- Gweneth B Lazenby, MD
Gweneth B Lazenby, MD
- Clinical Instructor
- Department of Obstetrics and Gynecology and Division of Infectious Diseases
- Department of Medicine
- Medical University of South Carolina
- Andrea R Thurman, MD
Andrea R Thurman, MD
- Associate Professor of Obstetrics and Gynecology
- CONRAD Clinical Research Center
- Eastern Virginia Medical School
- David E Soper, MD
David E Soper, MD
- Director & Professor of Gynecology & General Obstetrics
- Medical University of South Carolina
- Section Editors
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Vulvar abscess is a common gynecologic problem that has the potential to result in severe illness . These abscesses typically originate as simple infections that develop in the vulvar skin or subcutaneous tissues. Spread of infection and abscess formation in the vulvar area is facilitated by the loose areolar tissue in the subcutaneous layers and the contiguity of the vulvar fascial planes with the groin and anterior abdominal wall.
The microbiology, diagnosis, and management of vulvar abscesses are discussed here. Bartholin gland abscesses and other vulvar lesions are discussed in detail separately. (See "Disorders of Bartholin gland" and "Vulvar lesions: Diagnostic evaluation".)
The external female genitalia are referred to as the vulva (figure 1).
Skin and glands — Hair follicles and sweat and sebaceous glands of the vulvar skin are common sites of infection and abscess formation. The mons and labia majora are covered with hair, while the labia minora are not.
Two major vulvar glands underlie the vestibule; these are the Bartholin glands (also referred to as the greater vestibular gland) and the paraurethral (Skene) glands. The Bartholin glands drain through the Bartholin ducts, located bilaterally in the vestibule at approximately the four and eight o'clock positions with respect to the vaginal introitus. The paraurethral glands empty through Skene’s ducts, which are located bilaterally just inferior and lateral to the urethral meatus (figure 1 and figure 2) .
- Thurman AR, Satterfield TM, Soper DE. Methicillin-resistant Staphylococcus aureus as a common cause of vulvar abscesses. Obstet Gynecol 2008; 112:538.
- Rock JA, Jones HW. TeLinde's Operative Gynecology, Lippencott, Williams & Wilkins, Philadelphia 2003. p.71.
- Stenchever MA, Droegemueller W, Herbst AL, Mischell D. Comprehensive Gynecology, 4th ed, Mosby, St. Louis 2001. p.645.
- Pundir J, Auld BJ. A review of the management of diseases of the Bartholin's gland. J Obstet Gynaecol 2008; 28:161.
- Moore K. Clinically Oriented Anatomy, 3rd ed, Williams and Wilkins, Baltimore 1992. p.313.
- Faro S, Soper DE. Infectious Diseases in Women, WB Saunders Co, Philadelphia 2001. p.326.
- Netter FH. Atlas of Human Anatomy, Ciba-Geiby Corporation, New Jersey 1989.
- Nickles SW, Burgis JT, Menon S, Bacon JL. Prepubertal Skene's abscess. J Pediatr Adolesc Gynecol 2009; 22:e21.
- Andrews WW, Schelonka R, Waites K, et al. Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol 2008; 111:113.
- Laibl VR, Sheffield JS, Roberts S, et al. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol 2005; 106:461.
- Chen KT, Huard RC, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108:482.
- Bhide A, Nama V, Patel S, Kalu E. Microbiology of cysts/abscesses of Bartholin's gland: review of empirical antibiotic therapy against microbial culture. J Obstet Gynaecol 2010; 30:701.
- Stephenson H, Dotters DJ, Katz V, Droegemueller W. Necrotizing fasciitis of the vulva. Am J Obstet Gynecol 1992; 166:1324.
- Kilpatrick CC, Alagkiozidis I, Orejuela FJ, et al. Factors complicating surgical management of the vulvar abscess. J Reprod Med 2010; 55:139.
- Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355:666.
- Stumpf PG, Flores M, Murillo J. Serious postpartum infection due to MRSA in an asymptomatic carrier: case report and review. Am J Perinatol 2008; 25:413.
- Cook HA, Furuya EY, Larson E, et al. Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007; 44:410.
- Gorwitz, RJ, Jernigan, DB, Pwers, JH, Jernigan, JA, and Participants in the CDC-convened Experts' Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: summary of an experts' meeting convened by the Centers for Disease Control and Prevention 2006. http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html (Accessed on April 14, 2009).
- Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
- Schmitz GR, Bruner D, Pitotti R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010; 56:283.
- Lareau SM, Meyn L, Beigi RH. Methicillin-resistant staphylococcus aureus as the most common cause of perineal abscesses. Infect Dis Clin Pract 2010; 18:258.
- Miller NR, Garry DJ, Klapper AS, Maulik D. Sepsis after Bartholin's duct abscess marsupialization in a gravida. J Reprod Med 2001; 46:913.
- DeAngelo AJ, Dooley DP, Skidmore PJ, Kopecky CT. Group F streptococcal bacteremia complicating a Bartholin's abscess. Infect Dis Obstet Gynecol 2001; 9:55.
- Kdous M, Hachicha R, Iraqui Y, et al. [Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess]. Gynecol Obstet Fertil 2005; 33:887.
- Fröhlich EP, Schein M. Necrotizing fasciitis arising from Bartholin's abscess. Case report and review of the literature. Isr J Med Sci 1989; 25:644.
- ANATOMIC CONSIDERATIONS
- Skin and glands
- TYPES OF VULVAR ABSCESS
- Skin and hair follicle infections
- Bartholin gland abscess
- Skene gland abscess
- Wound or hematoma infections
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL MANIFESTATIONS
- DIAGNOSIS AND EVALUATION
- - Physical examination
- - Laboratory evaluation
- - Other tests
- Differential diagnosis
- General approach
- - Indications for referral
- Small abscesses
- - Conservative therapy
- - Antibiotics combined with conservative therapy
- - Incision and drainage
- Larger abscesses
- - Incision and drainage
- Operative setting
- - Antibiotic therapy after drainage
- Antimicrobial agents
- Duration of therapy
- Immunocompromised women
- Recurrent abscess
- Necrotizing fasciitis
- PREVENTION OF RECURRENCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS