How are Bartholin’s cysts diagnosed. What are the common symptoms of a Bartholin’s cyst. Which treatment options are available for Bartholin’s cysts. How can you prevent Bartholin’s cysts from recurring. What are the potential complications of untreated Bartholin’s cysts.

Understanding Bartholin’s Cysts: Causes and Symptoms

Bartholin’s cysts are a common gynecological condition that affects many women throughout their reproductive years. These cysts develop when the Bartholin’s glands, located on either side of the vaginal opening, become obstructed. The blockage causes fluid to accumulate, resulting in a swollen, sometimes painful lump.

What are the typical symptoms of a Bartholin’s cyst? The most common signs include:

• A painless lump near the vaginal opening
• Discomfort when walking or sitting
• Pain during sexual intercourse
• Redness and swelling in the affected area

In some cases, Bartholin’s cysts may become infected, leading to the formation of an abscess. This can cause more severe symptoms, including fever, intense pain, and difficulty walking.

Diagnosis and Initial Management of Bartholin’s Cysts

How are Bartholin’s cysts diagnosed? Typically, a healthcare provider can identify a Bartholin’s cyst through a physical examination. In some cases, additional tests may be necessary to rule out other conditions or assess the extent of the problem.

The initial management of Bartholin’s cysts often involves conservative measures. These may include:

1. Warm sitz baths: Soaking the affected area in warm water for 10-15 minutes, several times a day
2. Pain management: Over-the-counter pain relievers like paracetamol or ibuprofen
3. Warm compresses: Applying a warm, damp cloth to the area to promote drainage and relieve discomfort

These methods can help reduce inflammation and encourage the cyst to drain naturally. However, if symptoms persist or worsen, more advanced treatment options may be necessary.

Advanced Treatment Options for Persistent Bartholin’s Cysts

When conservative measures fail to resolve a Bartholin’s cyst, healthcare providers may recommend more invasive treatments. These options aim to drain the cyst and prevent recurrence.

Balloon Catheter Insertion (Fistulisation)

This outpatient procedure involves creating a permanent drainage passage for the cyst. How is balloon catheter insertion performed?

• A small incision is made in the cyst to drain the fluid
• A balloon catheter is inserted into the empty cyst
• The balloon is inflated with saline solution
• The catheter remains in place for about 4 weeks while new cells grow around it
• After epithelialization, the balloon is deflated and the catheter removed

This technique has shown promising results, with more than 80% of women experiencing successful healing and no recurrence of cysts or abscesses.

Marsupialisation

For recurrent cysts, marsupialisation may be recommended. This surgical procedure involves:

1. Making an incision to open the cyst
2. Draining the fluid
3. Stitching the edges of the incision to create a small pouch
4. Allowing for continuous drainage

Marsupialisation is typically performed as a day case procedure under general anesthesia. Recovery usually takes about two weeks, during which patients should avoid sexual intercourse.

Managing Bartholin’s Cyst Abscesses: Antibiotics and Drainage

When a Bartholin’s cyst becomes infected and develops into an abscess, additional treatment measures are necessary. How are Bartholin’s cyst abscesses managed?

The primary approach involves:

• Antibiotic therapy to clear the infection
• Drainage of the abscess, particularly if it’s large

Drainage procedures may include those mentioned earlier, such as balloon catheter insertion or marsupialisation. In some cases, a simple incision and drainage may be sufficient to resolve the abscess.

Surgical Removal of Bartholin’s Glands: A Last Resort

In rare cases where other treatments have proven ineffective and Bartholin’s cysts or abscesses continue to recur, surgical removal of the affected Bartholin’s gland may be considered. This procedure, known as excision, is typically performed under general anesthesia and may require a short hospital stay.

What are the potential risks of Bartholin’s gland removal?

• Bleeding
• Bruising
• Wound infection
• Scarring
• Changes in sexual function or sensation

Due to these risks, gland removal is usually considered only after other treatment options have been exhausted.

Alternative Treatments and Emerging Therapies for Bartholin’s Cysts

While traditional treatments remain the mainstay of Bartholin’s cyst management, several alternative approaches have shown promise in recent years. These include:

Silver Nitrate Gland Ablation

This minimally invasive procedure involves inserting a silver nitrate stick into the cyst cavity to destroy the cyst lining. It can be performed under local anesthesia and may offer quicker recovery times compared to surgical options.

CO2 Laser Treatment

Laser therapy uses focused light energy to vaporize the cyst and create a new opening for drainage. This technique may result in less scarring and faster healing than traditional surgical methods.

Sclerotherapy

This approach involves injecting a sclerosing agent into the cyst to cause it to shrink and eventually disappear. While less commonly used, sclerotherapy may be an option for some patients who are not candidates for surgery.

Preventing Recurrence and Long-Term Management of Bartholin’s Cysts

While it’s not always possible to prevent Bartholin’s cysts from forming, certain measures may help reduce the risk of recurrence:

• Practicing good hygiene
• Wearing breathable, cotton underwear
• Avoiding irritating soaps or douches
• Maintaining a healthy diet and lifestyle
• Managing underlying conditions that may contribute to cyst formation

For women who experience frequent recurrences, long-term management strategies may include:

1. Regular check-ups with a gynecologist
2. Prompt treatment of any new cysts or signs of infection
3. Consideration of preventive measures, such as sitz baths or topical treatments

Navigating the Emotional and Physical Impact of Bartholin’s Cysts

Dealing with Bartholin’s cysts can be both physically uncomfortable and emotionally challenging. Many women experience anxiety, embarrassment, or concerns about their sexual health and relationships. How can patients cope with these challenges?

• Seeking support from healthcare providers, partners, or support groups
• Educating themselves about the condition to alleviate fears and misconceptions
• Practicing self-care and stress-reduction techniques
• Communicating openly with sexual partners about the condition and any necessary precautions

Healthcare providers play a crucial role in addressing both the physical and emotional aspects of Bartholin’s cysts, offering comprehensive care that considers the patient’s overall well-being.

In conclusion, while Bartholin’s cysts can be a troublesome condition, a range of effective treatment options is available. From conservative measures to advanced surgical techniques, healthcare providers can tailor the approach to each patient’s needs. By understanding the condition, exploring treatment options, and addressing both physical and emotional concerns, women can successfully manage Bartholin’s cysts and maintain their quality of life.

Bartholin’s cyst – Treatment – NHS

If you have a lump in the opening of your vagina, get it checked by a GP.

If it turns out to be a Bartholin’s cyst and it does not bother you, it’s often better to leave it alone.

If the cyst is painful, a GP may recommend:

• soaking the cyst for 10 to 15 minutes in a few inches of warm water (it’s easier in the bath) – it’s best to do this several times a day for 3 or 4 days if possible
• holding a warm compress (a flannel or cotton wool warmed with hot water) against the area
• taking painkillers, such as paracetamol or ibuprofen

Always read the manufacturer’s instructions when using medicine you buy from a pharmacy or supermarket.

Treating an abscess

If the cyst becomes infected and an abscess (a painful collection of pus) develops, you may be prescribed antibiotics to clear the infection.

Once the infection has been treated, a GP may still recommend having the cyst drained, particularly if the abscess is large.

Draining cysts and abscesses

A number of techniques can be used to drain a Bartholin’s cyst or abscess and reduce the likelihood of it returning.

Balloon catheter insertion

Balloon catheter insertion, sometimes known as catheter placement or fistulisation, is a procedure used to drain the fluid from the abscess or cyst.

A permanent passage is created to drain away any fluid that builds up in the future. This is an outpatient procedure, which means you will not need to stay in hospital overnight.

It’s usually carried out under local anaesthetic, where you remain conscious, but the area is numbed so you cannot feel anything. It can also be carried out under general anaesthetic, where you’re unconscious and unable to feel anything.

A cut is made in the abscess or cyst and the fluid is drained. A balloon catheter is then inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

Once inside the abscess or cyst, the balloon is filled with a small amount of salt water. This increases the size of the balloon so it fills the abscess or cyst. Stitches may be used to partially close the opening and hold the balloon catheter in place.

The catheter will stay in place while new cells grow around it (epithelialisation). This means the surface of the wound heals, but a drainage passage is left in place. 

Epithelialisation usually takes around 4 weeks, although it can take longer. After epithelialisation, the balloon will be drained and the catheter removed.

A few small studies have reported more than 8 out of 10 of women healed well and their cysts or abscesses did not return after balloon catheter insertion.

