What are Bartholin’s gland cysts. How are they diagnosed. What causes these cysts to form. What are the most effective treatment options for Bartholin’s gland cysts. How can recurrence be prevented.

Understanding Bartholin’s Glands and Cyst Formation

Bartholin’s glands are small, pea-sized structures located on either side of the vaginal opening. These glands play a crucial role in producing fluid that lubricates the vaginal area during sexual arousal. However, when the ducts that drain these glands become obstructed, a cyst can form.

How do Bartholin’s cysts develop? The process typically begins when the opening of a Bartholin’s gland becomes blocked, often due to infection or injury. As a result, the gland’s secretions accumulate, causing the gland to swell and form a cyst. These cysts can vary in size, ranging from as small as a pea to as large as a golf ball or even an orange in some cases.

Anatomy of Bartholin’s Glands

To better understand cyst formation, it’s essential to know the anatomy of Bartholin’s glands:

• Location: On the vulva, at approximately 4 and 8 o’clock positions relative to the vaginal opening
• Size: Normally about 0.5 cm in diameter
• Function: Secrete mucus to lubricate the vagina during sexual intercourse
• Ducts: Small tubes that carry secretions from the glands to the vaginal opening

Recognizing Symptoms of Bartholin’s Gland Cysts

Identifying a Bartholin’s gland cyst early can lead to more effective treatment. What are the common symptoms to watch for?

• A painless lump near the vaginal opening
• Discomfort when walking or sitting
• Pain during sexual intercourse
• Swelling on one side of the vaginal opening

It’s important to note that not all Bartholin’s cysts cause symptoms. In fact, many small cysts may go unnoticed. However, if a cyst becomes infected and forms an abscess, additional symptoms may arise:

• Severe pain and tenderness
• Fever and chills
• Redness and swelling in the affected area
• Drainage of pus

Causes and Risk Factors for Bartholin’s Gland Cysts

While the exact cause of Bartholin’s gland cysts isn’t always clear, several factors can increase the likelihood of their development:

1. Bacterial infections: Various bacteria, including E. coli and those responsible for sexually transmitted infections, can lead to cyst formation.
2. Injury to the vulvar area: Trauma or irritation to the vaginal opening can cause blockage of the Bartholin’s gland ducts.
3. Age: Women between 20 and 30 years old are most susceptible to developing these cysts.
4. Childbirth: The physical stress of vaginal delivery can sometimes lead to cyst formation.
5. Previous cysts: Women who have had Bartholin’s cysts in the past are more likely to develop them again.

Are certain women more prone to developing Bartholin’s gland cysts? While any woman can potentially develop these cysts, some factors may increase the risk:

• Sexual activity: Sexually active women are at a higher risk due to potential exposure to bacteria.
• Poor hygiene: Inadequate genital hygiene can increase the risk of bacterial infections.
• Weakened immune system: Women with compromised immune systems may be more susceptible to infections that can lead to cyst formation.

Diagnosing Bartholin’s Gland Cysts

Accurate diagnosis is crucial for effective treatment of Bartholin’s gland cysts. How do healthcare providers diagnose these cysts?

1. Physical examination: A healthcare provider will visually inspect and palpate the vulvar area to identify any swelling or lumps.
2. Medical history: The provider will ask about symptoms, duration, and any previous occurrences of cysts or infections.
3. Fluid sample: If an infection is suspected, a sample of fluid from the cyst may be collected for laboratory analysis.
4. Biopsy: In rare cases, especially for women over 40, a small tissue sample may be taken to rule out cancer.

When should you seek medical attention for a suspected Bartholin’s gland cyst? It’s advisable to consult a healthcare provider if you notice:

• A painful, swollen lump near your vaginal opening
• Persistent discomfort that interferes with daily activities
• Signs of infection, such as fever or severe pain
• Any new growths in the genital area, especially if you’re over 40

Treatment Options for Bartholin’s Gland Cysts

The treatment approach for Bartholin’s gland cysts depends on the size of the cyst, the presence of infection, and the severity of symptoms. What are the most effective treatment options available?

1. Home Remedies and Self-Care

For small, uncomplicated cysts, conservative management may be sufficient:

• Sitz baths: Soaking the affected area in warm water for 10-15 minutes, several times a day, can help the cyst drain naturally.
• Warm compresses: Applying warm, moist compresses to the area can promote drainage and relieve discomfort.
• Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

2. Medical Interventions

For larger cysts or those that don’t respond to home remedies, medical treatments may be necessary:

• Antibiotics: If the cyst is infected, oral or topical antibiotics may be prescribed.
• Needle aspiration: A healthcare provider may use a needle to drain the cyst.
• Incision and drainage: A small cut is made in the cyst to allow it to drain.
• Word catheter placement: A small, inflatable catheter is inserted into the cyst to allow continuous drainage.
• Marsupialization: A surgical procedure that creates a permanent opening for the gland to drain.

3. Surgical Options

In cases of recurrent or particularly problematic cysts, surgical intervention may be recommended:

• Gland excision: Complete removal of the Bartholin’s gland.
• CO2 laser therapy: Uses laser energy to open and drain the cyst.

Preventing Recurrence of Bartholin’s Gland Cysts

While it’s not always possible to prevent Bartholin’s gland cysts, certain measures can reduce the risk of recurrence:

1. Practice good hygiene: Regular washing of the genital area with mild soap and water can help prevent bacterial infections.
2. Wear breathable underwear: Choose cotton underwear and avoid tight-fitting clothing that can trap moisture.
3. Safe sex practices: Using condoms and getting regular STI screenings can reduce the risk of infections that may lead to cyst formation.
4. Stay hydrated: Drinking plenty of water can help maintain overall vaginal health.
5. Regular check-ups: Schedule regular gynecological exams to catch any potential issues early.

Is it possible to completely prevent Bartholin’s gland cysts? While there’s no guaranteed method of prevention, maintaining good genital hygiene and overall health can significantly reduce the risk.

Living with Bartholin’s Gland Cysts: Long-Term Considerations

For women who experience recurrent Bartholin’s gland cysts, managing the condition becomes a long-term consideration. What should these women keep in mind?

• Regular monitoring: Be vigilant about any changes in the vulvar area and report them to your healthcare provider.
• Prompt treatment: Seek medical attention at the first sign of a new cyst to prevent complications.
• Lifestyle adjustments: Consider making changes to your daily routine, such as wearing looser clothing or using different hygiene products.
• Emotional support: Dealing with recurrent cysts can be emotionally challenging. Don’t hesitate to seek support from healthcare providers, support groups, or mental health professionals.

How does living with recurrent Bartholin’s gland cysts impact quality of life? While the condition can be frustrating and sometimes painful, with proper management and treatment, most women can maintain a good quality of life. Open communication with healthcare providers and partners about the condition is key to managing its impact on daily life and relationships.

When to Seek Immediate Medical Attention

While Bartholin’s gland cysts are often benign, certain situations require prompt medical evaluation. When should you seek immediate medical attention?

• Severe pain that interferes with daily activities
• Rapidly growing swelling in the vaginal area
• High fever (over 101°F or 38.3°C) accompanying vulvar swelling
• Signs of systemic infection, such as chills or body aches
• Difficulty urinating due to swelling
• Foul-smelling discharge from the cyst or abscess

Why is it crucial to seek immediate care in these situations? Prompt medical attention can prevent serious complications, such as the spread of infection to surrounding tissues or the bloodstream. Additionally, early intervention often leads to more effective treatment and faster recovery.

Potential Complications of Untreated Bartholin’s Gland Cysts

Leaving a Bartholin’s gland cyst untreated can lead to several complications:

1. Abscess formation: An infected cyst can develop into a painful, pus-filled abscess.
2. Cellulitis: The infection can spread to surrounding tissues, causing widespread inflammation.
3. Sepsis: In rare cases, the infection can enter the bloodstream, leading to a life-threatening condition.
4. Chronic pain: Untreated cysts may cause persistent discomfort and interfere with sexual activity.
5. Recurrence: Improper treatment can lead to frequent recurrences of cysts.

Understanding these potential complications underscores the importance of timely and appropriate treatment for Bartholin’s gland cysts. By seeking medical attention when necessary and following through with recommended treatments, women can effectively manage this condition and minimize its impact on their health and well-being.

Bartholin’s Gland Cyst: Causes & Treatment

What is a Bartholin’s gland cyst?

The Bartholin’s gland is a tiny organ on each of the labia (vaginal lips), near the opening of the vagina. If the vagina were the face of a clock, these glands would be found at about 4 and 8 o’clock. Normally they’re invisible. They make a small amount of fluid that lubricates the vaginal lips. If a flap of skin grows over the opening of one of the glands, the fluid backs up. It causes a round swelling called a cyst. The cyst can grow from the size of a penny to larger than an orange. Most don’t get bigger than a golf ball.

Symptoms of a Bartholin’s gland cyst

You may notice a round bulge on one of your vaginal lips, near the opening of the vagina. It may be painless or slightly tender. It may stay the same size or may slowly grow larger. Cysts that get infected are usually very tender. They usually appear quickly. In more severe cases, walking or sexual intercourse may be painful.

What causes a Bartholin’s gland cyst?

While most aren’t, some Bartholin’s gland cysts can be infected. Your doctor may want to check the fluid in the cyst. Most infected cysts (called abscesses) contain the normal bacteria (germs) found on your skin. Some are caused by bacteria that are transmitted sexually.

How is a Bartholin’s gland cyst diagnosed?

If your Bartholin’s gland cyst is small, you may not notice it. Once it grows large or becomes infected, you will notice symptoms. Your doctor will be able to diagnose the cyst by looking at it.

Can a Bartholin’s gland cyst be prevented or avoided?

There is no sure way to prevent a Bartholin’s gland cyst from forming. Good hygiene may play a role in prevention. However, sometimes the cysts appear no matter how good your personal hygiene. If you think you have one, tell your doctor right away. This way, you can get early and effective treatment.

Bartholin’s gland cyst treatment

Treatment depends on the size of the cyst, how painful it is, if it’s infected, and your age. You can often treat small cysts by soaking in a few inches of warm water (called a sitz bath) several times a day for 3 or 4 days. Adding Epsom salt or sitz salt can help even more. This allows the cyst to rupture and drain with little pain or discomfort.

In rare cases, the doctor can perform a minor procedure in the office. The doctor makes an incision and puts a small tube (called a catheter) into the cyst. The catheter stays in place for 4 to 6 weeks, draining the fluid. While the catheter is in, you can continue normal activity. However, ask your doctor if it’s safe to have sexual activity during this time. At the end of treatment, your doctor easily removes the catheter in his or her office.

Another procedure is when the doctor makes a small cut in the cyst to drain the fluid. He or she will place stitches at the edge of the cyst to allow a small opening to form. This procedure is called a marsupialization. You may have light discharge for a few weeks. Panty liners should be all you need to take care of this discharge.

Less common procedures involve using a laser or having surgery to remove the entire gland. Both of these are usually performed in a hospital as same-day surgery.

Living with a Bartholin’s gland cyst

It’s possible for Bartholin’s gland cysts to come back after treatment. This can happen even years later. If so, your doctor can treat the cyst again. Your doctor also may remove the Bartholin’s glands if cysts recur often.

Questions to ask your doctor

• I have a bump on one of my vaginal lips. Could it be a Bartholin’s gland cyst?
• Do I need any tests, such as tests for sexually transmitted infections?
• How serious is the cyst? Is it infected?
• What are my treatment options? What treatment do you recommend for me?
• Is it safe for me to have sex?

Resources

National Institutes of Health, MedlinePlus: Bartholin Cyst or Abscess

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Office Management of Bartholin Gland Cysts and Abscesses

D. ASHLEY HILL, M.D., AND JORGE J. LENSE, M.D.

Bartholin gland cysts and abscesses are common problems in women of reproductive age. Although the cysts are usually asymptomatic, they may become enlarged or infected and cause significant pain. Often the clinician is tempted simply to lance the cyst or abscess, since this technique can be effective for other common abscesses. However, simple lancing of a Bartholin gland cyst or abscess may result in recurrence. More effective treatment methods include use of a Word catheter and marsupialization, both of which can be performed in the office.

Physicians who provide care for women can expect to see Bartholin gland cysts or abscesses, since these problems develop in approximately 2 percent of all women.¹ Bartholin cysts are generally asymptomatic but can cause extreme pain and limitation of activity, usually due to enlargement or infection. If the cyst becomes infected, the abscess can grow rapidly, causing pain and making treatment difficult. A number of proven, office-based options are available for treating Bartholin gland cysts or abscesses. The appropriate choices depend on the age of the patient, the size of the cyst or abscess, and whether it has recurred despite previous treatment. The physician caring for women with Bartholin gland cysts or abscesses should have an understanding of the anatomy of the vulva and Bartholin’s glands, the differential diagnosis of cystic vulvar lesions, the many treatment options and their potential complications, the infectious agents found in Bartholin gland abscesses and the indications for excision.

