Vulvar Abscess and the Woman with Diabetes

Some of the sickest patients on our inpatient service in recent years have been women with vulvar abscesses who also had diabetes. We have so much concern about these women that we request that the Emergency Department have the gynecologic service see any woman with diabetes who presents with a vulvar abscess.

What is so much more concerning about this problem when it’s found in women with diabetes than in women without diabetes? Let’s review the facts.

What is the vulva and what is a vulvar abscess?

The vulva, or the woman’s external sex organs, are the area outside of the vagina that includes the labia majora and the labia minora, the mons pubis, the clitoris, and the opening of the vagina. An abscess, which can occur in any part of the body, is an infected collection of pus. If a woman gets an abscess in any of the parts of her vulva, it is called a vulvar abscess. A vulvar abscess is generally very red, painful, and swollen.

How is a vulvar abscess treated?

The best way to treat an abscess of the vulva is by cutting the abscess open and then allowing the pus to drain out. The abscess must be kept open until the infection is gone and the wound has healed. The healing of an abscess can be helped along by using a catheter to keep the incision open, or by filling up the abscess with special wound-packing gauze.

If a catheter is placed, it must stay in place for 3 to 4 weeks, so that the abscess will stay open during the healing process and allow the pus to drain out until the infection is gone. If wound-packing gauze is placed, it will need to be removed and replaced about once a day or so, until the abscess has healed and closed from the inside out.

Although the most important part of treatment is to drain out the pus, antibiotics can also be given for a couple of weeks. It’s also useful to sit in a shallow bathtub of clean warm water at least 3 times daily, for about 20 minutes at a time. This will keep the wound clean and will also help to wash away the infection.

So what is the worry with diabetes?

Most vulvar abscesses can be treated successfully in your healthcare provider’s office, or in the emergency department without any need for hospital admission. These infections, however, can create a more concerning situation when they appear in women with diabetes. Higher blood-sugar levels can lower the body’s immune defenses, thus making persons with diabetes at higher risk of infections.

By the same token, these infections can make it more difficult for persons with diabetes to control their blood sugar levels. Diabetes has been shown to be associated with longer recovery courses from infections. So even the smallest infection in someone with diabetes should be taken seriously and must be carefully monitored. In a woman with diabetes, a simple vulvar abscess can rapidly become a surgical emergency that is life threatening.

What should you do if you think you have a vulvar abscess?

Any vulvar abscess should be addressed by your healthcare provider—and, if you have diabetes, you shouldn’t wait very long to see that provider. If your healthcare provider cannot see you immediately, go to the emergency room. The combination of diabetes and vulvar abscess can become a serious condition that should be addressed immediately. 

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