Possible complications of balloon catheter insertion include:

• pain while the catheter is in place
• pain or discomfort during sex
• swelling of the lips (labia) around the opening of the vagina
• infection
• bleeding
• scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used.

The cyst is first opened with a cut and the fluid is drained out. The edges of the skin are then stitched to create a small “kangaroo pouch”, which allows any further fluid to drain out.

When the procedure is complete, the treated area may be loosely packed with gauze to soak up fluid from the wound and stop any bleeding. This will usually be removed before you go home.

Marsupialisation takes about 10 to 15 minutes and is usually performed as a day case procedure, so you will not have to stay in hospital overnight. It’s usually carried out under general anaesthetic, although local anaesthetic can be used instead.

Although complications after marsupialisation are rare, they can include:

• infection
• the abscess returning
• bleeding
• pain – you may be given painkillers for the first 24 hours after the procedure

After marsupialisation, you’ll be advised to take things easy for a few days. You should avoid having sex until the wound has completely healed, which usually takes about 2 weeks.

Removing the Bartholin’s gland

Surgery to remove the affected Bartholin’s gland may be recommended if other treatments have not been effective and Bartholin’s cysts or abscesses keep coming back.

This operation is usually carried out under general anaesthetic and takes about an hour to complete. You may need to stay in hospital for 2 or 3 days afterwards.

Risks of this type of surgery include bleeding, bruising and infection of the wound. If the wound does become infected, this can usually be treated with antibiotics prescribed by a GP.

Alternative procedures

There are a number of alternative ways of treating a Bartholin’s cyst, but they’re less commonly used or are not widely available.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used to burn (cauterise) blood vessels to stop bleeding.  A small, solid stick of silver nitrate is used in silver nitrate gland ablation.

A cut is made in the skin surrounding the vagina and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the empty space left after draining the fluid.

The silver nitrate causes the cyst cavity to form into a small, solid lump. After 2 or 3 days the silver nitrate and cyst remains are removed or may fall out on their own.

It’s possible for the silver nitrate to burn some of the skin of the vulva when it’s first used. One small study reported this occurs in about 1 in 5 of those who receive this treatment.

Carbon dioxide laser

A carbon dioxide laser can be used to create an opening in the skin of the vulva so the cyst can be drained.

The cyst can then be removed, destroyed using the laser, or left in place with a small hole to allow fluid to drain from it.

Needle aspiration

During needle aspiration, a needle and syringe are used to drain the cyst. It is sometimes combined with a procedure called alcohol sclerotherapy, where the cavity is filled with a 70% alcohol liquid after being drained. This is left in the cyst cavity for 5 minutes and then drained out.

Advice after surgery

To help the wound heal and reduce the risk of infection after surgery, you may be advised to avoid:

• having sex and using tampons for up to 4 weeks
• using perfumed bath products for up to 4 weeks
• driving or performing tasks that need careful attention for 24 to 48 hours after having a general anaesthetic

Page last reviewed: 26 October 2021
Next review due: 26 October 2024

Bartholin’s Abscess: Causes, Diagnosis, and Treatments

A Bartholin’s abscess can occur when one of the Bartholin’s glands, located on either side of the vaginal opening, develop an infection. When the gland is blocked, a cyst will usually form. If the cyst becomes infected, it can lead to a Bartholin’s abscess.

A Bartholin’s abscess can be more than an inch in diameter. It usually causes significant pain. While most people with a Bartholin’s abscess completely recover, in some cases the cyst will return and become infected again.

Women of childbearing age are the most affected population. Nearly 2 percent of women will experience a Bartholin’s abscess in their lifetime.

There are two Bartholin’s glands, each about the size of a pea. The glands sit on either side of the opening of the vagina. They provide lubrication to the vaginal mucosa.

Doctors believe that bacteria, such as E. coli, and sexually transmitted diseases (STDs), such as chlamydia or gonorrhea, may cause the infections that can lead to a Bartholin’s abscess. If bacteria get into the gland, swelling, infection, and an obstruction may occur.

When fluid builds up in the gland, pressure increases on the area. It may take years for fluid to build up enough to form a cyst, but an abscess can form quickly after.

If the infection and swelling advance, the gland may abscess, which breaks open the skin. A Bartholin’s abscess tends to be very painful. It usually only occurs on one side of the vagina at a time.