Anatomy

Bartholin’s glands are bilateral vulvovaginal bodies located in the labia minora at approximately the 4 and 8 o’clock positions on the posterolateral aspect of the vestibule. The glands are normally about the size of a pea and are composed of cuboidal epithelium. They drain into a duct approximately 2.5 cm long, which is composed mostly of transitional epithelium. The duct exits just external to the hymenal ring into a fold between the hymen and the labium, where the duct lining becomes squamous epithelium. Therefore, either squamous carcinoma or adenocarcinoma can develop in a Bartholin gland. The gland’s secretions provide some moisture for the vulva but are not needed for sexual lubrication; thus, removal of a Bartholin gland does not seem to compromise the vestibular epithelium or sexual function.

Differential Diagnosis

A number of vulvar and vaginal lesions can mimic Bartholin gland cysts or abscesses and should be included in the differential diagnosis (Table 1).

Sebaceous cysts of the vulva are common and present similarly to sebaceous cysts in other areas. These are epidermal inclusion cysts and are often asymptomatic. If infected, they respond well to simple incision and drainage. Dysontogenetic cysts are benign mucus-containing cysts located in the introitus or labia minora and are probably caused by incomplete separation of the cloaca from the urorectal folds. They contain rectal-like tissue and are usually asymptomatic. Hematomas of the vulva are caused by straddle injuries, sporting injuries, abuse or other trauma.

Fibromas are the most common benign solid tumors of the vulva. Indications for excision include pain, rapid growth and cosmetic concerns. Lipomas can also occur on the labia majora and can grow to an enormous size. Hidradenomas are rare benign tumors that arise on either the labia majora or, less commonly, the labia minora. They should be biopsied if they bleed or removed if they are symptomatic. Other rare vulvar masses include syringomas, vulvar endometriosis, granular cell myoblastomas, accessory breast tissue, leiomyomas and neural sheath tumors of von Recklinghausen’s disease (neurofibromatosis).

Cystic lesions can also occur in the vagina and are usually distinguished from Bartholin gland cysts by their anatomic location. In some cases, however, diagnosis can be difficult. Vaginal lesions include inclusion cysts, endometriosis, adenosis and Gartner duct cysts (benign cysts of mesonephric origin usually located on the anterolateral vaginal wall). We have encountered an interesting case in which a patient referred for treatment of a presumed Bartholin gland cyst actually had a painful 3-cm leiomyoma on the right posterolateral vaginal wall, about 1 cm proximal to the hymenal ring. In another case,² a presumed inguinal hernia was found to be a Bartholin gland cyst. If the diagnosis is in doubt, biopsy or excision of the vulvar or vaginal mass should be performed.

Management of Bartholin Gland Cysts

Normally, the Bartholin’s gland cannot be palpated. Bartholin gland cysts develop from cystic dilation of the duct following blockage of the duct orifice. They are generally 1 to 3 cm in size and are usually asymptomatic. The patient may notice a bulge in the labium majus or the cyst may be found during a routine gynecologic examination. When symptoms occur, the patient may report vulvar pain, dyspareunia, inability to engage in sports and pain during walking or sitting. Bartholin gland cysts tend to grow slowly. Since noninfected cysts are usually sterile, routine antibiotic therapy is not necessary.¹

Asymptomatic Bartholin gland cysts in patients under age 40 may not require treatment. As discussed below, some clinicians advocate excision of all Bartholin gland cysts in patients over 40 years of age because of the possibility of cancer.¹ Various treatment options are available if a cyst causes cosmetic problems or bothersome symptoms. If a patient has a Bartholin gland cyst that ruptures spontaneously, all she may need is hot sitz baths.

Occasionally, use of broad-spectrum antibiotics is indicated if secondary infection develops. Simple lancing and drainage of the Bartholin gland cyst is mentioned here only to discourage its routine use. One author³ reported an 85 percent cure rate using cyst or abscess aspiration in 34 patients after sending the aspirate for culture. We have found, however, that many cysts and most abscesses recur if treated only by aspiration. We often see patients who are referred because multiple incision and drainage procedures have been unsuccessful. Definitive methods of treatment include placing a Word catheter, marsupializing the cyst, performing a “window” procedure, using a carbon dioxide laser, applying silver nitrate to the cyst cavity or excising the entire cyst.

Word Catheter

Placement of a Word catheter (Figure 1) is a simple procedure that can be used to treat a symptomatic Bartholin gland cyst.4 (Catheter is available from Rusch Corporation, 2450 Meadowbrook Pkwy., Duluth, GA 30096; telephone: 800-553-5214.)

