Lumps, nodules, tubercles and other lumps on a woman’s outer labia are almost always a pathological phenomenon that requires emergency medical attention. Even if the neoplasms seem benign to you, without causing acute discomfort and pain.
Most common reasons
- Such phenomena can be detected in childhood and be congenital. In this case, it is advisable for parents to check their blood for syphilis, since most often changes in the genital organs in infants indicate its presence.
- In addition, the tubercles may be a sign of abnormal development of the labia, congenital defects of the urethra and other features that do not have an infectious or viral etiology. However, this is more of a special case than a healthy phenomenon.
- We should not forget that neoplasms in the genital area can become a sign of tumor processes in the body.
- In addition, nodular fragments may indicate the development of HPV (human papillomavirus). This disease in a certain percentage of cases leads to cervical cancer.
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If the tubercles appear suddenly and can be easily felt under the skin or mucous membrane, immediately contact a specialist for advice and all necessary tests. Perhaps it is the early intervention of a specialist that will help you avoid terrible irreversible consequences.
general characteristics
Pain in the labia area is most often observed in acute and chronic specific and nonspecific infectious diseases. Other possible causes are degenerative and atrophic changes, allergic reactions. With local inflammatory processes, there is a danger of upward spread of infection with damage to the vagina, cervix and body of the uterus, ovaries and fallopian tubes. Exogenous factors contributing to the development of this group of pathologies are:
- neglect of hygiene;
- mechanical injuries to the labia during sexual intercourse, using pads for too long, wearing rough and tight clothing;
- chemical irritation and skin damage due to the use of inappropriate hygiene products or attempts at self-medication;
- abuse of antibiotics, irrational use of hormonal contraceptives, radiation therapy.
Endogenous disorders that create favorable conditions for the occurrence of inflammatory and atrophic processes in this area include:
- metabolic and hormonal disorders: decreased estrogen levels, diabetes, obesity, deficiency of vitamins and minerals;
- urethro-vaginal, vesicovaginal and rectovaginal fistulas;
- skin diseases: psoriasis, perineal eczema;
- helminthic infestations, intestinal dysbiosis.
4. Papillomas
Papillomas
external genitalia - this is the growth of the epidermis of the labia. By their appearance, papillomas are easily differentiated from other formations. They are usually located on a stalk, resembling the shape of a mushroom. Unlike other uncomplicated formations, papillomas may itch or hurt; They are often injured. The reason for their appearance is HPV, the human papillomavirus, which is activated under favorable conditions (decreased immunity, stress, hormonal changes). HPV infection occurs through sexual contact or from the mother at birth. The latent period of this virus (without any formations on the skin) can last indefinitely. The actual growth of the epidermis on the genitals can be provoked by a number of factors, mainly associated with a decrease or depletion of the body's protective resources.
Papillomas are always treated comprehensively: formations on the skin are surgically removed, and the human papillomavirus itself is subjected to systemic therapy aimed at increasing immunity, restoring hormonal balance and balanced metabolism.
It is necessary to treat papillomas. Not only can they grow to large sizes, but they also carry the risk of infecting a sexual partner.
Why do the labia hurt?
Bacterial vulvitis
Acute vulvitis is manifested by pain, aggravated by touch, movement, and urination. Itching and burning are observed. The labia are red, swollen, sometimes covered with erosions and ulcers. With inflammation caused by staphylococcus, the discharge is thick and yellowish, with E. coli - greenish, watery, with an unpleasant odor. Sometimes general hyperthermia and inguinal lymphadenitis are observed. With vulvitis, girls may experience sleep disturbances and increased nervous excitability.
In chronic vulvitis, pain, swelling and hyperemia are detected in certain areas of the labia. There is itching, burning, and scanty leucorrhoea. The sebaceous glands of the perineal area hypertrophy. The pathology is characterized by an undulating course with frequent relapses. In girls, synechiae can form against the background of chronic inflammation and ulceration.
Bacterial vulvovaginitis
It is more often detected in menopausal women and girls under 10 years of age. In the acute form, as in the previous case, itching, burning, pain, swelling and redness are detected. The perineal area and inner thighs are often hyperemic, macerated, and covered with scratches. The type of leucorrhoea is determined by the type of pathogen. In severe cases, general infectious symptoms occur and erosions appear in the affected area. In the chronic course of vulvovaginitis, the symptoms are less pronounced, itching and pathological discharge predominate.
Bartholinitis
May be specific or nonspecific. Initially, the labia minora on one side turns red and swells, and a nodule forms in the area of the Bartholin gland duct. Then the lower third of the labia majora also becomes swollen and moderately painful. There is itching and minor discomfort. Body temperature sometimes rises to low-grade levels.
With the development of purulent bartholinitis, unilateral pain increases sharply. Painful sensations acquire a tugging, pulsating, tearing character. The condition worsens, fever and signs of general intoxication are observed. Symptoms are especially pronounced with an abscess of the Bartholin gland.
Labial herpes
Candidiasis
During their lifetime, thrush is diagnosed at least once in 75% of women. The main symptoms are burning and itching in the vulva, combined with profuse, curdled, milky-white discharge with a foul odor. Unpleasant sensations intensify at night, after taking a bath and urinating, and may be combined with minor pain. During sexual intercourse, pain and irritation intensify.
Gardnerellosis
It is the most common bacterial vaginosis. Along with burning and itching, a woman with gardnerellosis is bothered by swelling and redness of the labia, copious homogeneous foamy, watery or pasty grayish discharge with the smell of rotting fish. Soreness of the labia is minor and occurs or intensifies during sexual intercourse and urination. The general condition is not disturbed.
STI
As with other infectious processes, the prevailing symptoms are burning, itching, and discharge from the genital tract. Pain syndrome in the initial stages is absent or mildly expressed. It intensifies with irritation, maceration, the formation of erosive defects, and the development of bartholinitis.
- Gonorrhea.
The duration of the incubation period ranges from 5 to 10 days. The first symptom is profuse white or yellowish discharge, which a woman often interprets as a sign of nonspecific vaginitis. Urethritis and inguinal lymphadenitis indicate STIs. Bartholinitis is possible, accompanied by severe one-sided pain and symptoms of intoxication. - Chlamydia.
The incubation period is about 3 weeks. There is pain and burning in the vulva area. Pain appears during urination, the urine becomes cloudy. Sometimes there is a low-grade fever. With an exacerbation of the chronic process, the listed symptoms are supplemented by signs of an ascending infection - pain in the lower abdomen, groin and lumbar region. - Mycoplasmosis.
Symptoms, on average, appear 2 weeks after infection. The pain is raw, mild, and accompanied by light, clear discharge. When the infection spreads to neighboring structures, pain during urination, pain in the abdomen, menstrual disorders, and intermenstrual bleeding are noted. - Trichomoniasis.
Signs appear 5-14 days after infection. Cutting, pain and itching spread to the labia, urethra, and vagina. The vulva is swollen. Foul-smelling greenish or yellowish profuse foamy leucorrhoea is observed, sometimes mixed with blood. Possible deterioration of health, low-grade fever, abdominal pain.
Endophytic papillomatosis occurs latently, a detailed clinical picture is found in exophytic forms. The labia minora are most often affected, on which small, gradually growing “papillae” appear. The formations bleed easily. Subsequently, the growths turn red, pain, itching, and leucorrhoea with an unpleasant odor appear. With chronicity, there is an alternation of episodes of exacerbations and remissions.
With genital herpes, pain, paresthesia, itching, dysuria and pathological discharge are detected even at the prodrome stage. When rashes appear, the severity of symptoms decreases somewhat. Then the blisters burst, leaving behind painful ulcers and erosions. During the healing period, the area of the defects becomes covered with crusts and heals, the manifestations gradually disappear.
Kraurosis of the vulva
The pathology is observed mainly in elderly women. The leading symptom of vulvar kraurosis is unbearable paroxysmal itching, intensifying at night. Scratching the genitals causes abrasions, cracks, hemorrhages and areas of inflammation. Itching is complemented by pain. Initially, the labia are swollen, hyperemic, and later become wrinkled, dry, and rough.
Vulvodynia
This disease is characterized by chronic pain in the labia, clitoris, and vestibule of the vagina. With vulvodynia proper, the pain is constant, with vulvar vestibulitis it is paroxysmal, provoked by pressure on the vestibule area. The pathology develops against the background of neuropathy of the pudendal nerve, allergic reactions or individual hypersensitivity to irritants (synthetic underwear, hygiene products, oxalates in the urine, etc.).
The pain can be dull, sharp, or aching. It occurs or intensifies with movement, insertion of tampons, sexual intercourse, or wearing tight or rough underwear. Itching and a feeling of rawness may occur. In some women, objective changes are detected - swelling, hyperemia, rashes, whitish areas, ulcers, erosions. In other patients, the external genitalia look normal.
1. Lipomas
Formations on the genitals come in several varieties. The reasons, patterns, mechanisms of their occurrence in some cases are known and understandable, in others they remain not entirely clear. Different types of formations affect specific tissues. The following types of formations on the external genitalia are divided: lipoma, atheroma, bartholinitis, papilloma.
Lipomas
most often form in the subcutaneous fat layer. It is impossible to clearly identify the reasons for their occurrence, but a certain statistical connection with hereditary predisposition has been established. Moreover, the growth of lipomas has nothing to do with fat consumption or a tendency to develop subcutaneous fat deposits. The incidence of lipomas in thin and overweight people is the same. Lipomas can range in size from 1 to 15 cm and are usually not painful or itchy, presenting only a cosmetic problem. Cases of malignant degeneration of lipomas are very rare; More often, mechanical damage carries the threat of suppuration and infection. Lipomas up to 3 cm are treated non-surgically - by injecting them with a drug, the action of which leads to the resorption of the formation. Large lipomas are removed surgically: with laser, electrocoagulation or radioknife.
As a rule, a new lipoma does not appear at the site of a well-performed operation. However, it is not uncommon for new lipomas to form in nearby tissues.
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Diagnostics
Determining the nature of the pathology is the responsibility of the gynecologist. The primary diagnosis of STIs is made as part of a basic examination; if it is necessary to clarify the diagnosis and prescribe treatment, the patient is referred to a venereologist. The diagnostic plan for pain in the labia area may include the following procedures:
- Survey.
The specialist determines the nature and duration of the pain, the circumstances of its occurrence, and other symptoms. To determine the possible causes of pain, a detailed medical history is collected: features of the menstrual cycle, the number of pregnancies and births, the presence of gynecological, allergic and somatic pathologies. - Gynecological examination.
The doctor assesses the condition of the labia minora and majora, perineum, and anus. Performs speculum examination and vaginal examination. The technique allows you to detect swelling, redness, atrophic changes, ulcers, erosions and other signs indicating the etiology of the pain syndrome. - Bacterioscopy.
When examining a smear in patients with inflammatory diseases, a large number of leukocytes are revealed. The nature of the microflora depends on the type of infection. In bacterial vaginitis and vulvovaginitis, cocci often predominate. In patients with candidiasis, fungal cells and mycelial threads are detected. - Microbiological research.
Based on the culture results, the characteristics of the microflora and the sensitivity of pathogenic microbes to antibiotics are determined. The persistent recurrent course of candidiasis is considered as an indication for determining the subspecies of fungi and their sensitivity to antimycotic agents. - PCR analysis.
It is an accurate, highly informative way to identify STI pathogens. The advantage of the technique is the ability to identify any microorganisms: bacteria, fungi, protozoa, viruses. - Vulvar biopsy.
Recommended for ulcers, erosions, and atrophy areas on the labia. Carried out to exclude malignant neoplasms. The obtained material is examined during histological or cytological analysis. - Colposcopy.
Indicated for nonspecific vulvovaginitis, ascending spread of specific infections. Allows you to visualize erosions and inflammatory changes. - Gynecological ultrasound.
