Excision vaginal lumps at Bristol Hospital

What is excision of a vaginal lump?

Excision of a vaginal lump is an operation to remove a cyst or other growth from your vagina or vulva (the area around the opening of your vagina). Your surgeon cuts out the lump completely, and it’s usually sent to a laboratory afterwards to check what it is.

What conditions does it treat?

This operation can be used to remove several types of lump from the vagina or vulva, including:

• a Bartholin’s cyst or abscess, which forms when one of the glands near the opening of your vagina becomes blocked or infected
• other types of vaginal cyst, such as those forming after an injury during childbirth or previous surgery, or from tissue left over from before birth
• a lump that has grown large enough to cause discomfort, bulging, or symptoms similar to a prolapse.

Vaginal cysts are common, affecting around 1 in 200 women, and Bartholin’s cysts alone affect around 2 in 100 people. Most are small, painless, and don’t need treatment unless they become infected, grow large, or keep coming back.

What are the benefits of removing a vaginal lump?

Removing a persistent or recurrent lump can offer:

• relief from pain, discomfort or swelling that hasn’t settled with simpler treatments such as antibiotics or drainage
• a lower chance of the lump coming back, compared with drainage alone
• a sample of tissue that can be checked in a laboratory to confirm what the lump is.

Are there different types of surgical approaches?

If you have a Bartholin’s cyst or abscess, there are three main surgical options, usually tried in order of how invasive they are.

Balloon catheter insertion

A small balloon catheter is placed into the cyst to drain fluid and is left in for up to 4 weeks. This is usually done under local anaesthetic and takes 5–10 minutes.

Marsupialisation

The cyst is opened and drained, and the edges are stitched to leave a small permanent opening, which helps prevent it reforming. This takes 10–15 minutes, under local or general anaesthetic.

Surgical excision

The whole gland is removed. This is usually considered a last resort, often reserved for a cyst or abscess that keeps coming back on the same side after other treatments.

For other types of vaginal cyst, such as those on the vaginal wall itself, complete surgical excision is generally the recommended approach if the cyst is causing symptoms.

What happens before the procedure?

Before your operation, your doctor will examine the lump and discuss which treatment option is right for you. Depending on which procedure you’re having, you may be able to have it done on the same visit, or you may be asked to come back within the next day or two.

If you’re having a general anaesthetic, you’ll need to fast for at least 6 hours beforehand. Your doctor may take a small sample of fluid from the lump beforehand to test for infection.

What happens during the procedure?

1. You’re given your anaesthetic, local (you’re awake but the area is numbed) or general (you’re asleep), depending on the size and location of the lump and which procedure you’re having.
2. Your surgeon makes a cut into the lump to access it.
3. The lump, or the whole gland if appropriate, is carefully removed.
4. Any fluid or pus is drained, and a tissue sample may be taken and sent to a laboratory for testing.
5. The wound is closed, often with dissolvable stitches, or occasionally left partly open, or with a small gauze packing, to help drain.

How long this takes varies depending on the size and location of your lump and which procedure you’re having.

What does recovery look like?

Straight after the procedure

How quickly you go home depends on which procedure you’ve had. After a balloon catheter, most people go home within an hour. After marsupialisation, this is usually within 6 hours, once a nurse has checked you’re able to walk and pass urine, and has checked your wound.

At home

Wound pain, oozing or slight bleeding is common and usually settles over 1–2 weeks. Take pain relief such as paracetamol or ibuprofen if you need it. If you’ve had a general anaesthetic, you may also feel a little sick afterwards.

Rest for 2–3 days after your operation. Take daily baths or showers, but avoid scrubbing the area vigorously for at least 2 weeks, and avoid bubble bath, oils or talcum powder while the wound heals. Avoid sex until any discharge has stopped and you’re pain-free, and avoid tight-fitting clothing until you’re comfortable. To prevent the delicate dissolving stitches from tearing open and protect the raw wound from tracking bacteria, you must use sanitary pads only. Do not use tampons or menstrual cups, do not douche, and strictly avoid all sexual intercourse for at least 3 to 4 weeks if you have a balloon catheter or fresh excision lines, or until your wound is completely pain-free and healed.

If you’ve had a balloon catheter, you can usually resume normal activities, including exercise and sex, within 3 days, and you’ll have an appointment in around 4 weeks to have the catheter removed. If you’ve had marsupialisation, normal activities can usually resume within 2–3 weeks, and you won’t usually need a follow-up unless you have concerns.

What are the risks and complications?

As with any procedure, there are risks to be aware of:

• infection of the wound
• the cyst or abscess coming back
• pain when passing urine, which normally settles once the wound has healed
• pain during sex, which normally settles once healed
• rarely, long-term pain even after the wound has fully healed
• rarely, ongoing discharge from the area that was operated on.

Recurrence rates vary depending on which procedure you have.