After local anesthesia and sterile preparation with povidone-iodine or a similar solution, a no. 11 scalpel is used to make a stab incision 1.0 to 1.5-cm deep into the cyst, preferably just inside or, if necessary, just outside the hymenal ring (Figure 2). The stab wound should not be made on the outside of the labium, however, since a permanent fistula may develop. A hemostat or similar instrument is inserted to break up any loculations, and then a Word catheter is placed. The Word catheter is a small rubber catheter with an inflatable balloon tip that is inserted into the stab wound after the cyst’s contents have been drained. The bulb is inflated with water or lubricating gel, and the free end of the catheter is tucked up into the vagina (Figure 3). (Using water or gel rather than air will prevent premature deflation of the balloon.)

We have found that placing an 18- or 20-gauge needle into the catheter’s self-sealing injection port before inserting the catheter into the incision reduces the chance of accidental needle-stick injury. The catheter is left in place for up to four weeks to permit complete epithelialization of the new tract. The patient is asked to undergo pelvic rest until removal of the catheter and is advised to abstain from sexual intercourse. The catheter is removed by deflating the balloon, and over time the resulting orifice will decrease in size and become unnoticeable.

Marsupialization

A marsupialization procedure can be performed if a cyst recurs despite treatment with a Word catheter or if the physician prefers it as a first-line technique.^5,6 Marsupialization is a relatively straightforward procedure that can be performed in the office, emergency department or outpatient surgical suite in about 15 minutes, using local anesthesia. After sterile preparation of the cyst and surrounding area, a no. 11 scalpel is used to make a vertical elliptic incision just inside or outside the hymenal ring (Figure 4, left), but not on the outer labium majus. The incision should measure about 1.5 × 1.0 cm and should be deep enough to include both the vestibular skin and the underlying cyst wall (Figure 4, right). An oval wedge of vulvar skin and underlying cyst wall should be removed. The cyst or abscess will drain. Loculations are broken if necessary; the cyst wall is sewn to the adjacent vestibular skin using interrupted 3-0 or 4-0 delayed-absorbable sutures on a small needle (Figure 5). Silver nitrate sticks or direct pressure can be used for hemostasis of the skin edge. The new tract will slowly shrink over time and epithelialize, forming a new duct orifice. The recurrence rate after marsupialization is about 10 percent.¹ The instruments used in the marsupialization and Word catheter procedures are listed in Table 2.

Word catheter	Marsupialization
Povidone-iodine solution Anesthetic solution Word catheter 18- or 20-gauge needle and 5 mL-syringe plus water or gel for inflation of catheter tip No. 11 scalpel Hemostat (for breaking up loculations) Culture media for gonorrhea, Chlamydia and routine cultures Silver nitrate sticks Gauze pads	Povidone-iodine solution Anesthetic solution No. 11 scalpel
	3-0 or 4-0 delayed-absorbable suture on small cutting needle Small needle driver Scissors Hemostats Forceps Culture media Silver nitrate sticks Gauze pads

Other Techniques

A variation on the classic marsupialization procedure is a “window operation.” In one series,⁷ clinicians treated 47 patients with Bartholin cysts or abscesses by making an incision similar in location but larger than that of a marsupialization incision, which resulted in removal of a relatively large, oval piece of the cyst wall. The cyst wall was sewn to the skin of the vestibule using interrupted 2-0 chromic catgut in a similar fashion to the marsupialization procedure. No treatment failures or complications were reported. The authors theorized that the larger opening prevented occlusion of the newly formed orifice, a feature that may make the window operation more advantageous than the marsupialization procedure.

Other techniques include incision of Bartholin gland abscesses followed by curettage of the abscess cavity,⁸ application of silver nitrate to the cyst or abscess cavity^9,10 and use of a carbon dioxide laser.¹¹ One team compared excision with silver nitrate application for the treatment of Bartholin gland abscesses and cysts and concluded that silver nitrate was as effective as excision.⁹ It would be valuable to compare silver nitrate application with a treatment option less morbid than excision, such as marsupialization or placement of a Word catheter. The carbon dioxide laser is also an effective method of treating Bartholin gland cysts or abscesses.¹¹ We believe, however, that the laser usually offers no advantage over the less expensive and less technically difficult procedures described above.

Excision

A cyst that has recurred several times despite office-based treatment may require excision. Excision of a Bartholin gland cyst is an outpatient surgical procedure that probably should be performed in an operating suite because of the possibility of copious bleeding from the underlying venous plexus (vestibule bulbs). The procedure is usually performed under conduction or general anesthesia and can result in intraoperative hemorrhage, hematoma formation, secondary infection and dyspareunia due to scar tissue formation. Therefore, patients with recurrent Bartholin gland cysts that require excision should be referred to a gynecologist or other physician experienced with this procedure.

