Confirm suspicion or Quiet fear

[lmb2]

On 1/21 while showering I found what felt like a large “pimple-like” mass on my vulva. Upon exiting the shower I did a self-exam of the area with the aid of a mirror and found a oval shaped mass approximately kidney bean sized on the left labia minora, in the vicinity of the urethra. The mass was solid, resembled a boil, but was the same color and texture as the surrounding area. It was not painful, however was slightly tender when I applied pressure to the area. Did not seem to have any openings or drainage. On 1/22 I examined the area again in the am and found the mass to be larger and more tender than the previous evening. However there was no discoloration or drainage. By that evening, the mass was again larger and much more uncomfortable, but other than that the appearance had not changed. On 1/23 the area was the same as the evening before, very tender and large but still no discoloration or drainage. However later that evening after showering I noticed that there seemed to be a white head on the mass, I gently squeezed and the entire mass turned white. I let go to reposition for a better view. But when I looked again the mass was gone and the area had a small round red center (slightly smaller than pea sized) and the surrounding area was raised slightly and the same color as the surrounding areas. The area had moisture, however I am unsure if it was from the mass or the shower as it was clear. No presence of pus-like substance, or foul odor.  Tenderness and discomfort disappeared immediately and was only slightly tender when pressure was applied. On 1/24 examined the area again and found the area to be slightly raised, no discomfort, no drainage, no odor, no discoloration, no hard mass, no ridges.

I have had minor itching in the labia majora area for years and occasional spasm-like cramps in the same area as the mass, however my MD says this is most likely a side effect of my BP meds.

I am sexually active, however in a monogamous relationship for 11 years. While I don’t feel that my partner has been unfaithful, you just never really know. So my question is does this sound like a STD or am I worrying more than I need to be. I have made an appointment with the OB/GYN to be sure but would like to have a bit of a heads up. Any thoughts would be greatly appreciated.

[H. Hunter Handsfield, M.D.]

This sounds like an infected sebaceous cyst or folliculitis.  If just inside the vaginal opening on one side or the other, I would worry about a Bartholin gland infectin, which can be a sign of gonorrhea or chlamydia.  This surely isn't related to the cramps and probably not to labial itching.

So this doesn't sound like an STD.  I don't know your partner; you are a much better judge of his fidelity than I can be.  However, when I lecture to health care providers and talk about how to judge STD risk, I give 2 scenarios about the relationship when a patient may or may not have an STD:  "Our relationship is strong and I just don't believe for a minute he has had other partners"; and "I don't think he has had other partners, but you just never really know, do you?"--almost exactly the words you used.  Which one sounds like the greater risk?

So if you indeed have reason to doubt your partner's fidelity, it can't hurt to get tested for common STDs.  But I don't believe an STD is causing your problem.

Good luck--  HHH, MD