Chronic Discharging Sinus Of Labium Majus – An Unusual Case Report

Author Information

Tiwari N*, Chaudhari HK**
(* Assistant Professor, ** Associate Professor. Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Mumbai, India.)


We are reporting an unusual case of discharging sinus from a labium majus. It is a very rare site for a sinus of the genital tract.


A wound which fails to heal in 6 months or more is defined as a sinus. It starts with tissue damage that results from injury, surgery or infection. It is reported very rarely in developed countries. However, perineal sinus is much more common in developing countries. It is painless. But sometimes, it may cause embarrassing soiling problems.

Case Report

A thirty year old woman reported to our out patient unit with complaints of purulent  discharge off and on and some vague discomfort in the right labial region since 2 years.  She was treated with multiple courses of antibiotics (amoxicillin/ clavulanate potassium and third generation cephalosporins ) with no permanent relief. Her background history included two normal vaginal deliveries. She underwent a total abdominal hysterectomy at another hospital 2 years back for menorrhagia; details of that surgery and disease were not available. Her postoperative recovery was complicated by development of a right sided labial abscess within a month. It was incised and drained. The wound healed in almost 2 months. Since then she had multiple episodes of purulent discharge from a point in the right labia and vague perineal discomfort. There was no complaint of fever. There was no relieving or aggravating factors. Her previous menstrual cycles were regular. Her bowel and bladder habits were normal. Her symptoms lasted for two years, which were investigated and no cause was found. All her swab cultures were negative. However, there was some symptomatic improvement with multiple courses of antibiotics. Her symptoms had worsened since the last two months. On presentation to us, her general physical and systemic examination were normal. Abdominal examination was unremarkable except for the previous surgery scar. Local examination revealed an external opening of 1 mm on the right labia majora approximately 0.5 cm lateral and 1 cm below the clitoris extending along almost the whole length of the right labia majora with purulent discharge seen coming out form the opening on pressing. Per rectal examinations was unremarkable. Per vaginal examination revealed a healthy vault. There was no inguinal lymphadenopathy. She was planned for an examination under anesthesia and possible excision of the sinus. Routine biochemical and serological tests and investigations done to check for signs of infection were normal. Examination under anesthesia with a probe was done that revealed a sinus tract as seen in Figure 1 and Figure 2. There was no vaginal communication seen. Pus was sent for culture and sensitivity. Pus did not grow any organism.
After her preoperative check up, sinus wall was excised completely with sharp dissection through the subcutaneous fat of the right labia majora. Subsequently, the subcutaneous tissue and skin were sutured. (Figure 3) There was no deep extension of the sinus tract. There was no connection to the vagina or the rectum. Histopathology of the material demonstrated   sinus wall lined with hyperplastic stratified squamous epithelium. The wound healed fully with closure of the sinus track and she has had no further problems over a 3 months review period.

Figure 1. Opening of the sinus tract and determining its extent

Figure 2. Extension of the sinus tract between the upper and lower artery forceps ( black arrows).

Figure 3. After excision of the sinus tract.


A sinus is a discharging blind end track extending from the skin to an underlying cavity.The most common cause of abscess formation is infection. Tuberculosis may be a rare cause.[1,2] Frequently sinuses are formed because of some foreign body.[3] Iatrogenic causes include retained non absorbable suture or gauze material. Chronic abscesses that have been epithelialized eventually become a sinus.
Treatment of sinus is always focused on treating its cause. Treatment that is given ensures enhancement of the granulation tissue growth in the wound. Care has to be taken to ensure that the wound edges do not heal prematurely. The wound tract should be probed to assess the direction, depth and number of tracts. Other diagnostic methods to delineate the entire sinus tract are CT scan, MRI and sinography. Accurate detection of any associated deep extensions of the sinus tract is of significance for successful treatment. Failure to do so will result in recurrence of the sinus. Clinically, the external opening is often seen as a small dimpled area draining pus on manual compression.[3] The histopathology demonstrates acute and chronic inflammation in dermis and subcutaneous tissue.


Patients who receive multiple conservative management for discharging sinus in the absence of overt sepsis like fever, pain or other symptoms must be meticulously managed. Management includes local wound opening and drainage, debridement of ischemic tissues, removal of foreign bodies if present. The definitive treatment of chronic or persistent discharging sinus is a surgical excision of the sinus tract. Wound healing requires careful supervision to ensure that healing takes place from the depth of the wound.


Dr. Parul Gupta for the intraoperative images of the case.

  1. Kela M, Soma M, Lunawat A, Agarwal A, Shishodiya R, Palival RV. Tubercular sinus of labia majora: rare case report. Infectious Diseases in Obstetrics and Gynecology.2008;2008:3pages. Available from
  2. Nanjappa V, Suchismitha R, Devaraj HS, Shah MB, Anan A, Rahim SN. Vulval tuberculosis—an unusual presentation of disseminated tuberculosis.  J Assoc Physicians India. 2012;60:49-52.
  3. Duvvura S, Singh R, Anwar K. An Unusual Presentation Of Perineal Sinus: A Case Report. The Internet Journal of Gynecology and Obstetrics. 2006;7(1):3 pages. Available from


Tiwari N, Chaudhari HK. Chronic Discharging Sinus Of Labium Majus – An Unusual Case Report.  JPGO 2018. Volume 5 No.3. Available from: