Abscesses occurring between the urethra and the fourchette may be of uncertain origin. However, a surgical and histological study has shown that the majority of these do in fact represent the anterior extension of Bartholin's cysts or abscesses.
These are common in the labia majora and tend to be superficial. If infected, a sebaceous cyst should be incised and drained as for any abscess.
Infection of the hair follicles is common around the mons and vulva, usually with S. aureus. However, pustules are more common than abscesses and usually only antibiotics are needed with occasional incision of an enlarged pustule under local anaesthetic.
These are found in the anterior midline of the vagina over the ventral portion of the mid-urethra, approximately 2–3 cm from the introitus. The history of dysuria, post-void dribbling and dyspareunia aid the diagnosis. Urethral diverticulae need careful investigation and specialist repair but the presence of an abscess is an indication for incision and drainage, prior to definitive surgery. A urinary Foley catheter should be inserted at the time of drainage.
Skene glands abscess
Skene glands (lesser vestibular glands) are found in the anterior wall of the lower vagina and the lower urethra. These are homologous to the prostate gland in men. They are thought to have a role in protecting the urethra from microbial colonization. Skene gland abscess may present as peri-urethral swellings. Their close proximity to the clitoris may make any abscess disproportionately painful.
In one study, four out of 17 women diagnosed with vulval malignancies had an initial misdiagnosis of Bartholin's cyst or abscess, so careful examination should be performed with consideration of alternative diagnoses if the appearance is atypical.
Biopsy or referral to a gynaecological oncologist should be carried out if the abscess shows suspicious features or fails to heal.