WOMEN’S BODIES: MORE ABOUT EXTERNAL GENITAL PROBLEMS
Bartholin’s cyst and abscess
If the duct of one of these glands becomes blocked, its secretions are trapped to form a Bartholin’s cyst, which will be felt as a swelling, usually painless, beside the entrance to the vagina. Often the cyst remains small and soft and needs no treatment. If it becomes large and tense it may cause local discomfort and interfere with intercourse.
The cyst is treated by making a permanent opening in it to allow drainage. This simple procedure, called marsupialisation, can often be done with local anaesthetic. There is little postoperative pain, and healing is complete within a few weeks. Marsupialisation of Bartholin’s gland doesn’t interfere with lubrication of the introitus during intercourse.
If a cyst becomes infected it becomes a Bartholin’s abscess – a tense, hot, red, very painful swelling, usually with swollen groin glands on the affected side. Treatment is by antibiotics: pain relievers. It’s often necessary to make an incision in the abscess to allow pus to drain. Opening the abscess brings immediate reduction of pain.
If Bartholin’s abscess occurs more than once, marsupialisation of the gland, as described for Bartholin’s cysts, will prevent further recurrences.
Sebaceous cysts
There are many sebaceous glands in genital skin. If the duct of one of these glands becomes blocked, sebum is then trapped farming a sebaceous cyst. Sebaceous cysts in genital skin grow slowly and rarely become larger than 5 mm diameter. A cyst is usually discovered by chance as a firm, painless swelling. No treatment is usually necessary and sometimes sebaceous cysts will go away by themselves. Occasionally a sebaceous cyst becomes infected to form a painful abscess. Opening and draining the abscess brings quick relief, but the infection is inclined to recur. Surgical removal of the gland may be the only way to prevent recurrences.
Vulval skin can become ulcerated by chafing from sanitary pads or tight clothing, or from sexual activity when the vulva isn’t sufficiently lubricated. These simple ulcers heal quickly as soon as their cause is removed. Any ulcer that persists for more than two weeks should be checked by a doctor to rule out the possibility of infection or vulval cancer.
Cancer of the vulva
Vulval cancer is uncommon (about three out of each hundred pelvic malignancies). It can occur anywhere on the skin of the labia, clitoris or vestibule, and mostly affects women well past the menopause.
The most common symptom is persistent itching, which must always be checked in older women to rule out the possibility of cancer. Because vulval cancer often begins in skin affected by atrophic vulvitis, treatment of this condition with oestrogen cream may help to prevent malignancy.
Very rarely, a genital mole may become malignant (melanoma). Any mole that darkens, enlarges or changes shape should be checked without delay. Some doctors advise removal of benign genital moles because it’s difficult for you to keep an eye on them.
Treatment of vulval cancer is by surgery; the results are usually very good if diagnosis is early. Additional radiotherapy may be needed if the malignancy has spread.
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