A Bartholin’s abscess usually causes a lump to form under the skin on one side of the vagina. A Bartholin’s abscess will often cause pain during any activity that puts pressure on the area, such as walking, sitting down, or having sexual intercourse.

A fever may also accompany the abscess. The area of the abscess will likely be red, swollen, and warm to the touch.

To determine if you have a Bartholin’s abscess, your doctor will perform a physical exam. They will check for any lumps within the vagina that could indicate an abscess. They may also take a sample from the area to check for any STDs. STDs will need to be treated along with the abscess.

If you’re over the age of 40 or have already gone through menopause, your doctor may want to perform a biopsy on any masses found in the vagina to rule out other potential conditions. In rare cases, a Bartholin’s abscess can indicate cancer.

In its early stages, a Bartholin’s abscess can sometimes be treated at home using a sitz bath. A sitz bath is a warm, shallow bath you can give yourself in your bathtub or with a sitz bath kit. Soaking may not cure the abscess, but it can help ease your pain and discomfort.

To treat a Bartholin’s cyst, which can lead to an abscess, the Mayo Clinic recommends soaking in three or four sitz baths a day, for at least 10 to 15 minutes each.

It may take many days of sitz baths to treat an abscess because the opening of the Bartholin’s gland is very small, and it may close before drainage is complete.

Other home treatments for cyst care may help the abscess drain and heal on its own. Using a mix of tea tree and castor oil as a topical ointment on the abscess may promote drainage. Tea tree oil is known for its antibacterial properties, which may help clear an infection. Castor oil is thought to promote blood circulation in the affected area, which can reduce inflammation.

You can apply the tea tree and castor oil with a piece of gauze. Adding a hot compress on top of the gauze may make this remedy even more effective.

If you think you may have a Bartholin’s abscess, see your doctor. You can try sitz baths and cyst care at home, but the condition is unlikely to go away without medical treatment.

Typically, the abscess needs to be drained through surgery. In most cases, you can have this procedure at your doctor’s office under local anesthesia. General anesthesia in a hospital is also an option. Talk to your doctor about the best choice for you.

During the surgery, your doctor will make an incision in the abscess and place a catheter inside to drain the fluid. The catheter may remain in place for several weeks. Once the abscess heals, your doctor will remove the catheter or allow it to fall out on its own.

Since the abscess is likely the result of an infection, your doctor may prescribe antibiotics. However, antibiotics may not be necessary if the abscess drains properly.

It’s common for Bartholin’s abscesses to recur. If, after your treatment, the Bartholin’s abscess comes back repeatedly, your doctor may suggest a procedure called marsupialization.

Marsupialization is a surgery that’s similar to the other drainage procedure. But instead of allowing the incision to close, your doctor will stitch the incision open to allow for maximum drainage. They may use a catheter or pack the abscess with a special type of gauze that they will then remove the next day. Local anesthesia is an option during a marsupialization. The procedure can also be performed under general anesthesia. Your doctor will treat any infection present with antibiotics before the surgery.

If these treatments don’t stop the Bartholin’s abscess from recurring, your doctor may recommend having your Bartholin’s glands removed. This surgery is rare and requires general anesthesia in a hospital setting.

There’s no definitive way to prevent a Bartholin’s abscess. But practices such as safe sex, condom use, and good hygiene will help keep bacteria out of the area, which can help prevent infection. It’s also important to find out if you have an STD, and seek necessary treatment.

Maintaining a healthy urinary tract may also help prevent Bartholin’s cysts and abscesses from developing. Drink plenty of fluids throughout the day, and avoid waiting a long time to urinate. Cranberry supplements may help support good urinary tract health.

If a Bartholin’s abscess worsens and goes untreated, the infection could spread to other organs in your body. The infection may enter your bloodstream, a condition called septicemia. This condition is dangerous because the infection can be carried throughout your whole body.

If you have a fever over 103ºF, it’s important to seek medical attention. You should also seek medical help if the abscess ruptures abruptly, or if the pain doesn’t subside.

If you think you may have a Bartholin’s abscess, see your doctor. It’s especially important to seek medical care if you have a fever or if the pain starts interfering with your daily activities.

Once the abscess has drained, recovery time is minimal. Most women feel better within 24 hours after a Bartholin’s abscess has drained.

