of a single major vessel limited. Hematomas may result from sharp or blunt injury to the vulva. Most hematomas in women result from straddle injuries. A vulvar wound may be the only indication of deeper trauma, including vaginal injury, urethral compromise, and even pelvic fracture. Vulvar trauma in children or adults should be a marker to explore any evidence of potential abuse.

The management of vulvar hematomas is usually initiated with ice packs and pressure. The bleeding is usually venous in origin and therefore generally self-limiting. If the skin has not been violated and the hematoma is self-contained, it will gradually resorb with time. Any puncture wound or laceration at the time of the injury may introduce bacteria into the hematoma. In these cases broad-spectrum antibiotics should be initiated along with close observation for further evidence of infection, which will require incision and drainage. If drainage is necessary, it may be best accomplished after 4 to 5 days, as the hematoma liquefies. In cases of rapidly expanding hematomas, incision and drainage may also be necessary, with ligation of any active bleeding sites identified. Packing may be used temporarily to aid with compression, although it should be removed as quickly as believed prudent to decrease the risk of infection. Hematoma formation in children may require a general anesthetic for an adequate examination, which includes examination of the vagina, placement of a urethral catheter, and in some instances laparoscopy to ensure there has been no penetration into the peritoneal cavity.

Laceration

Lacerations of the vulva, which may also extend into the vagina as a result of trauma, should be evaluated thoroughly and may require a general anesthetic for complete delineation of the severity of the injury. Necrotic and damaged tissue should be removed. The areas involved should be copiously irrigated. Antibiotic therapy should be initiated to cover flora of the skin, vagina, and rectum, as well as any sexually transmitted diseases if indicated. If healthy tissue is demonstrated during the operative procedure, the areas of laceration may be closed primarily.

VULVAR LESIONS

Vulvar lesions may present in numerous forms. They may present as pigmented areas; depigmented areas; white, thickened, or grayish areas; reddened areas; atrophic or thinned areas; and grossly ulcerated or polypoid. Although certain characteristics exist for specific disease processes, biopsy is used for a definitive diagnosis. Less dramatic appearing areas in the vulva that remain symptomatic despite previously employed therapies should also raise the suspicion of an unidentified lesion and should prompt a biopsy. The Keyes punch biopsy (see previous discussion) is an excellent choice for obtaining a portion of tissue in an area that is diffuse, large, multicentric, or believed to be probably benign in origin. An excisional biopsy is often useful in situations where the lesion is small or where both diagnosis and therapy may be accomplished.

Excisional Biopsy

Excisional biopsy is generally employed for circumscribed lesions when complete removal is desired. The incision should be made with a no. 15 blade at a right angle to the skin’s surface. An elliptical incision is ideal, if possible, because this shape makes it generally easier to close the adjacent edges. A shallow wedge of subcutaneous tissue below the lesion should be included in the incision. The long axis of the incision should match the structure on which it is located on the vulva. Thus, incisions on the labia or lateral labial area should be parallel to the labial axis. Incisions at the introitus should match the curvature of the introitus, and incisions on the perineal body may be best performed with the long axis of the incision somewhat horizontal. These efforts will generally reduce the tension on the incision line. The vulvar skin is prepared with povidone-iodine and alcohol. The site is infiltrated with 1% lidocaine with epinephrine (Fig. 14). A 5- to 10-mm border of surrounding normal tissue is recommended for most lesions. The defect is closed with interrupted 3.0 delayed absorbable suture with direct reapproximation of the skin edges. A larger excisional biopsy may require a regional or general anesthetic. In these cases edema may be reduced with an ice pack during the first 24 hours, followed by daily warm sitz baths.

For treatment of a unifocal area of carcinoma in situ, Paget’s disease, or small superficial melanomas, a wide local excision carried down to Colles’ fascia is appropriate in order to achieve primary closure without tension. The defect may be slightly longer, wider, or a different shape than would be considered necessary for diagnosis alone. The goal should be to decrease tension as well as avoid unwanted folds and puckering. Deep layers of suture will not only assist with hemostasis but will relieve tension at the skin layer. A 3.0 delayed absorbable suture is ideal for closure.

Nevi And Melanomas

Vulvar nevi are common and generally asymptomatic. Because women do not tend to inspect this area closely, they are unaware of changes in the appearance of these lesions. Therefore, ideally vulvar nevi should be excised. This excision may be accomplished with local anesthesia. The obstetrician and gynecologist also has an excellent opportunity to inspect the vulva and remove any nevi at the time of an obstetric delivery or gynecologic surgery.

The vulvar area represents 1% of the skin surface of the body. In contrast, 5% to 10% of all malignant melanomas in women arise from this region. Approximately 30% of malignant melanomas arise from a preexisting nevus.²¹ The clinical features of an early malignant melanoma have been listed by Friedman and associates.²² These include asymmetry, border irregularity, color variegation, and a diameter usually greater than 6 mm. Melanomas with level I or II involvement have an excellent prognosis and demonstrate the principle that early removal of superficial lesions is the key to improved outcome.

Vulvar Dystrophy

Vulvar dystrophies represent a number of disorders of the epithelium that involve abnormalities of growth and maturation resulting in a white-appearing surface. Dystrophies include lichen sclerosus and hyperplasia with or without atypia. Although cases with atypia may have some premalignant potential, the majority of cases of chronic epithelial dystrophy show no increased risk of malignant change.

Lichen sclerosus may occur in any age group and symptomatically is characterized by intense pruritus. Extensive excoriation may be visualized. The vulvar architecture is progressively destroyed, with adhesions, agglutination, edema, and scarring. The surface epithelium is generally pale, with a shiny and crinkled appearance and varying degrees of hyperkeratosis. Biopsy reveals thinning of the epidermis, loss of rete peg architecture, an underlying acellular homogenous dermis, and deep chronic inflammatory cells. Biopsy is therefore recommended for definitive diagnosis. Treatment is topical testosterone propionate 2% in petrolatum. Lifetime maintenance therapy is generally required, with application once or twice a week even after adequate therapy has returned the vulva to a normal appearance. Some patients will also require a combination of 7 parts betamethasone valerate (Valisone) and 3 parts crotamiton (Eurax) applied intermittently for relief of pruritus. If this therapy is continued, alternating with testosterone, a dominant testosterone effect will be seen over a longer period of time.

Women with hyperplasia of the vulva generally present with thickened white vulvar epithelium with pruritus as their primary symptom. Histologic evaluation reveals a thickened epithelium, elongated rete pegs, and inflammatory cells in the underlying dermis. Cellular atypia may be present, as demonstrated by abnormal maturation in the acanthotic epithelium. In atypia, mature abnormally keratinized cells may be seen in the basal layer of the epithelium. Diagnosis is obtained with a biopsy. A combination of 7 parts betamethasone valerate and 3 parts crotamiton applied twice daily is the recommended therapy. Once the condition has completely regressed, recurrence is less common. Therefore, development of new areas should promote rebiopsy.

Some women will present with mixed dystrophy, that is, both lichen sclerosus and hyperplastic changes. When both lesions are present, corticosteroids are usually given as the initial treatment. Testosterone therapy is instituted once the hyperplastic areas have receded. Corticosteroids and testosterone preparations may also be used on alternate days and may be equally effective, but slower in producing resolution.

Paget’s Disease

Paget’s disease of the vulva is a lesion of apocrine origin with primary presenting symptoms of itching and burning. The lesions are usually velvet red with dotted white epithelial islands that are grossly suggestive of carcinoma in situ. Histologically the vulvar Paget cell is large, containing abundant almost-clear cytoplasm and a pale nucleus with a prominent nucleolus. This cell appears in the basal level of the epithelium, the basal cell layer being otherwise intact. One fourth to one third of patients with extramammary Paget’s disease of the vulva have invasive adenocarcinoma of the underlying apocrine gland structures. Therefore, if this diagnosis is made on the basis of a biopsy, referral should be made to a surgeon who will be prepared to perform a wide subtotal or total vulvectomy with frozen sections of the margins to guide excision intraoperatively. A skinning vulvectomy is not recommended in Paget’s disease, as these underlying areas of apocrine glands would not be adequately addressed. Local recurrences may be seen despite histologically clear margins.²³

Carcinoma In Situ

Carcinoma in situ may present with a symptom of pruritus, bleeding, pain, or a lump on the vulva. Lesions may be focally red or white and are often raised or ulcerated. Because lesions can mimic many of the other vulvar abnormalities previously described, a biopsy is imperative. A biopsy with a Keyes punch may be performed in the office setting under local anesthesia. Multifocal areas of neoplasia are common. Treatment options include wide local excision for unifocal areas, vulvectomy for larger or multifocal areas, and carbon dioxide laser therapy. CO₂ laser therapy may be particularly useful in areas where excision would hamper preservation of the anatomy, such as in the clitoral area. It should be employed, however, with liberal use of biopsies to exclude an occult invasion. Laser treatment of vulvar carcinoma in situ must also address extension of disease into hair follicles and therefore mandates deeper laser vaporization beyond the papillary dermis and into the upper reticular dermis or the third surgical plane. Baggish and co-workers²⁴ identified skin appendage involvement in 36% of cases of vulvar carcinoma in situ, predicting that laser vaporization to a depth of 2.5 mm would effectively treat 95% of involved appendages. Power densities of greater than 750 W/cm² are recommended to decrease thermal injury of underlying tissue produced with lower powered densities, thus decreasing the risk of scarring.

Bartholin’s cysts

A Bartholin’s cyst is a small fluid-filled sac (called a cyst) at the opening of your vagina.

You have two glands, one on either side of your vagina, called your Bartholin’s glands. They make the mucus that lubricates your vagina and keeps it moist. The mucus travels down a small tube, or duct, to your vagina. If the tube gets blocked it can cause a cyst.

