Painful swelling at the vulva: Bartholin’s abscess
She rushed into my clinic in pain. “Doc, I have a swelling at the bottom for a few days. It has become bigger this morning and is excruciatingly painful this afternoon. I can hardly sit or walk. Can you please do something ?” she pleaded.
She had a painful tender lump about the size of a walnut at the right side of the vulva near the vaginal opening. The surrounding skin was inflamed and red. It was a Bartholin’s abscess that required immediate medical attention.
With antibiotic coverage and under general anaesthesia, I drained the abscess surgically by a procedure called marsupialisation, A small hole was made over the abscess cavity to drain the pus and the edges stitched with absorbable sutures.
Bartholin’s abscess is fairly among women of reproductive age. It arises from Bartholin’s glands which are located on either side of the vagina. These glands secrete fluid that lubricate the vagina during sexual intimacy.
When the opening of these glands get blocked, fluid starts to collect in them. This may result in the formation of a relatively painless swelling called a Bartholin's cyst. If the cyst becomes infected, it will develop into an abscess with a collection of pus surrounded by inflamed tissue.
Besides the symptoms of painful lumps and discomfort, some patients may have fever if the infection is severe. A number of bacteria may cause the infection, including Escherichia coli (E. coli) and bacteria that cause sexually transmitted infections such as gonorrhoea and chlamydia.
When I saw her the next day after the operation, she was very relieved. “Thank you, doc, the pain has gone. See, I can sit up right now,”she smiled.
I asked her to have a sitz bath several times a day. Her vulva had to be soaked in a tub filled with a few inches of warm water mixed with an antiseptic solution. This would help drain the pus and promote wound healing. I also warned her that the cyst may recur and that good hygiene habits before sex may help prevent infection of the cyst.
She remained well when she returned for a review a month after her operation.