The procedures that have been described are safe and effective; however, complications can occur. Septic shock has been reported after drainage of a Bartholin gland abscess.¹² Other potential complications include excessive bleeding, cellulitis and dyspareunia.

Management of Bartholin Gland Abscesses

A Bartholin gland abscess can be so painful that the patient is incapacitated. Common symptoms are severe dyspareunia, difficulty in walking or sitting, and vulvar pain. Signs in addition to a large, tender mass in the vestibular area are vulvar erythema and edema. Bartholin gland abscesses usually develop over two to four days and can become larger than 8 cm. They tend to rupture and drain after four to five days. In the past, Bartholin gland abscesses were thought to develop mainly from gonococcal or chlamydial infections. However, Brook¹³ reported 67 different bacterial isolates similar to the natural vaginal flora in a series of Bartholin gland abscesses. While it remains important to test for gonococcal and chlamydial infection, the polymicrobial nature of these abscesses requires broad-spectrum antibiotic coverage.

Treatment of Bartholin gland abscesses is similar to that of symptomatic cysts. If an abscess points and ruptures spontaneously, the patient may need only sitz baths, antibiotics and pain medication. In fact, it is prudent to treat early abscesses with sitz baths until the abscess points, making incision and definitive treatment easier. Placement of a Word catheter, a marsupialization or “window” procedure, application of silver nitrate to the abscess cavity, carbon dioxide laser excision and surgical excision are all acceptable options for treatment of a Bartholin gland abscess, although excision would not be the primary choice because of the risk of hemorrhage. Cultures for Chlamydia and gonococcal organisms should be obtained and a course of oral broad-spectrum antibiotics prescribed. Diabetic patients need careful observation due to their susceptibility to necrotizing infections, and consideration should be given to inpatient management of these patients.

Adenocarcinoma of Bartholin’s Gland

Adenocarcinoma of Bartholin’s gland is rare but should be considered in the differential diagnosis of labial masses.¹⁴ The incidence is highest among women in their 60s. Symptoms and signs can mimic those of benign Bartholin gland cysts and abscesses, although fixation of the gland to the underlying tissue may be noted. While some authorities have advocated excision of all Bartholin gland cysts or abscesses in women over age 40,¹ others have suggested that excision is rarely necessary in these women. In a retrospective cohort study, investigators concluded that the incidence of Bartholin gland cancer in postmenopausal women is so low (0. 114 per 100,000 woman-years) that routine excision is unwarranted; instead, women in this age group may benefit from drainage and selective biopsy.¹⁵

Since patients with adenocarcinoma of Bartholin’s gland may require radical surgery, referral to a gynecologist or gynecologic oncologist familiar with the treatment of this carcinoma may be prudent in older patients with Bartholin gland cysts or abscesses.

Pregnancy

Although none of the treatment methods discussed are contraindicated in pregnant women, the increase in blood flow to the pelvic area during pregnancy may lead to excessive bleeding when Bartholin cysts or abscesses are treated. For this reason, surgical treatment for asymptomatic cysts should probably be withheld until after delivery. If treatment is necessary because a cyst becomes infected or the patient presents with an abscess, local anesthesia is not contraindicated, and most broad-spectrum antibiotics appear safe for use during pregnancy.

Occasionally, patients present with symptomatic Bartholin gland abscesses during labor. In this situation, it seems wise to withhold treatment until after delivery if possible, since an open labial abscess theoretically places the patient at risk for endomyometritis. Unless the abscess obstructs the vagina (soft tissue dystocia), cesarean section is not indicated.

Bartholinitis: symptoms, diagnosis, treatment

Bartholinitis is an inflammation of the Bartholin gland, which is located in the vestibule of the vagina. This disease most often affects women from 20 to 35 years old, cases of the disease at an older age are quite rare.

Bartholinitis is caused by pathogenic bacteria (Trichomonas, etc.), which, when exiting the genitourinary tract or vagina, provoke the onset of inflammation. The infection can also enter through the blood. Catalysts can serve as chronic diseases such as inflammation of the kidneys, bad teeth, sinusitis. Weak immunity, stress, lack of vitamins, systematic hypothermia, medical abortions, and surgical operations can also provoke bartholinitis.

The frivolous behavior of a woman during sexual intercourse with a random change of sexual partners, when there is a high probability of pathogenic microorganisms entering directly into the gland, is also one of the causes of bartholinitis. Most often, inflammation occurs when a lady acquires some specific and well-known diseases through sexual contact. Inflammation can be provoked by candidiasis. It can be seen that there are many reasons for the occurrence of the disease.