Sometimes the fluid gets infected, and the gland and duct fill up with pus. This is called a Bartholin’s abscess.

Doctors don’t know why the ducts between your Bartholin’s glands and vagina get blocked, but it could be due to infection or injury. Sometimes it’s linked to sexually transmitted infections such as chlamydia or gonorrhoea, or another bacterial infection such as E.coli.

Diagnosing a Bartholin’s cyst

If you have a Bartholin’s cyst you may notice a small, soft painless lump near the entrance to your vagina, or in the lips next to your vagina. This might not cause any problems and you might not even notice it. Sometimes these cysts are only found during an examination such as a routine cervical smear.

If it gets big it can be uncomfortable and sometimes painful when you sit, stand or walk, or have sex.

If the cyst gets infected then the lump may get big over just a few hours, and the skin around it can get red. It can be tender or even very painful, and you might have a fever.

Treating a Bartholin’s cyst

Treatment depends on the size of the cyst, how painful it is and whether it’s infected.

If the cyst is small and painless, it will probably go away by itself. If symptoms develop you’ll need to go back to your GP.

For a bigger cyst or abscess, you can try:

• pain relief
• antibiotics – your doctor might prescribe these if you have an infection
• warm water baths – soaking in a bath with a few centimetres of warm water in it, several times a day, may help a small infected cyst to burst (rupture) and drain on its own.

If the cyst is big and these treatments don’t work, a specialist (gynaecologist) may need to drain the fluid for you at the hospital.

Preventing a Bartholin’s cyst

If you get a Bartholin’s cyst, you usually won’t get another one. There’s nothing specific you have to do to prevent it. But because abscesses can be caused by sexually transmitted infections, practising safer sex and using condoms may stop some of these abscesses from happening.

Getting help with a Bartholin’s cyst

You should always see your GP if you find a lump. They will ask you about any symptoms and how long you’ve had the lump. They’ll also check the cyst for any signs of infection.

If the cyst seems infected, they might need to take a swab to check what bugs are causing the infection.

Written by HealthInfo clinical advisers. Last reviewed September 2021.

Source

The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public.

NHS – Bartholin’s cyst, retrieved October 2020

Page reference: 279444

Review key: HIVVC-53223

Bumps On Your Vagina – 16 Vaginal Lumps, Causes, Treatment

Listen, no one wants to deal with bumps on their vulva or vagina area. The skin down there is already sensitive enough without added irritation! But if your mind is jumping to scary conclusions about what those bumps are or mean for your health, know that there are tons of possible causes for bumps in this area, and they can all be treated and managed.

Before getting into the possible causes of bumps on the vulva and vagina regions, it’s important to note that for some people, these skin changes might be harder to spot when they first pop up. If you don’t remove your pubic hair, it’s smart to bring up any weird skin changes or symptoms you’ve had when you see your gyno, since they might not be able to actually see them. “This doesn’t mean that you should change your grooming practices, but if you have symptoms that you are concerned about, make sure to bring it up and point them out,” says Jodie Horton, MD, an ob-gyn in Washington, D.C., and chief wellness advisor for Love Wellness.

Same goes if you have a darker skin tone, she says. “Vulvar skin conditions may also be more difficult to notice in women with darker skin, especially if the skin in the genital area is protected by pubic hair,” says Dr. Horton. If you’re a Black, Indigenous, or person of color, it’s important to bring up any unusual symptoms you’re experiencing to help ensure that you receive an accurate diagnosis and treatment plan.

So what exactly are you dealing with down there? Use this guide to give you a better idea of what’s up with those vaginal bumps, and what can be done about them.

1. You have a breakout.

You probably thought pimples were over with as soon as you peaced out of your teen years, but breakouts can still haunt you in adulthood—and not only on your face.

“Same as anywhere else on the body, we may develop acne in the vaginal area as well,” says Carolyn DeLucia, MD, of VSPOT Medi SPA in New York City. They look just like any other acne blemish would: red, irritated, and sometimes filled with pus. (When they are pus-filled, they may appear as white bumps near the vagina.)

Uncomfortable as the zits may be, fight the urge to squeeze them. Dr. DeLucia recommends keeping your hands to yourself and letting your skin clear up on its own: “Vaginal acne usually resolves itself, as it does on the face.”

2. Your hair-removal routine is irritating your skin.

Removing hair down there can be a real pain. Aside from making the delicate skin along your bikini line red and itchy, it can also lead to ingrown hairs and folliculitis—a fancy term for an infected hair follicle. Basically, it’s super easy for hair removal to lead to bumps in your vagina region, more specifically the vulva.

“Due to efforts to treat the vaginal area with depilatories, shaving, and waxing, the hairs that grow back may get trapped [under the skin] and infected, causing bumps and pain,” says Dr. DeLucia.

Toning down the hair removal for a week or two should help prevent a hairy situation from getting worse, but grooming-inflicted bumps on the vulva usually tend to go away on their own anyway, says Eve Espey, MD, professor and chair of the obstetrics and gynecology department at the University of New Mexico School of Medicine.

3. You have new moles or skin tags.

Over time, sun exposure can bring new freckles or moles to the surface, while continuous friction caused by skin-to-skin or skin-to-clothing contact can result in skin tags (soft, painless flaps of skin).

Skin tags don’t pose a threat to your health and usually don’t require medical treatment—unless, of course, they annoy you to the point where you simply want to remove them. Moles are a bit of a different story: For the most part they’re no biggie, but it’s important that you’re able to tell the difference between the normal and suspicious varieties—especially if you spend a lot of time in the sun.

According to the Skin Cancer Foundation, normal moles are usually round and regularly shaped, and they can be either flat or raised. Atypical moles, however, tend to be asymmetrical and multicolored, and their size can increase over time. And yeah, they can show up in your groin area too, says Dr. DeLucia. If you’ve sprouted a brown spot that looks sorta funky down there, get it checked out right away.

4. You have sebaceous cysts.

Between sitting at a desk from 9 to 5, working up a sweat at the gym, and wearing constrictive underwear practically every minute of the day, your vagina definitely doesn’t get nearly as much fresh air as it needs.

A constantly stuffy environment between your legs and incessant rubbing against clothing can lead to the growth of sebaceous cysts (fluid-filled, possibly white bumps on your vagina area that can appear like acne).

“They’re often found in the groin area,” says Dr. Espey. “They can become infected, but the infection usually stays right in that area.” Warm soaks and a visit to the doctor might be needed to treat sebaceous cysts, says Dr. DeLucia, but they’re nothing to lose sleep over.

5. You have genital warts.

Vaginal warts are a type of sexually transmitted infection (STI), and they’re often caused by specific strains of the human papillomavirus (HPV). They’re small in size, they can be rough or smooth on the surface, and they’re typically skin color or slightly darker.

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“Warts do not cause health problems,” says Dr. Espey, “though most women seek treatment because of the stigma and cosmetic concerns around having genital warts, [which are contagious through sexual contact].”

Although the warts themselves aren’t dangerous, you should still check in with your physician to find out if they were caused by HPV, which could put you at risk for cervical cancer and other issues.

6. You have a Bartholin’s cyst.

If the weird bump or lump is near the opening to your vagina, it may be a Bartholin’s cyst, says Allison Hill, MD, an ob-gyn at Good Samaritan Hospital in Los Angeles and co-author of The Mommy Docs’ Ultimate Guide to Pregnancy and Birth.

You have glands on each side of your vaginal opening that are responsible for helping you get wet down there and stay nice and lubricated for fun times, but occasionally these can get blocked or backed up with fluid. The cyst on its own isn’t a huge deal but sometimes they get infected, becoming painful and pus-filled, Dr. Hill says.

If the cyst is small and painless, your doc will probably tell you to wait it out, and it will likely go away on its own. But if it becomes large and/or painful, you need to see your doctor right away. They can drain the cyst and prescribe antibiotics if necessary, she says.

7. You have ingrown hairs.

Pubic hair is characterized by its curly shape, but that tight coil can have a major downside: Pubic hairs are way more likely than other hairs to burrow back into your skin, causing ingrown hairs. “The most common reason I see for painful bumps in the vaginal area are ingrown hairs,” Dr. Hill notes.

These can become infected, but it’s pretty rare—more often than not they’re just itchy and annoying, she adds. You can use tweezers and a mirror to try and remove the offending hair yourself, or you can leave it alone and it should eventually heal on its own.

If the bumps aren’t going away or show signs of infection (redness, swelling, pain, or pus), check in with your doc, she says.

8. You have molluscum contagiosum.

No, it’s not a Harry Potter spell—molluscum contagiosum is a scary-sounding name for a common, benign condition. These small, pearly, firm bumps on your vagina area are a result of a skin infection caused by the molluscum contagiosum virus, and they’re typically the only symptoms. Sometimes, the bumps can get larger, turn red, itch, and ooze.

These bumps can appear anywhere on your skin, including your face, hands, and yes, genitals, Dr. Hill says. You get them by coming into contact with someone or something carrying the virus—say, by having sex or sharing a towel with someone who has open sores. You can even give them to yourself. If the bumps are oozing, they’re contagious, and when you itch them you can accidentally spread them to other parts of your body.

For most people, these vaginal bumps go away without treatment within a few months (as long as you don’t itch them and keep spreading them!) but if you have a weakened immune system, you may need medical treatment, she says.

9. You have an infected sweat gland.

Sweat glands are everywhere, including in your groin region, as any girl who’s ever worn light-colored leggings during a workout can attest. And those sweat glands can get infected, causing swollen, painful bumps on your vagina area, Dr. Hill says.

