Swelling is frightening in a way that itching is not, because you can feel it and you do not know what it is.
Most causes are benign and several resolve on their own. A few need seeing quickly. This article is about working out which you are looking at.
In this article
- First, the ones that need seeing today
- A lump near the opening: Bartholin cyst
- When a cyst becomes an abscess
- Generalised swelling: contact reaction
- Infection-related swelling
- Other causes
- What to do at home
- What not to do
- Frequently asked questions
First, the ones that need seeing today
Skip the rest and get seen if you have any of these.
- Swelling with fever
- Severe pain, particularly if walking or sitting is difficult
- Spreading redness or heat, which can indicate cellulitis
- Rapidly increasing swelling
- Swelling with difficulty passing urine
- Swelling after an injury with heavy bleeding
- Swelling with a rash and breathing difficulty, which is an emergency
Everything else can reasonably be assessed at a normal appointment.
A lump near the opening: Bartholin cyst
The most common cause of a discrete lump, and the one most women have never heard of.
The Bartholin glands sit either side of the vaginal opening and produce fluid for lubrication. When a gland becomes blocked, fluid builds up and forms a cyst, producing a swollen bump near the opening.
Key features:
- Usually on one side only
- A round, smooth lump
- Usually not painful unless infected
- Can range from pea-sized to considerably larger
Smaller cysts may be asymptomatic and may be left untreated. Larger ones require medical attention. Warm sitz baths several times a day are the usual first step and many small cysts resolve.
When a cyst becomes an abscess
This is the change to recognise, because it moves from watch-and-wait to see-someone.
If the cyst becomes infected it forms an abscess, which causes severe pain and sometimes fever. Larger cysts and abscesses tend to cause enough vulvar pain and swelling that walking, sitting and sex become difficult.
The tissue over an abscess can also become infected in what is called cellulitis, where the affected area is red and tender.
Treatment: large cysts and abscesses may require excision or drainage, and antibiotics are given where there is accompanying cellulitis. Drainage is a quick procedure and the relief is immediate.
Do not try to drain it yourself. Doing so risks a worse infection in tissue that is already compromised.
Generalised swelling: contact reaction
If the swelling is diffuse rather than a discrete lump, and it itches, contact dermatitis is the likeliest explanation.
ACOG lists contact dermatitis as caused by irritation from things such as soaps, fabrics or perfumes, with symptoms including extreme itching, rawness, stinging, burning and pain.
Common triggers: soap and shower gel, scented wipes and liners, laundry detergent and fabric softener, new underwear, lubricants, condoms in latex allergy, and topical products.
What to do: stop everything new, wash with water only, cool compresses, cotton underwear, and unscented detergent. Improvement usually begins within days.
The prevention version is in should you wash your vulva, since the most common trigger is the thing being used to prevent problems.
Infection-related swelling
Yeast infection. Swelling with intense itching, redness and thick white discharge. If this is a pattern rather than an event, see recurring yeast cycles.
Folliculitis. Small tender bumps at hair follicles, common after shaving or waxing.
Herpes. Swelling with painful blisters or ulcers, often with flu-like symptoms in a first episode. Needs testing.
Cellulitis. Spreading redness, heat and tenderness. Needs antibiotics promptly.
Other causes
- After sex. Mild temporary swelling from friction or normal engorgement, resolving in hours. Swelling that persists or is painful is different.
- After birth. Common and expected, covered in postpartum vulvar care.
- Pregnancy. Increased blood volume and pressure can cause generalised swelling and vulvar varicosities.
- Trauma, including straddle injuries and vigorous sex.
- Cysts other than Bartholin, including sebaceous cysts.
- Allergic reaction, which can be rapid and, with breathing difficulty, is an emergency.
What to do at home
While you are waiting for an appointment, or for something clearly mild.
Cool compresses, fifteen to twenty minutes, for acute swelling and irritation.
Warm sitz baths, fifteen to twenty minutes several times a day, for a suspected Bartholin cyst. Warm water increases circulation and encourages drainage. Plain water, nothing added.
Stop every product. Water only until it settles.
Loose cotton, no tight clothing.
Over-the-counter pain relief if needed.
Once it has settled, and only on intact unbroken skin, a balm formulated for this tissue supports a barrier that has been through something. Not on broken skin, not on an active abscess.
What not to do
- Do not squeeze, lance or drain anything yourself.
- Do not apply antiseptics or alcohol.
- Do not use hydrocortisone without advice, since it makes some infections worse.
- Do not use scented products to make it feel cleaner.
- Do not douche.
- Do not wait on fever or severe pain.
Frequently asked questions
What is the lump near my vaginal opening?
Most commonly a Bartholin cyst, which forms when one of the glands beside the opening becomes blocked. It is usually one-sided, smooth and not painful unless infected. Small ones often settle with warm sitz baths, larger ones need medical attention.
Will a Bartholin cyst go away on its own?
Small ones often do, and warm sitz baths several times a day encourage that. Ones that become infected form an abscess, which causes severe pain and sometimes fever, and usually needs drainage and sometimes antibiotics.
Why is my vulva swollen and itchy?
Diffuse swelling with itching is most often contact dermatitis, caused by soaps, fabrics, detergents or perfumes. Yeast infection is the other common cause and usually comes with thick white discharge. Stopping all products and washing with water only is the first step.
Is it normal for the vulva to swell after sex?
Mild temporary swelling from friction and normal engorgement is common and settles within hours. Swelling that persists, is painful, or comes with itching or discharge is worth checking, and may point to a reaction to a lubricant or condom.
When is vulvar swelling an emergency?
Fever, severe pain, spreading redness or heat, rapidly increasing swelling, or inability to pass urine all need same-day assessment. Swelling with a rash and breathing difficulty is an emergency.
Can I use ice on a swollen vulva?
Cool compresses help, wrapped rather than applied directly, for fifteen to twenty minutes at a time. For a suspected Bartholin cyst, warm sitz baths are more useful than cold, because warmth increases circulation and encourages the blockage to drain.
Sources
- Disorders of the vulva, common causes of pain, burning and itching: ACOG
- Bartholin cyst causes, symptoms and treatment: Cleveland Clinic
- Bartholin gland cyst and abscess: Merck Manual Professional Edition
- Clinical pathology of Bartholin's glands: PMC4483306