Differential Diagnosis Part 3 (Or where I find a vaginal mass and finally get a diagnosis)

I ended up having to get several referrals for urologists due to requiring one that took my student insurance (not the easiest thing). But once identified, I made the earliest available appointment – 4 weeks from then, and I hit google up for more ideas for some relief, primarily focusing on pelvic floor involvement and health (another post for another time). In the meantime, I spent a lot of time keeping my legs crossed and trying not to think about rushing water or warm streams. Five days before my appointment with the urologist, I start to notice an increase in vaginal itching (here we go again, I think). Something must have clued me in that this was different, however, because I used my (clean!) hands to try to locate the site of discomfort, and as I am examining myself, I realize my vulva is swollen and tender to touch. At this point, I grab a hand mirror and a desk lamp and try to take a look at things (since I’m not circus performer levels of flexible), and notice that my nether regions are an unusual shade of red – not healthy pink, but fiery angry red, and as I palpate around, I notice a palpable round, hard mass.
If I was nervous before this discovery, my anxiety is quickly reaching nuclear levels. I try to control my anxiety and my voice as I ask my partner to double check my findings – kind of a weird ask. “Hey honey, can you do me a favor?” “sure.” “Can you feel the inside of my vagina for me?” Basically the worst pick up line ever. He confirmed my findings – definitely a new development. The nodule is definitely in the vagina, but it isn’t deep and angled in, it’s more superficial, anterior (towards the front of my body), and superior (higher up). It doesn’t hurt, it just feels kind of weird, and it’s really hard, but also mobile – you can move it around with your fingers.
My internet search history was weird before with all of my pelvis centered searches, but the discovery of this nodule opened up my browser history to deep dark corners of the internet. Trying to find medical, informative, non pornographic pictures of vaginas is quite the challenge. I either ended up with textbook sex-ed diagrams or pornhub screenshots.

At this point, I have no idea what to think. None of my searches came up with anything that was in the same area as the mass I found. I can’t figure out how my urinary symptoms would be tied to this vaginal mass. Do I have two separate problems? What the hell is going on? I call the health center (for what seems like the thousandth time) and make an appointment. They fit me in for later in the week, either based on my description or the panic in my voice. In the meantime, I continue to freak out. My boyfriend tries to be a voice of reason, but I’m convinced I have cancer, even though I have exactly zero risk factors – no family history, I’m under age 50, no pain, and no unexplained weight loss.

At the student health center, the physician I see listens to my history and symptoms and you can hear the wheels in her head turning trying to put the pieces together. She mentions the Bartholin gland, which I had found in my research, but when she palpates it, she comes to the same conclusion I did – it isn’t in the right place. Those glands are found at the opening of the vagina and mine is definitely inside. She notices that I have recently had a bikini wax. She wonders aloud if it’s some type of inflammatory response to the wax. In any case, she immediately refers me out to a gynocologist. Like, calls their office for me – do not pass go do not collect 200 dollars. My feelings are mixed. On one hand, I’m terrified that my doctor doesn’t know what it is, although I do find it comforting that she doesn’t think it’s cancer. On the other hand, I feel that my concerns are validated. It is really hard to have symptoms that other people can’t see, especially when there’s no clear explanation for them. I am also the type of person who hates to see a problem unsolved – I’m like a dog with a bone.

I see the gynecologist during what has to be the worst gyno visit I’ve ever had (still not used to the stirrups, by the way). He has no more answers than anyone else. After challenging me on whether or not there’s even a problem (a story for another time), he tells me that it may be an inflammatory reaction like my PCP suggested, or it may be a urethral diverticulum, but in any case it’s really close to the urethra. He tells me he’ll look at it again after the urologist sees it if we don’t have a diagnosis by then (like it’s going to grow some feet and start tap dancing or something?), gives me some antibiotics and (you guessed it!) diflucan in case the meds give me a yeast infection and sends me on my way.

Thank God I finally saw the urologist that Friday. After giving my 6th? urine sample, I had imaging done to assess the ability of my bladder to empty. As it turns out, your bladder never empties completely, but if you retain too much urine, it can be a problem. While it can be a problem, it wasn’t my problem, as I got an A+ on bladder emptying. (Thinking about putting it on my resume.) After a thorough history and an exam, the urologist confirms that it is in fact a urethral diverticulum.

What the heck is a urethral diverticulum?