It makes it possible to assess the condition of the internal genital organs, diagnose concomitant pathological processes or establish the cause of the development of inflammation of the labia (for example, when irritated by secretions against the background of salpingoophoritis). - Other tests.
If there are signs of intoxication, a general blood test is prescribed to assess the severity of inflammatory changes. All patients undergo a general urinalysis. If irritation of the vulva due to parasitosis is suspected, a scraping is performed for enterobiasis, and stool is examined for worm eggs. In case of provoking endocrine and metabolic disorders, the indicators of a biochemical blood test are studied.
Gynecological examination
Tears after childbirth
Another problem of the perineum after childbirth is its rupture. Tears after childbirth or incisions often lead to the formation of rough scars, which in turn can cause pain during sexual intercourse, as well as grossly deform the perineum.
Non-surgical methods for treating tears after childbirth include laser scar resurfacing and intimate contouring. The effect of an erbium laser can soften and reduce the size of the scar. Due to this, pain is relieved and the quality of sexual life improves. Intimate contour plastic surgery (injection of hyaluronic acid preparations) can eliminate the perineal defect in the area of scars and tears. In addition to the aesthetic effect, by narrowing the entrance to the vagina, intimate contour plastic surgery solves the problem of “squelching”, the entry of air during sexual intercourse. Both methods are absolutely safe, practically painless (carried out under anesthesia with a cream), performed on an outpatient basis, and do not affect the ability to work or drive a car. Restrictions after the procedures - sexual rest for 1-2 days.
Treatment
Conservative therapy
The list of general recommendations for most pathologies accompanied by pain in the labia area involves changing hygiene habits, sexual rest, adjusting the diet and nature of the diet, and refusing to use synthetic underwear, highly allergenic or irritating hygiene products. Therapeutic measures for inflammatory and infectious processes include:
- Antibacterial agents.
For bacterial infections, antibiotics are prescribed for systemic and local (creams, suppositories, vaginal tablets) use, selected taking into account antibiotic sensitivity. - Other etiotropic medications.
For polymicrobial vulvitis and vulvovaginitis, combined drugs with antibacterial, antiprotozoal and antimycotic effects are used. Antifungals are effective for candidiasis, and antiviral drugs are effective for HPV and papillomatosis. - Local events.
For vulvitis, vaginal suppositories, douching with antiseptic solutions and herbal decoctions, and sitz baths are recommended. For acute bartholinitis, SMT, UHF and UV irradiation are effective; for chronic bartholinitis, ozokerite, paraffin, infrared laser, and mud applications are effective. - Treatment of background pathologies.
According to indications, insulin therapy or the dose of hypoglycemic agents for diabetes are adjusted, antiallergic drugs are prescribed, deworming is carried out, and infectious foci are sanitized.
Patients with vulvodynia are advised to avoid eating foods high in calcium oxalate (celery, strawberries, chocolate) to reduce the amount of this compound in the urine. For mild pain, exercises to strengthen the pelvic floor muscles are useful. Balneotherapy and physiotherapy are effective. If there are signs of atrophy, suppositories and creams are used to stimulate regeneration. For ovarian hypofunction, hormonal therapy is prescribed.
Antihistamines and sedatives are recommended for patients with vulvar kraurosis. For persistent itching, a pudendal nerve block is performed. Hormonal ointments with estrogens, androgens, corticosteroids and progesterone are used locally. The type of medication is selected taking into account age and endocrine status. Balneotherapy, reflexology, laser therapy, photodynamic therapy, and x-ray therapy are effective. It is necessary to take biostimulants, immunocorrectors and vitamin preparations.
Surgery
In most cases, pain in the labia area is eliminated using conservative methods. Surgeries may be required if the following pathologies are present:
- Bartholinitis:
marsupialization, removal of the cyst, removal of the Bartholin gland, opening of the abscess. - Kraurosis of the vulva:
cryodestruction, laser ablation or denervation of the vulva, if malignant tissue degeneration is suspected - vulvectomy. - Condylomatosis:
radiofrequency ablation, laser vaporization, cryodestruction, electrocoagulation, vulvar resection, vulvectomy.