Women who work out in tight leggings (which is pretty much all of us, right?) are particularly at risk for this affliction—especially if you don’t shower right away, she says. Staying in your damp workout pants, undies, or swimsuit, especially those that aren’t made out of wicking fabric, traps the sweat against your skin which can cause your sweat glands to become blocked or infected.

Proper hygiene, including thoroughly rinsing your vaginal area with clean water and a mild soap if you want, and changing into dry clothes as soon as possible, will prevent most of the bumps on your vagina, she says. Otherwise, they’ll probably go away on their own; but if they show signs of infection, call your doctor.

10. You have syphilis.

The first sign of syphilis is one or more small, painless bumps at the site of the infection—usually your genitals or mouth, says David Diaz, MD, a reproductive endocrinologist at Orange Coast Memorial Medical Center in Fountain Valley, California. The vagina bumps stay for three to six weeks then disappear on their own. But make no mistake, this doesn’t mean the syphilis is gone, and you still need treatment ASAP, Dr. Diaz says. Otherwise, it could become life-threatening.

Syphilis is highly treatable with antibiotics, but the sooner you catch it, the better. If you have any reason to believe you’ve been exposed to an STD, get tested, he says.

11. You have vaginal inclusion cysts.

Cysts can happen anywhere, explains Dr. Horton, but a vaginal inclusion cyst is the most common type of cyst you’ll find down there. They’re often caused by trauma, childbirth, or vaginal surgery.

While they typically don’t cause any pain and aren’t dangerous, they can definitely be annoying. If it turns out you have them, your gyno will monitor them.

12. You have Skene’s duct cysts.

Skene’s glands are found on each side of the urethra (the urinary opening where you pee), explains Dr. Horton. A Skene’s duct cyst will form if the gland becomes obstructed due to an infection. These cysts are usually less than a centimeter in size and don’t cause any other symptoms. Cysts larger than a centimeter, however, can cause pain with urination and sex.

If the cyst becomes infected and filled with pus, and forms an abscess, the gland will be tender, swollen, and red. An abscess can be treated with antibiotics or surgically removed.

13. You have vulvar varicosities.

Varicosities is the name for enlarged, dilated veins, and they can totally pop up on the vulva or outer part of your vagina. It’s most common in pregnant women and women with a condition called pelvic congestion syndrome. Basically, varicosities is the result of a change in blood flow and increased hormones that cause the veins to dilate and grow. Varicosities will look blue or purple and bulge out from the skin.

“This condition may be difficult to see in women who have darker skin, but if you experience vulvar pressure, heaviness, or pain during intercourse, you may want to get a pelvic exam to rule it out,” explains Dr. Horton. “Treatment can include applying ice, elevating your feet, and wearing compression stockings to increase blood flow to the vulva.”

14. You have lichen sclerosus.

This is a rare condition that causes thin, shiny white patches on the vulva and anus. It can occur at any age but it’s most common in women over 50. The patches come with itching, blisters, pain, and bleeding. Its cause is unknown, but experts believe it’s tied to immune system issues, hormonal imbalances, genetics and skin trauma.

“Diagnosis of lichen sclerosis can be difficult and is often confused with other skin disorders of the vulva, as it involves carefully examining the vulva, including areas with pubic hair,” says Dr. Horton. “If you do have it, it’s important to have life-long screenings of the skin affected by lichen sclerosus because it leads to an increased risk of vulvar cancer.”

15. You have genital herpes.

Herpes is a condition most women are aware of, as it’s a common sexually transmitted infection caused by herpes simplex virus (HSV) 1 and 2, says Dr. Horton. After initial exposure, the virus will become dormant and can reactivate at any time. Symptoms include pain, itching, small red bumps, tiny white blisters, or ulcers. During an initial outbreak, you may have flu-like signs and symptoms such as swollen lymph nodes in your groin, headaches, muscle aches, and fever, as well as itching and burning.

“There is no cure for herpes, but symptoms can be treated quickly with antiviral medication to decrease the duration of an outbreak,” says Dr. Horton. “Condoms are the best way to reduce your risk of exposure and transmission of herpes.”

16. You have vulvar cancer.

Vulvar cancer is most common in older women, and it typically forms as an itchy lump or sore on the vulva, according to the Mayo Clinic.

Before you freak out though, know that any bumps on your vagina likely aren’t cancerous unless they come with these other symptoms: itching that never goes away, pain and tenderness around the vulva, vaginal bleeding outside of your period, changes to the color or thickness of the vulvar skin, and any open sores or ulcers, per the Mayo Clinic.

If you have these symptoms persistently, get your lumps and bumps checked out by a doctor. If one of them is cancerous, it can be surgically removed.

Emilia Benton
Emilia Benton is a Houston-based freelance writer and editor.

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Differentiating Bumps: Renee Cotter, MD: Gynecologists

You were in the shower, minding your own business, washing up as usual when suddenly…a bump. A bump?! What does that mean?! Your first reaction: panic. Your second: doctor. There are a few things wrong with this situation here, but the most important is not to panic. There are many different causes of bumps found in the vaginal area including ingrown hairs, infected oil glands, bartholin glands, herpes sores, genital warts, or molluscum contagiosum.

 

No matter what the cause or type of bump, you can rest assure that none of these are an emergency or reason to panic. This week, we’ll cover these different types of bumps, what their cause is, how to treat them and prevent them if possible.

Ingrown Hair

Ingrown hairs are common causes of bumps in the vaginal area. When a hair follicle becomes blocked, it is referred to as an ingrown hair. This also increases the possibility of infection at the base of the hair shaft, typically caused by either staph or strep (types of bacteria). Ingrown hairs and their cysts can happen on their own, but shaving promotes this type of bump and infection.

Symptoms

• Small, red bump
• Bump may appear pimple like
• Tenderness and soreness at bump

Treatment

Hot soaks and compresses typically relieve pain and allow the affected follicle to drain. If you do visit the office, the doctor can help manually facilitate the draining of the follicle afterwhich hot soaks and/or compresses should still be continued. If the infection is serious, antibiotics might be prescribed.

Prevention

• Avoid shaving
• Good vulvar hygiene

Infected Oil Gland

An infected oil gland is also known as an infected sebaceous gland or a sebaceous cyst. These glands are normal glands found all over the skin on your body and produce oil and a waxy substance for your skin. When this gland gets blocked, oil and wax build up until the gland becomes a hard bump that is sometimes white in color. Sometimes the gland becomes infected, usually with staph or strep as in an infected hair follicle. Skin trauma can sometimes cause the oil glands to become clogged and/or infected.

Symptoms

• Hard bump under skin
• White/yellow in color
• If infection, the bump will be tender, red, and warm

Treatment

Similarly to an infected hair follicle, an infected oil gland may be treated and relieved with a hot soak or compress. If the gland is seriously infected and enlarged, the gland will be manually drained at the doctor’s office and you may be prescribed antibiotics for an infection.

Prevention

There is little to do to prevent this type of bump. Good hygiene can help. Some people propose that obesity plays a factor, but there is limited research for this.

Bartholin Gland Cysts

Bartholin glands are two glands that produce lubricant for the vagina in response to sexual contact. These glands are found on either side if the vaginal opening. This gland becomes swollen and enlarged when it becomes blocked and its mucous builds up. Sometimes these swollen glands may become infected. Unfortunately, return of these gland is very common and occurs in about 1 in 10 women who get a bartholin gland cyst. Some women have chronic bartholin gland cysts. The cysts are always present but they are not red or painful. ​

Symptoms

• Painful lump near the vagina
• Hotness/soreness near the bump
• Pain when sitting or walking
• Pain with intercourse
• Fever

Treatment

There are four treatment methods for Bartholin gland cysts. One may be done at home, though it is less effective than the other three options.

Soaking:
At home, you may try a hot sitz bath, however this is only if the gland is still very small, minimally tender, and not yet infected. To soak, submerge at least your lower half in warm-hot water 3-4 times a day for several days. This simultaneously relieves discomfort caused by the cyst and also attempts to help open the cyst so that it can drain. Though this method may be successful, you are also likely for the gland to become clogged again and reinfected. Again, I urge that this should only be tried while the gland is small and not extremely painful. A true bartholin abscess needs treatment the same day. If you are experiencing pain and if the gland is not caught early, you must be treated in the office.

Drain and Catheter:
At the office, a small cut in the gland can be made after numbing the area. This allows the cyst to drain. After this, a small catheter is placed and left in for 6 weeks. The goal of this is to create a new permanent opening for the gland to drain from. Leaving the catheter in place and allowing the skin to heal around it is what creates this permanent opening. After the area is drained, you should also begin soaking in a hot water bath for 2-3 days after. Drainage alone is not sufficient treatment of the gland. The cut made in the gland will always close on its own and only offers relief for a few days. Often, the bartholin gland cyst will return. Think of this procedure like getting your ears pierced. When your ears are pierced, the piercer will always instruct you to leave your earrings in place for 6 weeks and if you remove the earrings, the new piercing will close up. This procedure is the same. Without the catheter, the cut will close again and the gland will have no place to drain from permanently.

Marsupialization:
This is a procedure done in the operating room under anesthesia. Marsupialization opens the gland and stitches the lining of the gland to the skin of the inner labia with a dissolvable stitch. The goal of this procedure, like above, is to create a new, permanent opening to the bartholin gland. This procedure is favorable if you can not tolerate the in office procedure under local anesthesia (numbing). With general anesthesia, the procedure will be pain free.

Gland Removal:
This is done as a last option. For this type of treatment, the bartholin gland is surgically removed. Removal of the gland is only done if other treatment options and techniques have already failed.

Prevention

A common cause of bartholin gland cysts is gonorrhea. Therefore, safe sexual practices to avoid STDs may help prevent these cysts. Additionally, good hygiene can help. by avoiding infections, you can help prevent the gland from becoming inflamed and closed off.

