• Differentiating Bumps

    by Renee Cotter, MD
    on Nov 14th, 2015

You were in the shower, minding your own business, washing up as usual when suddenly...a bump. A bump?! What does that mean?! Your first reaction: panic. Your second: doctor. There are a few things wrong with this situation here, but the most important is not to panic. There are many different causes of bumps found in the vaginal area including ingrown hairs, infected oil glands, bartholin glands, herpes sores, genital warts, or molluscum contagiosum.

 

No matter what the cause or type of bump, you can rest assure that none of these are an emergency or reason to panic. This week, we’ll cover these different types of bumps, what their cause is, how to treat them and prevent them if possible.


Ingrown Hair

Ingrown hairs are common causes of bumps in the vaginal area. When a hair follicle becomes blocked, it is referred to as an ingrown hair. This also increases the possibility of infection at the base of the hair shaft, typically caused by either staph or strep (types of bacteria). Ingrown hairs and their cysts can happen on their own, but shaving promotes this type of bump and infection.

Symptoms

Treatment

Hot soaks and compresses typically relieve pain and allow the affected follicle to drain. If you do visit the office, the doctor can help manually facilitate the draining of the follicle afterwhich hot soaks and/or compresses should still be continued. If the infection is serious, antibiotics might be prescribed.

Prevention


Infected Oil Gland

An infected oil gland is also known as an infected sebaceous gland or a sebaceous cyst. These glands are normal glands found all over the skin on your body and produce oil and a waxy substance for your skin. When this gland gets blocked, oil and wax build up until the gland becomes a hard bump that is sometimes white in color. Sometimes the gland becomes infected, usually with staph or strep as in an infected hair follicle. Skin trauma can sometimes cause the oil glands to become clogged and/or infected.

Symptoms

Treatment

Similarly to an infected hair follicle, an infected oil gland may be treated and relieved with a hot soak or compress. If the gland is seriously infected and enlarged, the gland will be manually drained at the doctor’s office and you may be prescribed antibiotics for an infection.

Prevention

There is little to do to prevent this type of bump. Good hygiene can help. Some people propose that obesity plays a factor, but there is limited research for this.


Bartholin Gland Cysts

Bartholin glands are two glands that produce lubricant for the vagina in response to sexual contact. These glands are found on either side if the vaginal opening. This gland becomes swollen and enlarged when it becomes blocked and its mucous builds up. Sometimes these swollen glands may become infected. Unfortunately, return of these gland is very common and occurs in about 1 in 10 women who get a bartholin gland cyst. Some women have chronic bartholin gland cysts. The cysts are always present but they are not red or painful. ​

Symptoms

Treatment

There are four treatment methods for Bartholin gland cysts. One may be done at home, though it is less effective than the other three options.

Soaking:
At home, you may try a hot sitz bath, however this is only if the gland is still very small, minimally tender, and not yet infected. To soak, submerge at least your lower half in warm-hot water 3-4 times a day for several days. This simultaneously relieves discomfort caused by the cyst and also attempts to help open the cyst so that it can drain. Though this method may be successful, you are also likely for the gland to become clogged again and reinfected. Again, I urge that this should only be tried while the gland is small and not extremely painful. A true bartholin abscess needs treatment the same day. If you are experiencing pain and if the gland is not caught early, you must be treated in the office.

Drain and Catheter:
At the office, a small cut in the gland can be made after numbing the area. This allows the cyst to drain. After this, a small catheter is placed and left in for 6 weeks. The goal of this is to create a new permanent opening for the gland to drain from. Leaving the catheter in place and allowing the skin to heal around it is what creates this permanent opening. After the area is drained, you should also begin soaking in a hot water bath for 2-3 days after. Drainage alone is not sufficient treatment of the gland. The cut made in the gland will always close on its own and only offers relief for a few days. Often, the bartholin gland cyst will return. Think of this procedure like getting your ears pierced. When your ears are pierced, the piercer will always instruct you to leave your earrings in place for 6 weeks and if you remove the earrings, the new piercing will close up. This procedure is the same. Without the catheter, the cut will close again and the gland will have no place to drain from permanently.

Marsupialization:
This is a procedure done in the operating room under anesthesia. Marsupialization opens the gland and stitches the lining of the gland to the skin of the inner labia with a dissolvable stitch. The goal of this procedure, like above, is to create a new, permanent opening to the bartholin gland. This procedure is favorable if you can not tolerate the in office procedure under local anesthesia (numbing). With general anesthesia, the procedure will be pain free.

Gland Removal:
This is done as a last option. For this type of treatment, the bartholin gland is surgically removed. Removal of the gland is only done if other treatment options and techniques have already failed.

Prevention

A common cause of bartholin gland cysts is gonorrhea. Therefore, safe sexual practices to avoid STDs may help prevent these cysts. Additionally, good hygiene can help. by avoiding infections, you can help prevent the gland from becoming inflamed and closed off.


Herpes Sores

Herpes sores are caused by the Herpes virus, a very common Sexually Transmitted Infection (STI) affecting 1 in 6 people in the United States. There are two types of Herpes: Herpes Simplex I (HSVI) and Herpes Simplex II (HSVII). Both are a cause of the herpes sores in the genital area. The virus is harmless in nature, only causing annoying blister-like sores to appear repeatedly in the same area. For some women, these outbreaks occur frequently, and for others they occur only a few times a year. Treatment depends on how much the outbreak bothers you, frequency of outbreaks, and partner transmission.

Herpes is transmitted via sexual contact and can be given from one partner to another via vaginal, oral, or anal sex. The virus may be passed from one person to another, even if they do not have a sore. Because Herpes is a virus, there is no cure for it and antibiotics do not treat it. The first time you have a herpes outbreak, you may also experience a fever with flu-like symptoms. Frequent repeat outbreaks are also very common in the first year of infection.

