Treatment of Vaginal Abscess
The primary treatment for vaginal abscess is surgical incision and drainage, followed by appropriate antibiotic therapy if there are systemic signs of infection or significant surrounding cellulitis. 1
Diagnostic Approach
- Vaginal abscesses typically present with pain, swelling, and possibly discharge in the vaginal area 1
- Diagnosis is primarily based on clinical examination, though imaging may be helpful in complex cases or when the diagnosis is uncertain 1
- Transvaginal ultrasound can be useful for confirming the diagnosis and determining the extent of the abscess 1
Treatment Algorithm
Surgical Management
- Incision and drainage is the cornerstone of treatment for vaginal abscesses 1
- The timing of surgery should be based on the presence and severity of sepsis 1
- The incision should be kept as close as possible to the site of infection while providing adequate drainage 1
Drainage Approaches
- Transvaginal approach is commonly used for vaginal abscesses 1, 2
- For complex or deep abscesses, ultrasound-guided drainage may be beneficial 2
- Small, superficial abscesses may be managed in an outpatient setting under local anesthesia 1
Antibiotic Therapy
- Antibiotics should be added to surgical drainage in the following scenarios 1:
- Presence of systemic signs of infection (fever, elevated white blood cell count)
- Immunocompromised patients
- Incomplete source control
- Significant surrounding cellulitis
- When antibiotics are indicated, empiric broad-spectrum coverage should include agents effective against 1:
- Gram-positive bacteria (particularly streptococci and staphylococci)
- Gram-negative bacteria
- Anaerobic bacteria
Special Considerations
Primary Suture Technique
- For subcutaneous vulvar abscesses, evidence suggests that incision, curettage, and primary suture under antibiotic cover (single dose of clindamycin) may result in shorter hospital stays and healing times compared to conventional open treatment 3
- This technique resulted in a median hospital stay of 2 days versus 7 days for conventional treatment, and median healing time of 7 days versus 18 days 3
Recurrence Prevention
- Complete and thorough drainage is essential to prevent recurrence 1
- Inadequate drainage, loculations, and horseshoe-type abscesses are associated with higher recurrence rates 1
- Recurrence rates can be as high as 44% after drainage if not performed adequately 1
Vaginal Candidiasis Consideration
- If the abscess is related to or complicated by vulvovaginal candidiasis, appropriate antifungal treatment should be initiated 1
- Options include topical azoles (clotrimazole, miconazole) or oral fluconazole 1
Follow-up Care
- Monitor for resolution of symptoms and signs of infection 1
- Consider follow-up imaging if there is evidence of recurrence, non-healing wound, or suspected fistula formation 1
- For recurrent abscesses, investigation for underlying causes such as inflammatory bowel disease or immunodeficiency may be warranted 1