If your abscess needs surgical removal, your recovery time will vary depending on the details of your procedure. Expect to spend the first few days after the surgery reclining as much as possible. Be sure to rest and follow your doctor’s instructions. It’s important to let any incisions heal completely, and to take any antibiotics your doctor prescribes.

You should have no lasting effects from the abscess once it’s successfully treated, aside from possible skin scarring related to the treatment procedure.

symptoms, diagnosis, treatment of bartholinitis, cysts or abscess of the Bartholin gland – Department of Gynecology – State Hospital NCC No. 2 (CCH RAS)

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Bartholinitis (abscess of the Bartholin’s gland, Bartholin’s cyst) – a disease in which the Bartholin’s glands become inflamed. These glands are located on both sides of the vagina in the region of the labia minora (on the eve of the vagina). Their main function is to maintain the moisture of the entrance to the vagina during intercourse. The excretory ducts of the glands open to the surface of the labia minora. When the ducts are infected (sexually transmitted infections – gonorrhea, trichomoniasis and chlamydia, less often – gonococci, streptococci, staphylococci, Escherichia coli and other microorganisms), their inflammation occurs, which can later spread to the entire gland and surrounding tissues. In most cases, only one gland becomes inflamed, i.e. the inflammatory process is unilateral.

Causes of development of bartholinitis – infection through the excretory ducts of the Bartholin glands. It contributes to:

• Poor hygiene of the genitals;
• Unprotected sex;
• Sexual contact during menstruation;
• The presence of diseases such as colpitis, urethritis, the presence of sexually transmitted diseases;
• Reduced immunity.

Symptoms of acute bartholinitis

• Swelling and redness on the labia minora;
• Appearance of a lump on the labia minora; compaction is painful when pressed;
• Swelling and hardening of the labia majora on the side of inflammation;
• Discomfort and pain in the labia while walking, intercourse, contact with clothing;
• Fever;
• Enlargement of lymph nodes in the groin.

Bartholinite forms

Depending on the volume and localization of the affected area, such forms of bartholinitis are distinguished as:

Canaliculitis – the infection got into the excretory duct of the gland and caused its inflammation, there are no pronounced symptoms

Bartholin’s gland cyst – with a clogged excretory canal, the secretion of the gland accumulates in the formed cavity due to the lack of outflow, there is no suppuration of the tissues of the gland itself and the surrounding tissue.

Abscess of Bartholin’s gland – tissues of Bartholin’s gland and surrounding cellular tissue are involved in the inflammatory process.

Chronic bartholinitis

In the chronic form, the disease periodically worsens under the influence of factors such as hypothermia, decreased immunity, menstruation, etc. Outside of exacerbation, mild pain from the affected gland, discomfort during intercourse may appear. During the period of exacerbation, symptoms similar to those of acute bartholinitis occur.

Diagnosis of bartholinitis

Diagnosis is based on examination data. At the same time, to select the most effective treatment, the doctor may prescribe such studies as a general blood test, urine; examination for urogenital infections, laboratory examination of the secretion of the Bartholin gland or pathological discharge from it, and others.

Treatment of bartholinitis

In most cases, after determining the cause that caused the development of bartholinitis, antibacterial therapy is selected taking into account the sensitivity of microorganisms to antibiotics, the inflamed area is treated with antiseptic agents, and a course of physiotherapy can be prescribed.

Treatment of an abscess of the Bartholin gland is predominantly surgical – an opening, drainage and treatment of the cavity is performed, if necessary, drug therapy is prescribed. Gynecologists at the NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) will select the most effective and quick treatment for bartholinitis. Treatment of a Bartholin gland cyst is also mainly surgical, outside the period of exacerbation.

Removal of cysts of Bartholin’s gland and Opening of abscess of Bartholin’s gland is possible in a day hospital (without daily hospitalization).

