Condylomata Acuminata These are very common vulvar lesions and are usually easily recognized and treated with topical therapies such as trichloroacetic and bichloracetic acid. Other sexually transmitted organisms, such as the virus responsible for molluscum contagiosum and the lesions of syphilis and condylomata lata, may occasionally be mistaken for vulvar condylomata acuminata caused by HPV (see Chapter 18). A summary of benign vulvar tumors is listed in Table 14.15. There is argument regarding whether sebaceous cysts exist on the vulva or whether these lesions are histopathologically epidermal or epidermal inclusion cysts (238). So-called sebaceous cysts are clinically indistinguishable from epidermal inclusion cysts that may result from the burial of fragments of skin after the trauma of childbirth or episiotomy or that arise from occluded pilosebaceous ducts. These cysts are seldom symptomatic, although if infection develops, incision and drainage may be required acutely, and ultimately complete excision is indicated.
Bartholin Duct Cysts These are common vulvar lesions in reproductive-age women. They result from occlusion of the duct with accumulation of mucus and may be asymptomatic. Infection of the gland can result in the accumulation of purulent material, with the formation of a
Table 14.15 Types of Vulvar Tumors 1. Cystic lesions 3. Anatomic
Cyst in the canal of Nuck (hydrocele) Urethral diverticulum
Skene duct cyst 4. Infections 2. Solid tumors Abscess—Bartholin, Skene, periclitoral, other
Cherry angioma 5. Ectopic
Figure 14.33 Skene’s gland cyst.
rapidly enlarging, painful, inﬂammatory mass (a Bartholin abscess). An inﬂatable bulb-tipped catheter was described by Word and is quite easy to use (239). The small catheter is inserted through a small stab wound into the abscess after infiltration of the skin with local anesthesia; the balloon of the catheter is inﬂated with 2 to 3 mL of saline and the catheter remains in place for 4 to 6 weeks, allowing epithelialization of a tract and the creation of a permanent gland opening.
Skene’s Duct Cysts These are cystic dilations of the Skene glands, typically located adjacent to the urethral meatus within the vulvar vestibule. Although most are small and often asymptomatic, they may enlarge and cause urinary obstruction, requiring excision (Fig 14.33).