Current

The disease goes through several stages and has the following symptoms:

• Inflammation blocks the duct in the gland. Masses of secretion accumulate in the duct, which leads to the appearance of a cyst.
• Further, it is filled with pus, inflammation passes into the gland and an abscess occurs. On external examination, this is a small painful bump in the muscles of the labia.

Symptoms

Get expert advice:

• Gynecologist

According to the severity of the disease, bartholinitis is classified as acute and chronic.

In the first case, it manifests itself as an abscess of the true and the false. When false, the first signs of bartholinitis are unilateral edema in the area of ​​the labia, pain on movement, high temperature. Further, when there is more pus, the tumor becomes larger and more painful, hyperemia occurs, that is, a false abscess. The temperature may rise to 37.5 degrees.

true abscess. In this case, the infection enters directly into the body of the Bartholin’s gland. It’s more painful. Puffiness is stronger, lymph nodes in the groin increase, sharp pains when moving. The temperature can rise up to 40 degrees. The fever is replaced by chills, the state of health worsens. Removal of pus can bring temporary relief of the condition, but no more, since the abscess is not completely emptied. It is impossible to squeeze out the abscess, as this will lead to sepsis. To avoid complications, you should consult a gynecologist.

Acute bartholinitis without treatment is guaranteed to turn into a chronic form. In this case, there is an alternation of temporary improvement and deterioration. Menstruation, reduced immunity, infectious diseases can cause exacerbations of bartholinitis. The result of a long chronic bartholinitis is a cyst.

Pregnancy and bartholinitis

an extremely undesirable situation, as it may adversely affect the child. A woman’s immunity in such a situation cannot always protect the fetus from infection and intoxication. There is a risk of intrauterine infection through the umbilical cord. Infections from Trichomonas and other bacteria can interfere with the formation of the child’s organs and systems. During these periods, infections are dangerous for the child. Therefore, for pregnant women, a visit to the doctor and immediate treatment are mandatory as soon as the first symptoms of bartholinitis appear. Vaginal infections are dangerous because the question of artificial termination of pregnancy is real here. As with any other disease, the appearance of bartholinitis is better to prevent than to treat later.

At the first signs of inflammation, you should immediately contact a gynecologist. Because the consequences of bartholinitis are dangerous for their complications:

• True abscess may occur.
• The appearance of a Bartholin gland cyst.
• Enlargement of the gland causes pain when walking. Frequent recurrences are possible, up to an abscess of the gland.
• An untimely visit to a doctor and refusal of intensive treatment usually ends with the fact that pus from the gland enters the vagina and melts deep-lying tissues. This is called diffuse phlegmon of the perineum, which is extremely dangerous.

Diagnostics

The most used types of diagnosing bartholinitis are:

1. Visual inspection is the most commonly used method for diagnosing bartholinitis. The diagnosis is determined by an external examination of the organs. Seals and the condition of the Bartholin gland are detected precisely with this method of examination.

2. The causes of the disease help to find out the study of the secretion of the gland using a microscope. As a rule, these are certain pathogenic bacteria.

3. The presence of bacteria is determined by taking swabs from the vagina.

Treatment

Treatment of bartholinitis, as well as diagnosis, is carried out by a gynecologist. With mild and moderate severity, conservative treatment is prescribed, with severe surgical treatment. With unformed bartholinitis or canaliculitis, surgical intervention can be avoided. But you should adhere to a certain regimen. Run less on the street, and it’s better to stay at home until you fully recover. Even better is bed rest, which excludes the presence of a nearby sexual partner.

With swelling, you can put a small bubble with ice wrapped in a towel on the gland area. This will help relieve inflammation and pain. It is recommended to apply tampons with levomekol, Vishnevsky ointment, ichthyol ointment to the area of ​​inflammation. Since the fight is carried out by bacteria, broad-spectrum antibiotics (ceftriaxone, amoxiclav) are needed. It is desirable to use them with antifungal agents (fluconazole). To maintain the intestinal flora, appropriate drugs and multivitamins are prescribed.

In the case when the process of inflammation nevertheless touched the gland, that is, with true bartholinitis, surgical intervention is prescribed.

There are two types of operation:

1. Complete removal of the inflamed gland is called an extirpation operation. During the rehabilitation period, sexual activity is prohibited so as not to bring the infection again.
2. Sometimes marsupialization is done, that is, the formation of a new excretory duct. Surgical intervention does not always bring the desired results, since the incisions tend to stick together quickly and relapses often occur after the operation. After a certain time, the appearance of acute bartholinitis is again possible.

