Definition & Overview
The incision and drainage of a vulvar or perineal abscess is the procedure of removing the pus that has accumulated in the vulva or perineum to facilitate healing. It also involves the removal of dead tissues within and around the abscess cavity.
An abscess occurs when pus accumulates within an inflamed tissue. The pus is composed of debris from white blood cells, plasma products, and subcutaneous tissue. Typically, an abscess cavity is formed when the dermis and epidermis get infected leading to inflammation. Subcutaneous abscess is quite common and can occur anywhere in the body. The vulva and the perineum are particularly prone to this condition.
The vulva is part of the female reproductive system and located in the external genitalia. It is the opening of the female reproductive tract and is composed of several parts, including the labia majora, labia minora, mons pubis, and clitoris, among others. The skin of the vulva is quite delicate, with numerous blood vessels and nerves running through it. It functions in promoting pleasure during sex.
The perineum, on the other hand, is the region located between the legs, just below the pelvic diaphragm. Among males, it is the area between the scrotum and the anus while among females, it is located between the anus and the vulva. It provides support to the pelvic floor and could be ruptured when a woman gives birth.
Who Should Undergo and Expected Results
Patients diagnosed with Bartholin’s abscess are suitable candidates for the procedure. This condition occurs when there is an infection in the Bartholin gland, which is a pair of glands located on both sides of the vaginal opening. Its symptoms include pain during sexual intercourse, walking, and even sitting down. The abscess typically starts as a blockage of the glands that leads to the formation of a cyst. If left untreated, the cyst could get infected and develop an abscess.
Those who are suffering from infections of the skin and hair follicles of the vulva can also undergo incision and drainage, especially if the condition has significantly impacted their daily activities. An example of such condition hidradenitis suppurativa or acne inversa. It is characterised by the presence of nodules that are quite painful and make it difficult for the patient to sit down or walk. These nodules often develop into abscesses. When the nodules rupture, the resulting discharge is quite odorous and can cause significant distress. This condition can also spread to surrounding structures like the perineum and thighs.
Women who recently gave birth are prone to developing infections in the vulvar area due to episiotomy or haematoma. An episiotomy is the laceration made in the perineum to enlarge the vaginal opening and facilitate childbirth. In some cases, the wound does not heal normally and this could lead to bacterial infection. A related condition, called puerperal haematoma, can also develop after giving birth. A haematoma, or collection of blood clots, is formed due to the trauma of blood vessels during a difficult and prolonged delivery. The haematoma can then develop into an abscess that would need to be drained so it will heal completely.
This procedure is also recommended for those who have developed perineal abscess after being infected with sexually transmitted diseases like genital herpes and syphilis. Ulcers could develop in this area and progress to the formation of an abscess.
Other conditions that can cause lesions and ulcers to form in the vulva and perineal area include yeast infection, trauma, and psoriasis. It can also occur as a side effect of certain medicinal drugs.
Most vulvar and perineal abscesses can be successfully treated with incision and drainage. The complete removal of the infecting agent and the necrotised tissue typically ensures the patient achieves immediate relief from pain and discomfort associated with these conditions.
In most cases, the procedure is done in an outpatient setting and the patient is allowed to go home on the same day. The physician may prescribe antibiotic treatment after the procedure to facilitate healing and prevent recurrence. Patients are advised to rest for a few days and avoid strenuous physical activity. Any dressing must be regularly replaced until the wound heals completely.
How is the Procedure Performed?
Depending on the size of the abscess that needs to be removed, the patient is placed under either local or general anaesthesia. The patient is made to lie on their back, with the knees flexed and thighs spread apart, similar to the position assumed during childbirth. If local anaesthesia is used, the drug is injected near and around the abscess. The physician then makes an incision along the anterior-posterior axis. The pus is allowed to drain and samples are collected to be sent to the pathology lab for evaluation. The necrotic tissue around and at the base of the abscess cavity is removed through debridement. The wound is also cleansed with sterile saline solution. Once the physician is satisfied that all pus and dead tissue are removed, the wound is packed with gauze soaked with saline solution. Sutures are not used for this type of procedure.
Possible Risks and Complications
The incision and drainage of a vulvar or perineal abscess is a simple and safe procedure. However, it is associated with risks. These include:
- Allergic reaction to the anaesthesia used
- Recurrence - In some cases, the infection may not be completely removed or the patient is exposed again to conditions leading to the formation of an abscess.
- Sepsis - In some cases, sepsis could develop even after the procedure. This is characterised by the spread of infection into the bloodstream leading to life-threatening conditions. Among immunocompromised patients, like those suffering from diabetes, the risk of septic episodes can be significant.
One rare complication of the procedure is the occurrence of necrotising fasciitis. This happens when the surrounding fascia becomes inflamed and infected. The infection rapidly spreads and cause cell death even to underlying subcutaneous tissues. If left untreated, this condition can be fatal.
- Townsend CM, et al. Surgical Infections and Choice of Antibiotics. Sabiston Textbook of Surgery: the biological basis of modern surgical practice. 18. Philadelphia,PA: SAUNDERS ELSEVIER; 2007. 299-327
- Calero-Lillo A, Caubet E. Lesion mimicking perianal abscess in an immunocompromised patient: Report of a case. Int J Surg Case Rep. 2014. 5 (12):893-5.