Herpes Sores

Herpes sores are caused by the Herpes virus, a very common Sexually Transmitted Infection (STI) affecting 1 in 6 people in the United States. There are two types of Herpes: Herpes Simplex I (HSVI) and Herpes Simplex II (HSVII). Both are a cause of the herpes sores in the genital area. The virus is harmless in nature, only causing annoying blister-like sores to appear repeatedly in the same area. For some women, these outbreaks occur frequently, and for others they occur only a few times a year. Treatment depends on how much the outbreak bothers you, frequency of outbreaks, and partner transmission.

Herpes is transmitted via sexual contact and can be given from one partner to another via vaginal, oral, or anal sex. The virus may be passed from one person to another, even if they do not have a sore. Because Herpes is a virus, there is no cure for it and antibiotics do not treat it. The first time you have a herpes outbreak, you may also experience a fever with flu-like symptoms. Frequent repeat outbreaks are also very common in the first year of infection.

Symptoms

• One or more of small blister-like bumps called “lesions”
• Sores may be tender

Treatment

There is no cure for Herpes, however outbreaks may be suppressed or treated by an antiviral medication. Depending on the frequency or severity of outbreaks, you may take an antiviral right as symptoms appear or daily for suppression. People often describe a tingling sensation in the area right before an outbreak occurs. This helps them determine when to take their antiviral.

Prevention

The best way to prevent genital herpes is to be in a long-term monogamous relationship with a partner who has screened negative for HSVI and II, using latex condoms, abstaining sex if it fits your lifestyle. Since herpes can also occur on areas not covered by a condom, it is still possible to pass on the virus even while using a condom.

Stress is also a large contributor to herpes outbreaks. By controlling and managing stress, you can help prevent outbreaks. Use techniques such as meditation, yoga, exercise, massage, and activities that bring you joy in order to help reduce stress. Caffeine and alcohol are also food items that can contribute to the body’s stress response so consume them in moderation.

L-Lysine is a supplement commonly used to help suppress HSV. L-Lysine is available most places that sell vitamin and mineral supplements. Other over the counter products such as Abreva also work to shorten the course of an outbreak and may be used.

Genital Warts

Genital warts are another type of bump caused by a virus. The virus that causes genital warts it the ever popular Human Papilloma Virus (HPV), the most common sexually transmitted virus. 360,000 people are affected by genital warts each year. Like other STIs, HPV and genital warts are passed through sexual activity. Fortunately, the type of HPV that causes warts are typically not cancer causing. The warts are very stubborn, unfortunately, and typically require more than one office visit to completely remove. It’s important to treat the warts at a doctor’s office because without treatment they can increase in number, cause discomfort, and are more likely to be spread to another person. Getting them checked by a doctor also rules out the possibility that they are a type of skin cancer rather than a genital wart, which look similar in appearance. You should still continue routine pap smears as it is possible to have more than one type of HPV and HPV is the leading cause of cervical and vulvar cancer.

Symptoms

• Soft, pink or flesh colored bump
• Painless
• Itchiness

Treatment

At the office, warts can be treated in several ways. In the office, warts can be frozen, cut off under local anesthesia, treated with a laser, treated with a topical acid, or destroyed with an electric current. Sometimes medication is given to apply directly to the wart at home for 16 weeks, however this is not commonly practiced as swift medical action is important with genital warts in order to prevent more from occurring.

Prevention

The best way to prevent genital warts and any STD is to have a long-term monogamous relationship, use condoms during sex, or avoid sex if it fits your lifestyle. Again, though condoms are great at preventing STDs, because genital warts can be on areas not covered by a condom, it is still possible to transmit the virus even when wearing a condom.

Molluscum Contagiosum

What a name huh? Molluscum Contagiosum is the name of another virus that causes bumps in the vaginal area. Technically, Molluscum is not an STI, though it is a virus. The bumps caused by molluscum can be found anywhere on the body. Commonly, it is passed between children and is actually in the same family as the Chickenpox virus. In the case of molluscum appearing in the vaginal area, however, it is most likely passed from sexual contact. Is it possible to pass Molluscum by sharing towels or using an improperly cleaned and sanitised towel at a public area such as a sauna or pool. Molluscum causes several small, skin colored bumps to appear. The virus only lives on the very surface of the skin, so once the bumps are gone, the virus is also gone. Thankfully, the virus is also not dangerous aside from causing you minor annoyance.

Symptoms

• Tiny, painless, flesh colored bumps
• Clusters of bumps

Treatment

At the doctor’s office, molluscum bumps can be simply removed with a scraping tool. The procedure only causes minimal discomfort. Older techniques include application of acid to the bumps, however this is no longer practiced because it is not effective and may cause scarring in the area. Once the bumps are treated completely, the virus is gone. It may take several different office visit to completely treat and remove the bumps, however, because the bumps take several days to form. Even though all the bumps at one time were removed, the ones still in the process of growing could not be removed and thus would have to be removed at another visit.

Prevention

Molluscum can be prevented, like other STIs, by limiting your number of sexual partners, using condoms, or avoiding sex if it fits your lifestyle. Also, like the STIs above, condoms cannot always protect against molluscum because it may be on other areas of the genitals not protected by the condom.

Another way to prevent Molluscum is to always bring your own personal towel when visiting a public pool, sauna, bath, or other facility where towels are provided or rented out. This limits the possibility of you contracting the virus from a surface.

Conclusion

Bumps and lumps in the vaginal area have several causes. Thankfully, they are typically not dangerous. In rare cases, skin cancer can appear in the genital area. If you find a misshapen mole, see your doctor or dermatologist to rule out the possibility of a skin cancer. Causes of bumps in the vaginal area include ingrown hairs, infected oil glands, bartholin glands, herpes sores, genital warts, and molluscum contagiosum. Some of these, like the viruses herpes, HPV and molluscum can be prevented using safe sexual practices. The risk of others may be reduced by proper genital hygiene. By becoming familiar with these bumps, you can hopefully spare yourself any panic in the future by understanding what treatments are available, symptoms to look for, and when to see a doctor.

References

Self
National Library of Medicine. Bartholin cyst or abscess. Medlineplus Medical Encyclopedia. 2014.
CDC. Genital HPV infection – fact sheet. CDC. 2014.
CDC. Molluscum Contagiosum. CDC. 2015.
National Library of Medicine. Genital Warts. Medlineplus medical encyclopedia.
AAD. Genital warts: Diagnosis, treatment, and outcome.

Vaginal lumps and bumps: a guide

Finding a new lump or bump on your body can be worrying – especially when it’s around your genital area or vagina. “That wasn’t there yesterday”, you think. But a lot of the time there’s no need to jump straight into panic mode.

It may appear to be a sinister-looking new arrival to your body, however these things are usually fairly harmless and are almost always easy to treat.

So how do you tell what lumps, spots and ingrown hairs are serious and what isn’t? We spoke to London-based gynaecologist Dr Anita Mitra, aka Gynae Geek, to get to grips with the various things that can grow in your lady garden.

Read on for your guide to the lumps and bumps that can develop your genital area, and which require a trip to see the doctor.

Ingrown hairs

What are they?

This is one we probably all can (and do) recognise, as ingrown hairs on your vagina or genital area are totally normal. “Ingrown hairs are where the hair starts to grow back on itself so that it curls back down into the skin rather than coming out of the surface; they often form a ‘head’ like a spot does, and you can often see a hair inside,” says Dr. Anita.

“Just because it may have a white head, doesn’t necessarily mean it’s infected or full of pus. The white stuff is sebum and oil that your skin usually makes, but is now trapped underneath the skin.”

How are they treated?

Ingrown hairs can be treated at home with DIY methods; by exfoliating with a hot flannel or a hot compress to ease the hair out.

Does it require a doctor’s visit?

“If the ingrown hair is very large and very, very painful with red sore skin around or, in some rare cases, you can start to feel unwell with high fever – pop some paracetamol and ibuprofen and call your GP. You may need some antibiotic cream/tablets.

“Folliculitis is a slightly more serious condition that can result from hair removal; rather than just one isolated hair being affected, large clusters of hair follicles may be red, inflamed, bumpy and can look like acne or a rash. It’s often caused by a bacterial Staphylococcus infection and needs to be seen by a doctor, and may need antibiotic/anti-fungal or steroid treatment.”

Rashes (itchy or non-itchy)

What are they?

If you suffer with eczema or psoriasis, you’ll probably recognise it if it’s spread to your nether regions. “These can both affect the vulval area and tend to be very itchy with their own characteristic appearance,” says Dr. Anita.

“Lichen planus is another kind of itchy rash which can also be red and inflamed to start with, but can cause white, scarred areas which can eventually narrow the entrance to the vagina. Lichen sclerosis is a less common skin condition, which may or may not itch, and causes a pearly white discolouration of the vulval skin.

“Thrush (also known as vulvovaginal candidiasis) is the most common cause of vaginal itching, but doesn’t often cause a rash.”

Does it require a doctors visit?

“If you’re certain it’s thrush or have a high suspicion, you can try and treat it with over-the-counter medication such as Canesten. But if that doesn’t work, and there is a definite rash or something else you’re worried about, then you do need to go and see your GP to find out exactly what it is. The treatments may be subtly different, and may even require a small skin biopsy to determine the exact condition.”

How are they treated?

“Often with steroid creams, but may involve a trip to a dermatologist for a specialist treatment plan.”

Varicose veins

What are they?

We bet you thought you could only get these in your legs. Bad news: you can also get varicose veins of the vulva. “They appear like blueish lumps, on the labia majora or minora, that are soft and will go away temporarily if you put pressure on the area, but rise up again when you take your fingers away,” says Dr. Anita. “They can be itchy and sometimes bleed, and are often accompanied by a heavy sensation.”

