Post-Surgery Wound Recovery Issues in Gynecology: Pain and Inflammation

Postoperative wound healing issues?

Hello Doctor, on June 13th, I discovered a pus-filled bump on the upper inner side of my right labia minora, which felt like it had already burst and was very painful.
When I visited the hospital, the doctor scheduled surgery for June 14th to remove the abscess (he mentioned it was not a Bartholin cyst).
I was hospitalized for seven days and discharged with a prescription for oral antibiotics.
On June 29th, I returned to the outpatient clinic to have my stitches removed, and I continued to have regular follow-up appointments in July to check the wound.
I expressed to the doctor that the wound was still very painful, and he reassured me that it was healing well.

However, on July 17th, while caring for the wound and applying medication as usual, I noticed that one of the stitches had not been completely removed.
I then went to the emergency department of that hospital for treatment and decided to consult another gynecologist.
During the examination, the doctor noted that the wound was still very painful, and he suspected that it had not healed properly and was still inflamed.
Upon further examination, he found a swollen area on the inner right side of the vaginal opening that was painful to the touch.
This swollen area was also within the range of the surgical wound's sutures.

It appeared that there was a small piece of tissue slightly protruding between the sutures, which made the doctor hesitant to determine whether the swelling on the inner side of the vaginal opening was a normal post-suture structure or if it was due to inflammation from other wounds.
He mentioned the possibility of a Bartholin cyst but could not make a definitive diagnosis at that time.
The current management plan is to continue oral antibiotics to see if the swelling resolves, but I still experience pain in other areas of the wound.

My concern and confusion stem from the fact that it has been just over a month since the surgery, and the wound has not healed and continues to be painful, significantly affecting my daily life and mobility.
Based on your clinical experience, do you think this could be a Bartholin cyst, or is it more likely that the prolonged inflammation from the postoperative wound is causing the swelling? Thank you for taking the time to respond amidst your busy schedule.

Xiao Hui, 30~39 year old female. Ask Date: 2017/07/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On June 13th, I discovered a pus-filled bump on the upper inner side of my right labia minora, which felt like it had already burst and was very painful.
When I visited the hospital outpatient clinic, the doctor scheduled surgery for June 14th to excise the abscess (he mentioned at the time that it was not a Bartholin's cyst).
After a 7-day hospital stay, I was discharged and prescribed oral antibiotics.
On June 29th, I returned to the outpatient clinic to have my stitches removed.
Throughout July, I had regular follow-up appointments to check the wound.
I reported to the doctor that the wound was still very painful, and he responded that it was healing well.

However, on July 17th, while caring for the wound and applying medication as usual, I noticed that one stitch had not been completely removed.
I then went to the emergency department of that hospital for treatment and decided to consult another gynecologist.
During the examination, the doctor noted that the wound was still very painful.
His assessment was that the wound had not healed properly and was still inflamed.
Upon further examination, he found a swollen area on the inner right side of the vaginal opening that was painful to the touch.
This swollen area was also within the range of the surgical wound's sutures.

Based on the appearance after the initial suturing, it seemed that the swelling was due to a small piece of tissue slightly protruding between the sutures.
Therefore, the doctor was hesitant to determine whether the swelling on the inner vaginal side was a normal structure after suture removal or if it was caused by inflammation from other wounds.
He also mentioned the possibility of a Bartholin's cyst but could not confirm it.
The current management plan is to continue oral antibiotics and monitor whether the swollen area resolves, as well as the pain from other wounds.

My concern and worry are that it has been just over a month since the surgery, and the wound has still not healed and remains painful, causing significant distress in my daily activities.
Based on your clinical experience, do you think this could be a Bartholin's cyst, or is it more likely that the swelling is due to prolonged postoperative inflammation and poor healing?
Answer: It is more likely that the swelling is due to prolonged postoperative inflammation and poor healing.

Reply Date: 2017/07/25

More Info

Post-surgery wound recovery, especially in gynecological procedures, can be a complex and sometimes frustrating experience for patients. Your situation, involving a painful wound and potential inflammation after the removal of a cyst, raises several important considerations regarding healing, pain management, and the possibility of complications.

Firstly, it is essential to understand that surgical wounds can take time to heal, and various factors can influence the healing process. After surgery, the body goes through a natural healing response, which includes inflammation. This inflammation is a normal part of the healing process, but it can sometimes become excessive or prolonged, leading to complications such as infection or poor wound healing.

In your case, the persistent pain and the presence of a swelling at the surgical site could indicate that the wound is not healing as expected. The fact that you have been experiencing pain for over a month post-surgery is concerning and warrants further investigation. It is not uncommon for patients to experience some discomfort after surgery, but if the pain is severe or worsening, it could suggest an underlying issue.

One possibility is that the swelling you are experiencing could be related to the sutures used during the surgery. Sometimes, sutures can cause irritation or an inflammatory response, leading to localized swelling and pain. If the sutures are not dissolving properly or if there is a reaction to them, this could contribute to the symptoms you are experiencing. Additionally, if there is any residual infection or if the wound has not healed properly, this could also lead to ongoing pain and swelling.

Regarding your concern about the possibility of a Bartholin cyst (巴囊), it is important to note that these cysts can develop in the area of the vaginal opening and may cause pain and swelling. However, given your recent surgery and the context of your symptoms, it may be more likely that the issues you are facing are related to the surgical site rather than a new cyst formation. Nonetheless, a thorough examination by a healthcare professional is necessary to rule out any new developments.

In terms of management, continuing with the prescribed antibiotics is crucial if there is any suspicion of infection. Additionally, it may be beneficial to follow up with your healthcare provider for a more detailed evaluation of the swelling and pain. They may consider imaging studies, such as an ultrasound, to assess the area more thoroughly and determine if there are any complications such as abscess formation or other issues that need to be addressed.

In the meantime, you can take some steps to help manage your symptoms. Applying warm compresses to the area may help reduce discomfort and promote healing. Additionally, ensuring that you are following proper wound care instructions, including keeping the area clean and dry, is essential. If you notice any signs of increased redness, warmth, or discharge from the wound, it is crucial to seek medical attention promptly.

In summary, while it is not uncommon to experience pain and swelling after surgery, persistent symptoms warrant further evaluation to rule out complications. Your healthcare provider is the best resource for assessing your specific situation and determining the appropriate course of action. It is important to communicate openly with them about your symptoms and concerns, as this will help ensure that you receive the best possible care and support during your recovery.

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