Drainage of abscesses of the female genital organs

The most common localization of abscesses in the vulva is an abscess of the Bartholin gland. Inflammation of the Bartholin’s gland leading to an abscess is most often the result of a gonorrheal infection. Gonorrheal inflammation affects almost exclusively the excretory duct of the gland; the gland itself remains unaffected. The inflamed excretory duct is filled with pus, its opening swells and sticks together, as a result of which the pus cannot pour out. The accumulated pus stretches the excretory duct of the gland and turns it into a false abscess. Suppuration usually does not occur in the surrounding connective tissue. If pyogenic microorganisms join the gonococci, then the gland itself can fester, and then a true abscess of the Bartholin gland is formed. The disease occurs when infectious agents enter the Bartholin gland. The most common are sexually transmitted diseases: gonorrhea, trichomoniasis, chlamydia.

There are also bartholinitis caused by other pathogens:

• staphylococci,
• streptococci,
• E. coli,
• candida
• and others.

However, most often the disease is caused by an association of two or three infections. As a rule, pathogens enter the duct of the Bartholin gland from the urethra or vagina during urethritis and / or colpitis. However, sometimes it is possible for an infection to enter directly into the gland itself with a blood or lymph flow. Non-compliance with the rules of personal hygiene (especially during menstruation) contributes to the infection entering directly into the duct of the gland. “for infection. Wearing tight underwear disrupts the normal outflow of gland secretions, so it stagnates, creating ideal conditions for a pathogen to enter the gland duct. A promiscuous sex life at times increases the likelihood of infection with sexually transmitted diseases. The presence of foci of chronic infection (caries) in the body , pyelonephritis). In this case, pathogens enter the Bartholin’s gland with blood or lymph flow. Impairment of the immune system, general or local hypothermia, lack of vitamins leads to a decrease in protective factors in the body. This contributes to the entry of infectious agents both directly into the gland itself and into its duct. Surgical interventions on the urogenital area (for example, abortion) performed in violation of health standards during manipulation, as well as with non-compliance with the rules of the postoperative period.

Types and symptoms

The disease begins acutely: there is severe pain in the region of the labia majora, in which an abscess has developed. The pain intensifies when walking, sitting, during intercourse and passing stools. The body temperature rises to 38-39 ° C, fatigue, weakness and chills appear. There is swelling of the labia majora on the side of the lesion. Moreover, sometimes it is so pronounced that it closes the entrance to the vagina. The appearance of a fluctuation (softening of the swelling) indicates that a true abscess of the Bartholin gland has developed, and a purulent capsule has formed in its cavity. The woman’s condition worsens: the body temperature rises to 40 ° C, phenomena of intoxication (weakness, chills, headache). Pain in the region of the labia majora, in which the cyst has formed, intensifies, acquiring the character of a constant pulsating.

Local changes

Severe swelling (edema) of the labia majora on the side of the lesion, which sometimes reaches up to 5-7 cm in diameter. The abscess can open on its own. At the same time, the general condition of the woman improves: the body temperature drops, swelling and pain decrease.

Diagnosis

Recognition of a typical false abscess is not difficult. An abscess differs from a Bartholin gland cyst in pain and soreness when palpated, redness in the area of ​​​​the opening of the excretory duct of the gland. This redness is often accompanied by swelling of the skin. Furuncles, sometimes localized in this area, rarely reach such a size as an abscess of the Bartholin gland; in addition, boils lie more superficially. With a hematoma, which has a characteristic color and is the result of an injury, as evidenced by anamnestic data, it is, of course, difficult to mix an abscess. In the same way, it is difficult to mistake a hernia of the pudendal lip for an abscess of the Bartholin’s gland.

Treatment

Abscess opening technique. The preparation of the operating field is normal. The hair on the external genital organs is shaved, the vagina is washed with some disinfectant solution (potassium permanganate solution, etc. ) and, in order to avoid contamination with pus, it is tamponed with a strip of sterilized gauze. For anesthesia, we usually use ether or chloroethyl stunning. The incision area is smeared with iodine tincture. The incision should be made large and brought to the lower pole of the abscess, otherwise pockets will remain in which pus will accumulate, resulting in a purulent fistula that does not heal for a long time. The incision is made in the place of the clearest fluctuation, where the tissue covering the abscess is most thinned. After the pus has flowed out, the abscess cavity is sprinkled with white streptocide or wiped with a small tupfer moistened with iodine tincture; then a strip of gauze or a thin rubber tube is inserted into the cavity so that the hole does not close prematurely. At the end of the operation, the end of the gauze strip is removed, and a day later it is completely removed. A gauze and cotton pad is placed in front of the vulva to absorb the pus flowing from the wound.