Do they require a doctors visit?

“As with most things around the vulva, because it can be difficult for you to be sure of the diagnosis, it’s worth seeing your GP to ensure that’s exactly what they are.”

How are they treated?

“They rarely need surgical treatment,” Dr Anita adds, “compression underwear is the most common way to manage them.”

Genital warts

What are they?

There’s a lot of confusion around genital warts and what exactly causes them. “A lot of people think they’re caused by herpes, but they’re actually caused by the Human Papilloma Virus (HPV), which is in the same family of wart virus that causes cervical cancer,” says Dr. Anita.

“The types that cause warts, however, are called ‘low-risk HPV’ because they don’t cause cancer, so having warts won’t increase your risk. HPV warts are transmitted through sexual contact and are usually fleshy and non-painful, although they can itch, bleed and cause irritation during sex.”

Do they require a doctors visit?

“Yes, to confirm the diagnosis. It may also be worth visiting the sexual health clinic, because about 20% of people with genital warts also have another sexually transmitted infection.”

How are they treated?

“One-third of cases will go away on their own within six months; you may be offered a cream to treat them or treatment to remove them by freezing or surgery,” says Dr. Anita. “These are normally done by sexual health specialists, or a dermatologist/gynaecologist at a specialist clinic for vulval skin problems.”

Herpes

What is it?

“Genital herpes is caused by Herpes Simplex Virus type 1 or 2; type 1 also causes cold sores, and the most common way for a woman to get genital herpes is through oral sex,” Dr Anita tells us. “It typically causes a tingling/itching followed by formation of small red blisters which then pop, release a clear/yellowish fluid and then form ulcers which can scab over and disappear.

“They can cause intense pain when urinating; you may also have flu-like symptoms at the same time including aching muscles and joints, a high fever and nausea/vomiting. The first episode tends to be the worst and lasts about 2-3 weeks, while subsequent episodes may be shorter and less severe.”

Does it require a doctors visit?

“Yes, because it’s important to be sure of the diagnosis in women in particular because outbreaks can happen in pregnancy, which require prompt treatment. Many doctors will also give you treatment from 36 weeks of pregnancy to reduce risk of an outbreak around the time of delivery, and therefore reduce the risk of transmission to the baby.”

How is it treated?

“With an antiviral medication called acyclovir – it’s more effective the sooner it’s taken from the onset of symptoms.”

Bartholin’s cysts/abscesses

What are they?

Cysts are build-ups of fluid caused by a blockage. “The Bartholin’s gland sits on the edge of the entrance to the vagina and makes a mucus-like secretion which acts as a lubricant. If this gland opening gets blocked it will cause a cyst, because the fluid is still made, but can’t escape,” says Dr. Anita. “These can range from the size of a pea to the size of a golf ball. Typically larger means more uncomfortable, but they are not dangerous.

“They can, however, get infected by the bacteria that normally lives on your skin in that area. This is called a Bartholin’s abscess, and they can get even larger and more painful than a cyst, making it uncomfortable to walk, sit or have sex. They’re surprisingly common and some people may get recurrent cysts/abscesses. Smoking increases the risk of getting a Bartholin’s abscess.”

Do they require a doctors visit?

“These should be checked by a doctor to decide whether it’s a cyst or an abscess.”

How are they treated?

Usually, cysts won’t require any treatment. “You can try and do a sitz bath yourself (hot bath several times a day) or a hot flannel compress to see if it will burst of its own accord,” says Dr. Anita. “An abscess may require antibiotics and, if it doesn’t improve, some people need a small operation to drain it. Some gynaecologists prefer to treat them with antibiotics where possible, as many report vaginal dryness after an operation if it’s necessary to remove the gland.”

Labial cysts

What are they?

“Similar to a Bartholin’s cyst, these are also blocked glands, but they don’t generally have the potential to get as big as a Bartholin’s cyst,” says Dr. Anita. “They can also get infected, and are treated in the same way.”

Do they require a doctors visit?

Same as above – let your doctor check whether it’s a cyst or an abscess.

How are they treated?

This one’s also the same as Bartholin’s cyst. Cysts won’t require treatment, but an abscess might.

Vaginal cysts

What are they?

Cysts aren’t just limited to Bartholin and Labial, guys. “These cysts are are pearly white lumps around the size of a pea on the wall of the vagina,” says Dr. Anita. “They can sometimes happen after childbirth, particularly if you had a cut or a tear.”

Do they require a doctors visit?

“It’s worth having them looked at to check that’s exactly what they are because they may be difficult for you to see yourself,” advises the expert.

How are they treated?

“They don’t usually require treatment unless they are very large or painful, and they don’t usually get infected.”

Tumours

What are they?

When we find a new growth or weird rash, it’s totally normal for our brains to jump straight to thinking it’s a lump indicating vaginal cancer.

It’s normal to panic, but as Dr. Anita explains, “vulval cancers are very rare, and vaginal cancers even more so. There are only about 1400 cases of vulval cancer and 250 cases of vaginal cancer diagnosed in the UK each year. Women with lichen sclerosis or lichen planus are slightly more likely to get a vulval cancer, but it’s still very uncommon. They are often associated with HPV, and are more common in smokers and women who have gone through the menopause.”

Do they require a doctors visit?

For peace of mind, yes. “Any unusual lumps/bumps/thickened patches of skin that are itching/bleeding/burning, don’t go away or are associated with abnormal vaginal discharge or bleeding should prompt you to make a GP appointment,” advises Dr. Anita. “It’s more likely to be one of the things mentioned above – but that’s why it’s always worth checking.”

How are they treated?

“Treatment varies depending on the type of tumour and whether it has spread.”

The moral of the story? If in doubt, go and see your doctor – to stop you wondering what it could be, and to find out what it actually is.

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Bartholin’s abscess

​

First line management includes analgesia, warm bath or a compress to encourage drainage.

1. Spontaneous drainage

If the cyst or abscess has ruptured and pus is draining, take a swab for culture.

No further treatment or follow-up is required.

The patient should be advised to contact their GP if the abscess stops draining and reforms.

If obvious cellulitis please refer to treatment below

2. Medical treatment

Antibiotics may be used if there is evidence of soft tissue skin infection (cellulitis). Antibiotics may be more effective prior to the formation of an abscess.

1^st Line Antibiotics for all patients (including pregnant women)

• Co-amoxiclav            625mg every 8 hours for 5 days

 

Penicillin allergic patients

• Doxycycline              200mg stat dose followed by 100mg daily for a further 4 days

         + Metronidazole    400mg every 8hours for 5 days

Penicillin allergic pregnant patients

• Erythromycin           500mg every 6 hours

+ Metronidazole     400mg every 8hours for 5 days

If symptoms persist or worsen, refer to Gynaecology Triage/Ward 210 at RIE or Ward 12 at SJH via the gynaecology registrar on call.

Once referred to secondary care the further options are:

Word Catheter

Patients requesting drainage of their Bartholins abscess or cyst should be offered a Word catheter. This 3cm long balloon-tipped silicone catheter has a diameter of a number 10 French Foley catheter and is inserted into the cavity of the abscess or cyst following drainage to avoid premature closure and re-accumulation. The recurrence rate associated with a Word catheter is similar to surgical marsupialisation.

The Word catheter is inserted under local anaesthetic as an outpatient in Gynaecology triage at RIE and on ward 12 in SJH.

The catheter is left in-situ for a maximum of 4 weeks. This allows re-epithelialisation of the Bartholin’s duct and on removal of the catheter the newly created duct will shrink and the gland will return to normal function. This does not impede normal daily activity or intercourse.

Most catheters will fall out prior to 28 days.

Please contact/ ask the patient to contact the RIE Gynaecology triage/ SJH ward 12 if the word catheter;

• falls out ≤ 5 days or
• > 5 days and symptoms have recurred

The patient will be followed-up by the gynaecology department between day 23-25 following insertion and an appointment will be arranged to remove it on day 28 if necessary.

Surgical Management

Marsupialisation of the Bartholin’s gland under general anaesthesia is the main surgical treatment used in the UK. This is associated with a 5 to 15% recurrence rate. There is a small risk of subsequent scarring, slow healing, haematoma, infection and dyspareunia.

Women who decline a Word catheter or who have other labial or vulval abscesses are offered marsupialisation over incision and drainage (which has a higher recurrence rate).

Surgical excision of the cyst is reserved for recurrent cysts only and is associated with significant risks such as excessive bleeding, vulval dryness and dyspareunia. 

Bartholin gland cyst removal – Paracelsus Medical Center

Cyst of the Bartholin gland.

Bartholin glands are located at the entrance to the vagina in women, one on each side. They are small, and normally they are not noticeable in any way. The function of the Bartholin glands is to release fluid onto the mucous membranes, the inner surfaces of the labia minora.

Bartholin gland cyst develops when the exit channel in the gland is blocked.This usually only happens to one of the two glands. The liquid that is produced in the gland begins to accumulate inside. As a result, the gland enlarges and forms cysts. If the cyst becomes infected, an abscess occurs.

Bartholin gland cyst symptoms.

A cyst of the Bartholin gland causes swelling of the labia on one side, near the entrance to the vagina.

By itself, a cyst usually does not cause severe pain. And if such pain appears, this may indicate the development of an abscess.

Diagnostics of the Bartholin gland cyst. In our Paracelsus MC in one day you can undergo all the necessary examinations to make this diagnosis and prepare for surgical treatment!

