Labial Swelling: When Surgery is Necessary - Obstetrics and Gynecology

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Labial swelling, particularly in the context of the labia majora, can arise from various conditions, including infections, cysts, or other benign growths. The situation you described, where a physician diagnosed a "Bartholin gland cyst" (which I assume is what you meant by "巴士線硬塊"), is a common cause of labial swelling. The Bartholin glands are located at the 4 o'clock and 8 o'clock positions of the vaginal opening and can become blocked, leading to cyst formation.

In your case, the physician's recommendation to start with medication rather than immediate surgery is a common approach. Here are some key points to consider regarding when surgery might be necessary for labial swelling:
1. Nature of the Cyst: If the swelling is indeed due to a Bartholin gland cyst, many of these can be managed conservatively. If the cyst is small and asymptomatic, observation may be all that is required. However, if the cyst becomes infected (a condition known as a Bartholin gland abscess), surgical intervention may be necessary to drain the abscess and relieve pain.

2. Symptoms: If the swelling is accompanied by significant pain, fever, or other systemic symptoms, this may indicate an infection or other complications that could warrant surgical intervention. Persistent pain that does not improve with medication or conservative management is also a reason to consider surgery.

3. Size and Recurrence: If the cyst is large or recurrent, surgical options may be considered. Surgical procedures can include marsupialization, where the cyst is opened and the edges are stitched to the surrounding tissue to create a permanent drainage site, or excision of the cyst.

4. Response to Treatment: If the initial treatment with medication does not lead to improvement, or if the swelling worsens, further evaluation and potential surgical options should be discussed with your healthcare provider.

5. Patient Preference: Ultimately, the decision for surgery can also depend on the patient's quality of life and personal preferences. If the swelling is causing significant discomfort or affecting daily activities, discussing surgical options with your physician may be warranted.

In summary, while many cases of labial swelling, particularly those related to Bartholin gland cysts, can be managed conservatively, surgery may be necessary in cases of infection, significant symptoms, or recurrence. It is crucial to maintain open communication with your healthcare provider, follow their recommendations, and seek further evaluation if your symptoms do not improve or worsen over time. If you have any concerns or if the situation changes, do not hesitate to reach out to your physician for further guidance.