Should a patient with recurring vaginal abscesses be referred to an OB/GYN (Obstetrics and Gynecology) specialist or a General Surgery specialist?

Referral for Recurring Vaginal Abscesses

Refer patients with recurring vaginal abscesses to OB/GYN, as these are anatomically distinct from anorectal abscesses and require gynecologic expertise to identify underlying causes such as Bartholin's gland pathology, hidradenitis suppurativa, or other vulvovaginal conditions.

Anatomic Distinction Guides Specialty Referral

The term "vaginal abscess" refers to abscesses of the vulva and vaginal structures, which are fundamentally different from anorectal abscesses in both etiology and management:

• Vulvar abscesses are subcutaneous infections of the vulvar tissue that require gynecologic assessment and may involve Bartholin's glands, hair follicles, or other vulvovaginal structures 1
• Anorectal abscesses involve the perianal and perirectal spaces (intersphincteric, perianal, ischiorectal, or supralevator locations) and are managed by general surgery or colorectal surgery 2

Why OB/GYN is the Appropriate Referral

Identification of Underlying Gynecologic Causes

For recurrent abscesses, you must search for local anatomic causes that only gynecologists are trained to identify and manage 2:

• Bartholin's gland cysts or chronic infection - the most common cause of vulvar abscesses requiring specialized gynecologic procedures
• Hidradenitis suppurativa affecting the vulvar region - requires long-term gynecologic management 2
• Vulvar skin conditions or dermatologic pathology specific to the female genital tract
• Foreign material or retained products that may be gynecologic in origin 2

Specialized Diagnostic and Treatment Capabilities

OB/GYN specialists can provide:

• Proper anatomic assessment of vulvovaginal structures through specialized examination techniques 3, 4
• Bartholin's gland procedures including marsupialization or Word catheter placement for recurrent gland abscesses
• Evaluation for sexually transmitted infections that may predispose to recurrent infections 2
• Assessment for underlying gynecologic conditions including vaginitis, cervicitis, or pelvic inflammatory disease that may contribute to recurrent infections 2, 5

Management Approach for Recurrent Cases

Initial Acute Management (Can Be Done in Primary Care or Emergency Setting)

• Incision and drainage remains the primary treatment for acute presentation 2
• Culture the abscess early in the course to identify the pathogen 2
• Antibiotic therapy for 5-10 days based on culture results, particularly if systemic signs present 2

When to Refer to OB/GYN

Refer immediately for:

• Second occurrence at the same site - this mandates search for local causes 2
• Multiple recurrences despite adequate drainage
• Suspected Bartholin's gland involvement - requires specialized gynecologic procedures
• Associated vaginal discharge or other gynecologic symptoms 5, 3

Common Pitfall to Avoid

Do not confuse vaginal/vulvar abscesses with anorectal abscesses:

• If the abscess is truly in the perianal or perirectal region (within 3-4 cm of the anal verge, involving the anal sphincter complex, or in the ischiorectal fossa), refer to general surgery or colorectal surgery 2
• If the abscess involves the vulva, labia, or vaginal structures, refer to OB/GYN 1, 3
• Perform a careful physical examination to determine the exact anatomic location before making the referral 2, 4

Decolonization Protocol for Recurrent S. aureus

If cultures reveal recurrent Staphylococcus aureus infection, consider a 5-day decolonization regimen before or concurrent with specialist referral 2:

• Intranasal mupirocin twice daily
• Daily chlorhexidine washes
• Daily decontamination of personal items (towels, sheets, clothes)