Many women had to go through such operations more than once. In addition, they require a long rehabilitation period, up to one and a half weeks, and leave rather unaesthetic seams.

In this regard, special ring-shaped catheters have recently gained popularity. They are placed under local anesthesia for 2 months. The catheter passes through the body of the gland. It turns out that there was one excretory duct, and two ducts are formed. Thanks to this operation, the risk of recurrence is reduced to nothing. This operation is called marsupialization. After it, physiotherapy, magnetotherapy, ultraviolet irradiation are prescribed, which take place within 3-4 days. In general, the complete cure of the gland does not occur immediately, it takes a lot of time. Bed rest is recommended

Treatment for an abscess of the Bartholin’s gland is recommended only surgical treatment. The cavity is opened, drained, then washed with a disinfectant solution. In parallel, antibiotic therapy and physiotherapy are carried out. The disadvantage of this method is that it gives a temporary effect. The cyst may re-form as soon as the edges of the incisions heal.

Prophylaxis

Preventive measures are simple and easy to do, but following them can save a woman from recurrent bartholinitis. First of all, it is strengthening the immune system and following the rules of intimate hygiene, which includes a more puritanical attitude towards sexual intercourse. Timely treatment of various kinds of urethritis, colpitis and other female sores. You should not bring your gland to an abscess and subsequent surgical intervention.

Hygiene of the external genital organs is quite simple. After visiting the toilet, it is obligatory to wash the perineum and anus with warm water. The flow of water should go from the vagina to the anus. Before using infusions of herbs and antiseptics, it is advisable to consult a doctor. It is advisable to wear looser underwear.

It is important to remember that problems such as caries, chronic tonsillitis, pyelonephritis, colpitis and similar infectious diseases should be treated immediately. A visit to your gynecologist at least once a year for the purpose of a preventive examination is mandatory.

causes, symptoms, treatment at the NCC of Russian Railways, with a branch of the Central Clinical Hospital No. 1

Bartholinitis – this disease has another name: Bartholin’s gland abscess. The Bartholin glands are located at the base of the labia majora at the entrance to the vagina. Their function of the gland is to produce a secret necessary for normal sexual intercourse and childbirth. Bartholinitis – inflammation of the large gland of the vestibule of the vagina. It is caused more often by gonococci, staphylococci, less often by streptococci, E. coli, Trichomonas and other microorganisms that usually penetrate into the excretory duct of the gland from infected vaginal or urethral secretions.

With bartholinitis, the skin of the labia majora turns red around the outlet of the Bartholin gland. Then the excretory duct of the gland is clogged due to its edema and thickening of the secret, a cyst of the Bartholin gland occurs, with its suppuration – an abscess of the Bartholin gland.

Causes:

Inflammation in the Bartholin’s gland occurs when an infection enters it through the excretory duct. Microorganisms that enter the gland begin to grow rapidly, which causes inflammation and suppuration.

Most often, the development of bartholinitis contributes to the presence of sexual infections – gonorrhea, trichomoniasis or chlamydia. But there are also bartholinitis, which have a nonspecific etiology, caused by pathogens such as E. coli, streptococcus or staphylococcus aureus. It must be said that bartholinitis does not occur in all patients with STIs. A strong immune system plays an important role in preventing the disease, and when it is weakened, the chances of bartholinitis increase.

Symptoms:

Bartholinitis usually begins acutely, and if there is no timely treatment, the disease becomes chronic.

Acute bartholinitis may occur with the formation of a true or false abscess in the Bartholin gland.

False abscess:

With the formation of a false abscess at the initial stage of the disease, inflammation captures the excretory duct, which is called canaliculitis. The skin over the site of inflammation turns red, a pronounced swelling appears, and when pressed, a purulent liquid is released.

The next stage is the blockage of the duct, as a result of which pus cannot be discharged and begins to collect in the Bartholin’s gland. Because of this, a painful seal forms at the base of the labia majora, which prevents normal walking and movement. Patients note a strong burning sensation and pain, the temperature may rise slightly.

True abscess:

In bartholinitis with a true abscess, the infection penetrates directly into the gland itself. In this case, all the symptoms of the disease are much more pronounced, there is a pronounced edema, severe pain, high fever, and the inguinal lymph nodes increase.

Such an abscess can open without outside intervention, while pus is separated and the patient feels much better. However, the opening of the abscess does not mean a complete recovery, if bartholinitis is not treated, then a relapse is inevitable.