Vulvar Issues: Causes, Symptoms, and Treatment Options

Genital issues

Hello doctor, on March 27th, when my menstrual period started, I noticed a small pimple on the right side of my vulva.
I thought it would go away on its own, but by April 5th, it had turned red and swollen inside my labia minora.
I went to a clinic, and they prescribed me antibiotics, but the next day my external genitalia became swollen as well.
I visited another clinic, and they said there was no pus and advised me to continue taking antibiotics, suggesting it didn't seem like a Bartholin's gland cyst but rather cellulitis.
After taking the medication, the swelling remained the same; it neither increased nor decreased, but the pain from the wound became unbearable.
I decided to go to the hospital, where the doctor used a needle to aspirate the pus but mentioned that there was still a hard lump that couldn't be drained.
They prescribed me antibiotics for atypical Bartholin's gland issues.
The next morning, I noticed that half of my vulva was even more swollen than the day before, and the pain from the hard lump was constant.
I would like to know what possible solutions there are, as it has been several weeks, and I am unable to work properly, walk, or even sit without pain.
Thank you for your assistance.

Amy, 20~29 year old female. Ask Date: 2019/04/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On March 27, I noticed a small pimple on the right side of my vulva when my period started.
I thought it would go away, but by April 5, the area inside my labia became red and swollen.
I went to a clinic, and they prescribed antibiotics, but the next day my external genitalia became swollen as well.
I visited another clinic, and they said there was no pus and advised me to continue antibiotics, suggesting it didn't seem like a Bartholin's gland cyst but rather cellulitis.
After taking the medication, the swelling remained the same; it neither increased nor decreased, but the pain from the wound became unbearable.
I decided to go to the hospital, where the doctor used a needle to aspirate the pus but mentioned there was still a hard lump that couldn't be drained.
They prescribed antibiotics for atypical Bartholin's gland issues.
The next morning, I noticed that half of the area was even more swollen than the day before, and the pain from the hard lump was constant.
I would like to know what solutions are available, as it has been several weeks, and I cannot work properly, walk, or even sit without pain.

Answer: If it is a mild perineal cellulitis, the treatment would be Ciproxin 500 mg orally twice daily plus Metronidazole 500 mg orally every 6 hours (or Clindamycin 300-450 mg every 6 hours).
For severe perineal cellulitis, hospitalization and intravenous antibiotics are required: Rocephin 1-2 g IV every 24 hours plus Metronidazole 500 mg every 6 hours (or Clindamycin 600 mg every 8 hours).

Reply Date: 2019/04/13

More Info

Vulvar issues can be quite distressing and may stem from various causes, including infections, cysts, or inflammatory conditions. Based on your description, it seems that you are experiencing a painful condition that has not improved with initial treatments. Let's break down the potential causes, symptoms, and treatment options for your situation.

Causes
1. Infections: Bacterial infections, such as cellulitis or abscess formation, can lead to swelling and pain in the vulvar area. The fact that you were prescribed antibiotics suggests that your healthcare provider suspected an infection.

2. Bartholin's Gland Cyst: The Bartholin's glands are located on either side of the vaginal opening and can become blocked, leading to cyst formation. If these cysts become infected, they can cause significant pain and swelling.

3. Folliculitis: This is an inflammation of the hair follicles that can occur in the vulvar area, leading to painful bumps.

4. Other Conditions: Conditions like vulvodynia, lichen sclerosus, or contact dermatitis could also cause similar symptoms, although they may not present as an acute swelling or abscess.

Symptoms
- Pain: You mentioned persistent pain, especially when sitting or walking, which can significantly impact your quality of life.

- Swelling and Redness: The swelling and redness you observed indicate inflammation, which is often a response to infection or irritation.

- Hard Lump: The presence of a hard lump suggests that there may be an underlying cyst or abscess that has not fully resolved.

Treatment Options
1. Antibiotics: Since you have already been prescribed antibiotics, it is crucial to complete the course as directed. If there is no improvement, you may need a different antibiotic or a longer course.

2. Incision and Drainage: If an abscess is suspected and has not fully drained, a healthcare provider may need to perform a procedure to drain the fluid. This can provide immediate relief from pain and pressure.

3. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain. Your doctor may also prescribe stronger pain medications if necessary.

4. Warm Compresses: Applying warm compresses to the affected area can help reduce swelling and provide comfort.

5. Follow-Up Care: It is essential to follow up with your healthcare provider if symptoms persist or worsen. They may consider imaging studies or refer you to a specialist, such as a gynecologist, for further evaluation.

6. Avoid Irritants: During this time, avoid irritants such as scented soaps, lotions, or tight clothing that may exacerbate the condition.

When to Seek Immediate Care
If you experience any of the following, seek immediate medical attention:
- Increasing redness or swelling
- Fever or chills
- Severe pain that is not relieved by over-the-counter medications
- Any discharge that is foul-smelling or unusual

Conclusion
Your situation sounds quite uncomfortable, and it is understandable that you are seeking answers and relief. It is crucial to maintain open communication with your healthcare providers and report any changes in your symptoms. Persistent vulvar issues can sometimes require a multi-faceted approach to treatment, and a specialist may provide additional insights into your condition. Remember, you are not alone in this, and effective treatments are available to help you regain your comfort and quality of life.

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