Symptoms

Treatment

There is no cure for Herpes, however outbreaks may be suppressed or treated by an antiviral medication. Depending on the frequency or severity of outbreaks, you may take an antiviral right as symptoms appear or daily for suppression. People often describe a tingling sensation in the area right before an outbreak occurs. This helps them determine when to take their antiviral.

Prevention

The best way to prevent genital herpes is to be in a long-term monogamous relationship with a partner who has screened negative for HSVI and II, using latex condoms, abstaining sex if it fits your lifestyle. Since herpes can also occur on areas not covered by a condom, it is still possible to pass on the virus even while using a condom.

Stress is also a large contributor to herpes outbreaks. By controlling and managing stress, you can help prevent outbreaks. Use techniques such as meditation, yoga, exercise, massage, and activities that bring you joy in order to help reduce stress. Caffeine and alcohol are also food items that can contribute to the body’s stress response so consume them in moderation.

L-Lysine is a supplement commonly used to help suppress HSV. L-Lysine is available most places that sell vitamin and mineral supplements. Other over the counter products such as Abreva also work to shorten the course of an outbreak and may be used.


Genital Warts

Genital warts are another type of bump caused by a virus. The virus that causes genital warts it the ever popular Human Papilloma Virus (HPV), the most common sexually transmitted virus. 360,000 people are affected by genital warts each year. Like other STIs, HPV and genital warts are passed through sexual activity. Fortunately, the type of HPV that causes warts are typically not cancer causing. The warts are very stubborn, unfortunately, and typically require more than one office visit to completely remove. It’s important to treat the warts at a doctor’s office because without treatment they can increase in number, cause discomfort, and are more likely to be spread to another person. Getting them checked by a doctor also rules out the possibility that they are a type of skin cancer rather than a genital wart, which look similar in appearance. You should still continue routine pap smears as it is possible to have more than one type of HPV and HPV is the leading cause of cervical and vulvar cancer.

Symptoms

Treatment

At the office, warts can be treated in several ways. In the office, warts can be frozen, cut off under local anesthesia, treated with a laser, treated with a topical acid, or destroyed with an electric current. Sometimes medication is given to apply directly to the wart at home for 16 weeks, however this is not commonly practiced as swift medical action is important with genital warts in order to prevent more from occurring.

Prevention

The best way to prevent genital warts and any STD is to have a long-term monogamous relationship, use condoms during sex, or avoid sex if it fits your lifestyle. Again, though condoms are great at preventing STDs, because genital warts can be on areas not covered by a condom, it is still possible to transmit the virus even when wearing a condom.

Molluscum Contagiosum

What a name huh? Molluscum Contagiosum is the name of another virus that causes bumps in the vaginal area. Technically, Molluscum is not an STI, though it is a virus. The bumps caused by molluscum can be found anywhere on the body. Commonly, it is passed between children and is actually in the same family as the Chickenpox virus. In the case of molluscum appearing in the vaginal area, however, it is most likely passed from sexual contact. Is it possible to pass Molluscum by sharing towels or using an improperly cleaned and sanitised towel at a public area such as a sauna or pool. Molluscum causes several small, skin colored bumps to appear. The virus only lives on the very surface of the skin, so once the bumps are gone, the virus is also gone. Thankfully, the virus is also not dangerous aside from causing you minor annoyance.

Symptoms

Treatment

At the doctor’s office, molluscum bumps can be simply removed with a scraping tool. The procedure only causes minimal discomfort. Older techniques include application of acid to the bumps, however this is no longer practiced because it is not effective and may cause scarring in the area. Once the bumps are treated completely, the virus is gone. It may take several different office visit to completely treat and remove the bumps, however, because the bumps take several days to form. Even though all the bumps at one time were removed, the ones still in the process of growing could not be removed and thus would have to be removed at another visit.

Prevention

Molluscum can be prevented, like other STIs, by limiting your number of sexual partners, using condoms, or avoiding sex if it fits your lifestyle. Also, like the STIs above, condoms cannot always protect against molluscum because it may be on other areas of the genitals not protected by the condom.

Another way to prevent Molluscum is to always bring your own personal towel when visiting a public pool, sauna, bath, or other facility where towels are provided or rented out. This limits the possibility of you contracting the virus from a surface.


Conclusion

Bumps and lumps in the vaginal area have several causes. Thankfully, they are typically not dangerous. In rare cases, skin cancer can appear in the genital area. If you find a misshapen mole, see your doctor or dermatologist to rule out the possibility of a skin cancer. Causes of bumps in the vaginal area include ingrown hairs, infected oil glands, bartholin glands, herpes sores, genital warts, and molluscum contagiosum. Some of these, like the viruses herpes, HPV and molluscum can be prevented using safe sexual practices. The risk of others may be reduced by proper genital hygiene. By becoming familiar with these bumps, you can hopefully spare yourself any panic in the future by understanding what treatments are available, symptoms to look for, and when to see a doctor.



References

Self
National Library of Medicine. Bartholin cyst or abscess. Medlineplus Medical Encyclopedia. 2014.
CDC. Genital HPV infection - fact sheet. CDC. 2014.
CDC. Molluscum Contagiosum. CDC. 2015.
National Library of Medicine. Genital Warts. Medlineplus medical encyclopedia.
AAD. Genital warts: Diagnosis, treatment, and outcome.
Author Renee Cotter, MD

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Renee Cotter, MD
7320 Woodlake Ave, Suit 160
San Fernando Valley

West Hills, CA 91307
Phone: 818-208-4280
Fax: 818-887-5577
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818-208-4280

Renee Cotter, MD
7320 Woodlake Ave
Suit 160
West Hills, CA 91307