In order to diagnose a Bartholin gland cyst, a medical examination is required. To prepare for surgical treatment, a number of examinations will be required. Surgery examination and validity of examination results: colposcopy-12 months

Ultrasound of the pelvic organs – 3 months

Ultrasound of the veins of the lower extremities – 3 months

Swab for flora, bacteriological culture from the cervical canal -10 days

Oncocytology from the cervix – 6 months

General analysis of urine-10 days, General analysis of blood and reticulocytes -10 days,

Electrocardiogram with decoding -14days,

Blood for HIV, Hepatitis B, Hepatitis C, Syphilis – 3 months.

Biochemical blood test: general, direct, indirect Bilir., Total protein, albumin,

urea, glucose, creatinine, uric acid, AST, ALT, blood sodium and potassium, cholesterol -10 days

Coagulogram – 10 days

Blood group and Rh factor

Fluorography – 6 months.

Mammography -24 months (after 36 years), 12 months (after 50 years) Ultrasound of the mammary glands -12 months (up to 36 years)

Consultation of a therapist, anesthesiologist and other specialists according to indications.Other examinations can be added according to indications.

Surgical treatment of the Bartholin gland cyst. In our MC Paracel, surgical treatment of the Bartholin gland cyst is carried out in a planned manner after a complete examination of the patient, if necessary, a certificate of incapacity for work is issued. Stay in the hospital for 1 day.

The operation is performed on a gynecological operating table, during the intervention, not only the cyst wall is removed, but also the gland itself, in order to exclude relapses (repetitions) of the disease.The cyst is accessed through a small incision on the inner surface of the labia. Due to the good reparative qualities of the vaginal mucosa and vulva, the surgical wound heals completely without leaving a trace. The removed tissue must be sent for histological examination to exclude the malignancy of the process. Method of anesthesia. These operations are performed under spinal anesthesia or machine-mask anesthesia . During the operation, the patient is completely relaxed and does not feel any pain.

Bartholin gland cyst

Bartholin gland cyst is a common gynecological disease. It is diagnosed mainly in young women. Bartholin’s gland is a paired gland located in the thickness of the labia, on the eve of the entrance to the vagina. Its function is to produce a lubricant that allows for the physiological process of sexual intercourse. For certain reasons, a blockage of the Bartholin gland duct is possible.In this case, a cyst may form – a pathological formation, which is a fibrous capsule around the stagnant secretory substance.

Causes provoking the formation of a cyst of the Bartholin gland:

• sexually transmitted diseases
• candidiasis (thrush)
• trauma to the labia during intercourse, during depilation, tight underwear, etc.
• insufficient hygiene of the external genital organs
• termination of pregnancy and other gynecological operations.

After blockage, two options for the development of events are possible: either an abscess is formed, or the formation and growth of a cyst is observed, as it grows and when the infection is attached, bartholinitis develops.
Unlike an abscess, a cyst of the Bartholin gland lasts for a rather long time with practically no symptoms and can only be detected when it reaches a large (up to 8 cm) size or during the next gynecological examination.

As the cyst grows, the symptoms intensify:

• vaginal dryness;

90,081 itching and burning;

• discomfort, bloating or foreign body sensation;
• throbbing pain, aggravated by physical activity;
• Possible fever and general fever.

Without treatment, a Bartholin gland cyst can cause serious complications. The main ones are bartholinitis or purulent abscess. Since the genitourinary sphere is characterized by active blood flow, the infection can quite easily migrate to the surrounding tissues and organs. Attempts to open or warm up the cyst on their own are especially dangerous. Even if the abscess spontaneously opened and the woman thinks that she has recovered, then, most likely, the infection will remain and with the slightest damage or hypothermia, a relapse is possible.

A festering cyst will require serious long-term treatment, most likely surgical. If you start treatment in the early stages, then the disease can be easily treated. The best way to prevent a cyst of the Bartholin gland is to have regular check-ups with a gynecologist.

Zvezda Medical Center invites you to undergo a preventive examination by a gynecologist. Our competence and our delicacy are at your service!

90,000 diagnostics and treatment in Kaliningrad – Nadezhda Medical Center

Bartholin glands perform an important function for the female reproductive system: they produce a viscous secret that moisturizes the vagina.In a normal state, they do not bring discomfort, a woman does not feel a burning sensation, itching and other unpleasant symptoms. Bartholinitis disease disrupts the natural secretion process and significantly worsens a woman’s life. High-quality diagnostics and treatment using modern, safe medicines will prevent complications of the disease and restore the functionality of the Bartholin glands.

Description

Bartholite is an inflammation of the Bartholin gland that occurs for a number of reasons.The disease affects women of all ages, but more often girls who are promiscuous. Bartholinitis in women has three conditions: acute, subacute and chronic. Depending on the focus of inflammation, it is divided into the following types:

• canaculite;
• abscess;
• cyst.

The last stage of complications is the most dangerous – the cyst of the Bartholin gland. It does not always respond to conservative treatment and often leads to complications. If a pregnant woman is exposed to the disease, then there is a risk of infection of the fetus with its subsequent death.

Symptoms

Bartholin glands, inflammation of which can occur during any period of the menstrual cycle and even during pregnancy, practically do not manifest themselves at the first stage of the disease. There is only slight redness and mucopurulent discharge. If bartholinitis is diagnosed at this stage, the treatment will be as effective as possible and will take several days. Further, there is a blockage of iron with the manifestation of more vivid symptoms:

• severe, sudden pain in the labia, where suppuration occurs;

90,081 increase in body temperature;

• chills, weakness, drowsiness.

The development of an abscess and cyst leads to a deterioration in the woman’s well-being:

• increase in body temperature to 40 degrees or more;
• dizziness, loss of consciousness;
• severe pain when urinating and defecating;
• enlargement of glands, palpation of a sac filled with fluid.

Reasons

The causes of inflammation of the Bartholin glands are very diverse:

• non-observance of hygiene rules, especially during menstruation;
• frequent change of sexual partners without the use of contraception;
• tight underwear;
• decreased immunity;

90,081 chronic infections;

• microtrauma;

90,081 sexually transmitted infections.

Diagnostics

After hearing the symptoms of bartholinitis in women, the gynecologist prescribes additional studies. These include a visual examination of the external genital organs, colposcopy, bacterioscopy, PCR diagnostics, analysis for latent infections.

Treatment

Acute bartholinitis, the symptoms of which make it possible to diagnose the disease in a timely manner, is quite easy to treat. For this, doctors prescribe antibiotic therapy. To reduce the inflammation of the Bartholin glands, treatment should be directed towards relieving symptoms.Local therapy can alleviate the patient’s condition and prevent further development of the disease. Treatment of a cyst of the Bartholin glands is almost always surgical. Excision of the inflamed sac is performed under general anesthesia.

Prevention

Measures for the prevention of bartholinitis are to observe the rules of hygiene, change the pads on time, wear comfortable underwear made from natural fabrics, and treat infectious diseases. If you are worried about a cyst of the Bartholin gland, the operation can be performed in our medical center.High quality of service, diagnostics of various diseases by doctors of the highest categories and affordable prices for services – we offer all this to our clients. Be healthy!

90,000 Paraurethral cysts – causes, etiology and pathogenesis of benign paraurethral formations

The etiology of paraurethral cystic formations is still controversial. There are several theories regarding the etiology and pathogenesis of these diseases.

In 1890, in England, Routh first proposed the most widely accepted theory. He determined that obstruction of one or more paraurethral glands can lead to the formation of a retention cyst at the site of the gland. Further infection and abscess formation of the cyst leads to the formation of a rupture of the cyst wall and its drainage into the lumen of the urethra. Epithelialization of the anastomosis between the lumen of the urethra and the cavity of the cyst leads to the formation of the neck of the diverticulum.

Diagram of the formation of a paraurethral cyst and urethral diverticulum
A – obstruction of the duct of the paraurethral gland, leading to a violation of the outflow of the secretion of the gland.
B – the formation of a retention cyst at the site of the gland.
C – infection and abscess formation of the cyst, which leads to the formation of a rupture of the cyst wall and its drainage into the lumen of the urethra.
D – the formation of a diverticulum of the urethra.

A number of studies have been conducted that support this theory. First, the anatomical position of most paraurethral cystic masses corresponds to the location of most paraurethral glands. The overwhelming majority of them are localized along the posterolateral wall along the distal two-thirds of the urethra.Some authors indicate that 85% of diverticula occurred in the distal two-thirds of the urethra, others that approximately 60% of diverticula were located along the middle or distal third of the urethra, in about 15% they were multiple. In 4% of cases, the location was unknown. In addition, minor enlargements of the paraurethral glands and their ducts were also found in women without any symptoms.

Another etiological theory is the theory of trauma to the urethra with obstruction of the excretory ducts of the paraurethral glands as a result of it.Obliteration can occur with trauma during childbirth (for example, with a mismatch between the head of the fetus and the mother’s pelvis, with incorrect insertions, after the production of certain obstetric aids and operations), as well as due to iatrogenic surgical trauma such as episiotomy, or surgical interventions on urethra. Most often, the inflammatory processes of the urogenital sphere, bougienage or suppression of the urethra lead to obliteration of the excretory ducts of the paraurethral glands. Although this mechanism may be the cause of a small number of paraurethral cystic formations, it is practically impossible to establish or disprove it.In addition, a large number of authors note that in 15% or more these formations are found in nulliparous women and in the absence of any medical or other manipulations on the urethra in the anamnesis.

In recent years, reports have begun to appear in the world literature on the development of paraurethral cystic formations in women who have undergone suburethral loop plastic. HammadFT in 2007 and MahdyAetall in 2008 reported 3 patients with paraurethral cystic lesions after TVT surgery.These cases were probably associated with surgical destruction of the submucosal connective tissue or erosion of the loop through this layer.

Some paraurethral cystic lesions can be congenital, as evidenced by the fact that they occur in newborns. Many of these cysts have epithelial lining, which indicates that they develop from structures that are not paraurethral glands. Examples are cloacogenic cysts lined with colonic epithelium, Gartner’s duct cysts, and remnants of the Müllerian duct.Also in the world literature there are reports of cystic formations that have developed as a result of the presence of an abnormal accessory urethra. These cysts are present at birth as a large fluid-filled mass that sits between the main urethra and the clitoris. The external opening of the accessory urethra is stenotic or obliterated, which leads to the accumulation of urine in the formation. At the same time, these patients had various developmental anomalies, such as the absence of the perineum, the absence of the labia minora, polycystic kidneys, and hydronephrosis.

Attempts have been made to elucidate the etiology by evaluating the cyst lining. Some authors noted that if the cyst is lined with epithelium, then it is of congenital origin, others believe that the urethral epithelium can grow and line the old abscess cavities. With purely purulent cavities, there may be no lining, which is the result of necrosis of the latter due to the existing infection.

However, the vast majority of authors believe that the most likely pathophysiological mechanism for the development of most cases of paraurethral cystic formations, in one way or another, is reduced to obstruction and infection within the paraurethral glands.The glands are believed to become enlarged, inflammation develops in them, which ultimately leads to the formation of a retention cyst. In this case, the cyst grows, protruding into the genital cleft in the form of a hemispherical body, and its back wall, which usually has the form of an elongated sac, protrudes deeply along the urethra, sometimes pushing the latter to the side. This part of the cyst can be welded to the urethra, it can enter into the immediate vicinity of the higher corpora cavernosa. Such anatomical ratios of the cyst to adjacent organs can be the cause of a number of complications.With the further development of the process, the cyst wall breaks and the cystic cavity is drained, usually back into the urethra. In 1890, Routh was the first to describe this pathophysiological mechanism.

In 1953, TeLinde suggested that gonorrheal infection in the paraurethral glands is an important factor leading to the development of paraurethral cystic lesions. Later, in a small study in 1975, it was shown that 10 of 31 patients had proven gonorrhea, and another 7 had anamnestic data suggestive of gonorrheal infection.Stepanov V.M. and Terpigoriev A.N. also reported on the role of gonorrheal infection in the development of paraurethral cysts in women.

Bacteriuria is a fairly common common symptom in patients with paraurethral cysts and / or urethral diverticula. However, in the urine cultures, most often there is not a specific flora, but typical microorganisms that cause inflammatory diseases of the urinary system. It is believed that bacteriuria and lower urinary tract infection are due to bacterial growth in stagnant urine within the cyst / diverticulum and reflux of infected urine through the fistula into the urethra and further into the bladder.

Due to the presence of chronic inflammation, changes in the mucous membrane within paraurethral cysts often resemble chronic cystitis. Chronic mucosal trauma can cause hyperplastic and neoplastic changes within the cyst. Quite rarely, carcinoma develops within the paraurethral cystic formations, about which a fairly large number of publications can be found in the world literature. These cases represent about 5% of all cancers of the urethra.For unknown reasons, cancer is more common in African American women with paraurethral cystic lesions. Among these tumors, approximately 60% are adenocarcinomas, 30% are transitional cell carcinomas, and 10% are squamous cell carcinomas.

Acquired cysts can occur with latent vaginal adenosis, which is known to occur in healthy women.

The role of hormonal influences in the formation of paraurethral cysts is not excluded, given that the Senian glands are hypertrophied during pregnancy and atrophy during menopause.

In recent years, there has been a trend towards an increase in the number of women suffering from paraurethral cysts. Although this may be due to the fact that previously, cysts were often missed during examination or diagnosed with chronic cystitis, urethritis, gonorrhea and others. Currently, with the development of more advanced diagnostic methods, the frequency of recognition of this pathology has increased.

Removal of benign neoplasms, vaginal cysts

An operation to remove a vaginal cyst, also called a cystectomy, is a manipulation aimed at treatment by eliminating a capsule with a liquid content located on the vaginal wall, performed by surgical intervention.A vaginal cyst is a retention tumor-like formation of the vaginal wall that does not have proliferative growth, but increases as a result of the accumulation of liquid contents. This pathology appears in about two percent of patients. Usually it is inherent in women of reproductive age. The size of the cyst most often does not exceed eighty centimeters. The capsule is not a hindrance to pregnancy and labor. A neoplasm can be natural (congenital, which occurs in a minority of cases, its localization is usually on the lateral vaginal wall) and obtained during life (acquired) due to a violation of the anatomical integrity or functional state of the mucosa as a result of surgery or labor.

If you decide to remove benign neoplasms of the female genital organs, it is very important to take into account that the therapeutic effect and the absence of complications after treatment largely depend on how experienced the specialist is.

You can remove the vaginal cyst from a qualified gynecologist in the network of clinics “Doctor near” in Moscow at an affordable cost. It is very simple to make an appointment – call the round-the-clock phone +7 (495) 127-84-73 or create an appointment on our website.

Signs of benign neoplasms inside the vagina

According to statistical studies, usually a vaginal cyst does not have any obvious symptoms and does not manifest itself in any way, unless it is excessively large. In the absence of systematic sexual intimacy, it is very possible that the presence of a neoplasm will be revealed only during a preventive examination by a gynecologist. One of the most common types of tumors that occurs in the vagina is an epidermal cyst.It has a very small size and is therefore difficult to see.

If the size of the cyst exceeds ten centimeters, the patient will complain of discomfort and a feeling of a foreign object in the vagina. During intimacy, sudden, strong painful sensations appear. With an increase in education in size, urination disorders are possible, accompanied by cramps and pains, and stool due to compression of the rectum.

When the tissues covering the neoplasm ulcerate, the fluid inside it becomes infected with pathogenic bacteria, and pus is formed.The patient complains of an aggravation of pain sensations that arise not only in the process of intimacy. In addition, symptoms of inflammation of the vaginal mucosa (colpitis) appear, which include:

• sensations of irritation, burning and tingling, localized at the entrance, on the front wall or on the back wall of the vagina;

• a feeling of heaviness, arising mainly in the lower abdomen;

• discharge with an admixture of blood, the cause of which is not menstruation;

• discoloration of the vaginal mucosa – it turns red;

• discharge from the vagina of a cloudy purulent exudate.

In what cases it is required to remove the cyst

Usually, doctors are inclined to believe that if the tumor is small and does not manifest itself in any way, it is not required to carry out surgical intervention to eliminate it, it is enough to carry out dynamic tracking and, if necessary, carry out drug therapy.

It is necessary to perform an operation to eliminate the cyst when:

• the size of the tumor exceeds three centimeters in diameter, the cyst grows;

• the patient experiences discomfort, a feeling of pain;

• symptoms of a purulent-inflammatory process in the tumor were found;

• revealed signs of inflammation of the vaginal mucosa (colpitis).

In what cases it is impossible to remove the cyst

• if the patient is diagnosed with inflammatory processes of the pelvic organs in the acute stage, in this case, therapy is first required;

• if a woman is diagnosed with serious diseases that last for a long time (chronic), as a result of which there have been disruptions to the normal functioning of an individual organ, organ system or the whole organism.

What types of transactions exist

Doctors use the following types of surgical interventions to eliminate cysts:

• violation of the integrity (puncturing) of the tumor wall and extraction (suction) of the liquid inside by means of a special medical device is performed – puncture aspiration;

• dissection of the neoplasm, elimination of its contents and circular stitching of the edges of its wall into the external wound – marsupialization;
• the mucous wall of the tumor is divided by elliptical or longitudinal dissection, then the neoplasm with the capsule is removed (exfoliation), and the place of its location (bed) and the mucous membrane are connected with sutures through the use of a special absorbable suture material from catgut – this manipulation is called radical excision.

Puncture aspiration is usually used if a woman is expecting a baby, and the tumor is significant. The result of this intervention is inconsistent. After a while, the fluid reappears inside the cyst. The third technique carries the risk of damaging the walls of the bladder and rectum. As a result, the most common way to remove a tumor in the vagina is marsupialization. In the absence of effectiveness in the implementation of transvaginal elimination of the formation, surgical intervention can be performed by dissecting the anterior abdominal wall (laparotomy) or by creating access through small holes in the abdominal cavity (laparoscopy).

How is the removal of benign neoplasms inside the vagina performed

First of all, a specialist prescribes a woman to undergo the necessary examinations – the delivery of urine and blood tests, a smear that determines the types of bacteria that inhabit the vagina, a polymerase chain reaction analysis to identify sexually transmitted infections. Three to five days before the intended intervention, you should protect yourself from intimacy. The operation is not performed on the days of menstruation.It is usually performed under local anesthesia. The day before it is necessary to empty the intestines. The attending physician will tell the woman in detail about the preparatory measures.

The selected surgical technique depends on the type of tumor to be removed. The woman takes a horizontal position, an anesthetic is injected. The doctor then begins the removal procedure. If it is required to eliminate the embryonic formation from the remnants of the mesonephral (Wolffian) duct with a transparent protein fluid inside, secreted by the serous membranes, which is usually located on the lateral wall of the vagina, it is cut, and the sides of the wound surface, from which blood flows out, are sheathed with a continuous marginal twisted eversion suture …When the tumor is localized deep in nearby tissues and its upper part is located too close to the bladder, the doctor, removing the cyst with the capsule, is still forced to leave a small particle of the neoplasm wall in this area in order to eliminate the risks of violation of the integrity of the bladder wall.

A cyst on the eve of the vagina implies the simplest manipulation to remove it. It is dissected to the capsule – doctors mainly use an elliptical dissection in order to prevent the integrity of the tumor membrane and the penetration of the fluid contained within it into the vaginal cavity.A part of the tissue is captured by means of forceps and its smooth movement in the direction of dissection, the capsule is detached from the neoplasm. Then, if required, suturing is carried out. The surgical area is treated with antiseptic agents, and the woman is transferred to the ward, where she remains under the supervision of doctors for some time – this usually takes several hours.

Rehabilitation period

Usually the operation to remove the cyst of the Bartholin gland, vagina does not cause complications.If the specialist has sufficient qualifications, the manipulation is performed efficiently and with due care, damage to the integrity of the walls of the bladder and rectum does not occur. Therefore, you should take a responsible approach to the choice of a clinic and a doctor to eliminate the tumor.

The recovery period after surgery takes about several weeks. It is recommended to protect yourself from intimacy from ten days to two weeks. During the first thirty days after the completion of the intervention, one should not wash in baths, saunas, swim in public pools and reservoirs, in order to prevent infection from entering the wound remaining after removal of the cyst.

Elimination of benign neoplasms of the female genital organs does not interfere with the patient’s ability to become pregnant and the normal course of pregnancy, and also does not affect the menstrual cycle. A woman should not neglect visits to a doctor for preventive examinations after surgery – this should be done once every three to four months, at least. If all the instructions of the attending doctor are followed, the patient can return to normal life in fourteen to twenty days, not forgetting to undergo preventive gynecological examinations in a timely manner in the future.

Advantages of vaginal cyst removal in the “Doctor near” network of clinics

• the operation is carried out by experienced gynecologists, thanks to which it is safe, brings an excellent therapeutic effect and delivers a minimum of discomfort;

• only high quality drugs and sterile materials are used;

• clinics are equipped with the latest medical equipment;

• convenient location of clinics near the metro;

• affordable prices for services.

90,000 photos, why popped up and what to do?

Author Maria Semenova For reading 8 min. Published November 21, 2017

Very often women do not pay attention to their health and sometimes “miss diseases” that can have serious consequences.

Often women notice the formation of pimples on important organs, including the genitals. Is there any reason for concern, and for what reason are pimples formed in intimate places?

Pimples on the genitals

Both men and women are susceptible to the formation of pimples on the genitals.Of course, many panic, and some even ignore the appearance of acne. What to do in such situations? Could there be any threat from such rashes?

In fact, the appearance of acne on the genitals is a reason for visiting a highly qualified specialist. This is necessary, first of all, to understand the cause of the acne rash.
Of course, the appearance of pimples is not always an indicator of any disease.

Often, they disappear on their own and are completely harmless.However, there is another side to such cases. Sometimes, acne breakouts can cause serious illnesses. In this case, reliable diagnostics and medical assistance are required.

To understand what is at stake, you need to identify what acne is and in what form they appear on the genitals. Pimples are spherical formations with contents such as pus. We can say that acne is an enlarged sebaceous gland.

The formation of pimples can be attributed to the inflammatory process due to the fact that the contents of the formations are pus.

Pimples can appear both singly and multiple. There are many types of acne, differing from each other in content, nature, size and other characteristics. What types of acne can form on the genitals?

Types of rashes

As you know, rashes are different and differ in the content that fills the pimple. Often, there are pimples with pus, with water.

Pimples also differ from each other in color.Inflamed pimples of a bright red color may be noticed. This suggests that the process of inflammation is at its peak. You may notice yellow pimples, the contents of which are composed of pus.

It often happens that the skin under pressure is accompanied by painful sensations, but there are no visible changes on the skin. This suggests that the pimple is subcutaneous. This type of acne is painful.

There are seals on the skin, and it will take enough force to remove the pimple.A seal on the skin prevents the contents from coming out, which are often purulent.

White pimples on the labia

White small pimples on the labia minora are not uncommon today.

Among white acne, there are two types of rashes:

• similar in appearance to goose bumps;
• having a white head with purulent contents.

White pimples that look like goose bumps can pop out due to a large accumulation of cells that are considered dead.These cells are directly related to the epidermis. The accumulation of cells is often concentrated near the hair follicles or on the inner side of the mucous membrane.

Due to the appearance of pimples, the skin becomes rough, hard, and also rough. To get rid of pimples, it is enough to provide the necessary hygiene, as well as to treat the area of ​​rough skin with a washcloth.

Causes of occurrence:

• Frequent shaving. This is often the case when the hair removal method is selected with a razor.When using a razor, it is very easy to damage not only the skin, but also the hairs on the skin. If damaged, microbes can easily penetrate into the epidermis, due to which the inflammatory process begins, resulting in a rash of pimples. Due to frequent depilation, the hairs become quite thin. This, of course, is an advantage, but still such hair cannot grow out and grows into the skin. Hair ingrown into the skin also contributes to the inevitable inflammatory processes.
• Synthetic underwear. Today in lingerie stores you can see a large assortment, which, unfortunately, is offered from a non-breathable fabric called synthetics. Synthetic underwear is the first cause of inflammation. Due to the synthetic fabric, the skin begins to sweat, thus creating a favorable environment for the development of bacteria.
• Hypothermia of the body. In such situations, the immune system is at risk. Indeed, first of all, the level of immunity decreases, which further causes the activity of bacteria, accompanied by the formation of pimples.
• Sexually transmitted and infectious diseases. When diagnosing diseases of an infectious nature, as well as venereal, the processes of inflammation and the appearance of pimples can develop.

Subcutaneous acne on the labia

Subcutaneous acne is another type of rash that often worries women. Being under the skin, a large amount of pus accumulates in such pimples, they are dense.

When you press on the spot where the pimple has formed under the skin, you may feel pain.

This type of pimple can be identified by the compaction in the skin.

Many people try to get rid of this type of acne on their own. This is not worth doing.

Firstly, it is very easy to bring an infection with your hands into an already inflammatory process. Secondly, such a pimple cannot be completely removed.

It is best to leave the pimple on and not touch it yourself. After all, it is also dangerous because this type of pimple can develop into a boil, the removal of which will not work without medical intervention.If such a pimple bothers for a long time and the exacerbation does not go away on its own, then it is better to consult a doctor.

Red pimples

Often, women confuse red pimples and rashes. If a rash appears on the skin, then this is not a threat. A red rash can occur due to a change in hormonal levels, as well as during gestation, as well as during puberty and menopause.

If red acne develops, it can cause stressful situations.Such rashes, as a rule, go away on their own and do not pose any harm to a woman’s health.

Colds

Due to a cold, acne may also erupt. This is due to a decreased level of the immune system. Such rashes do not pose any threat and will disappear on their own as soon as the body returns to its usual state and the level of immunity is restored.

Watery

Watery pimples often occur in women.Many patients do not attach importance to rashes, but in vain. After all, it is the watery-looking pimples that can cause genital herpes.

Genital herpes is transmitted from a sexual partner. During the period of treatment, you need to refrain from intercourse. Moreover, a diagnosis is required, as well as a doctor’s consultation.

Reasons for occurrence:

• Transitional age. During puberty, every girl faces such a problem as pimples.Pimples can appear not only on the face, but also on the genitals. There is an explanation for everything – puberty. Due to hormonal changes in the body, pimples appear. The most important thing is not to remove the rash yourself. This can aggravate the condition.
• Inflammation. Inflammatory processes are also one of the reasons why pimples appear. The point is that inflammatory processes manifest themselves quite simply and easily. Inflammation can be due to lack of hygiene, due to synthetic underwear, with increased sweating, as well as stressful situations and a lowered immune system.
• Uncomfortable underwear. Uncomfortable underwear means wearing synthetic underwear. Due to the non-breathable material of the linen, the skin under the linen starts to sweat. In this case, favorable conditions are created for the development of bacteria, which subsequently cause inflammatory processes and the rash of pimples. It is recommended that women choose cotton underwear.
• Poor hygiene. Non-observance of hygiene rules also leads to the appearance of rashes and pimples.To avoid such problems, it is recommended to wash yourself twice a day – in the morning and in the evening. It is also necessary to choose a gel for intimate hygiene and exclude laundry soap.
• STDs. This type of rash is the most dangerous of all existing. As a rule, with STDs, warts, genital herpes, and syphilis can appear. With such diseases, you must immediately consult a doctor for diagnostics and full and effective treatment. With such diseases, pimples appear in multiples and contain water.The big disadvantage of these diseases is the immediate spread of the genitals.
• Papillomas . Papillomas, like warts, can begin to spread throughout the genital organ. Papillomas look the same as pimples. It is also better to diagnose such rashes by a doctor and achieve effective treatment.

When to see a doctor?

It is necessary to see a doctor when acne does not go away for a long time and at the same time causes severe pain, may itch, itch.They should be treated immediately.

If you have an STD, you need to urgently pass tests, as well as undergo appropriate diagnostics. In such cases, you cannot do without the help of a doctor. The formations are somewhat similar to acne, but have a different content. They resemble small warts, as well as watery blisters, which instantly and repeatedly spread throughout the genital organ.

Treatment

1. If the rash does not pose a threat to the woman’s health , most often doctors prescribe hygiene (twice a day), as well as treating the skin with antiseptic drugs.
2. If the rash is the cause of an infectious or any venereal disease , the doctor prescribes an individual complex treatment, depending on which disease was diagnosed and what severity it is. Treatment is prescribed with drugs that have active substances. This is prescribed in the case when infectious or venereal diseases are detected. In such cases, an integrated approach is used with the use of a complex of vitamins in the supplement.Often they get by with such treatment as the use of an antiseptic and the observance of basic hygiene rules.

Prophylaxis

Preventive measures:

• it is recommended to choose an appropriate method of hair removal in order to avoid irritation of the skin;
• to select gels for intimate hygiene;
• to exclude laundry soap;
• to exclude promiscuous sexual intercourse;
• monitor the immune system.