Pictures of labia minora cysts: Bartholin’s Cysts, Treatment, Causes, Pictures, Symptoms, Popping & Drainage

14.11.197320.09.2021 by alexxlab

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Brittany’s Cancer Survivor Story | CDC

“You know your body better than anyone. If there are any changes, get it checked out.”

—Brittany R., Vulvar Cancer Survivor
Age at diagnosis: 28

I am a captain in the United States Air Force and have been married to my high school sweetheart for 5 years. I am the happy pet parent to an Australian Shepherd and a Collie. My husband and I live in Montana, and I enjoy running, skiing, and reading in my free time.

In September 2015, I was completing Squadron Officer School (SOS) when I noticed a lump on my vulva one day when getting out of the shower. I didn’t pay much attention to it at first because I thought maybe I had pulled something during training. I was in great physical health, having just accomplished a Commanders Challenge, and besides the lump, I had no other symptoms.

After I graduated SOS, I noticed the lump on my vulva was still there, it was growing, and it was uncomfortable when I wore jeans. It was at this point that I decided to get it looked at by my doctor.

I was diagnosed in November 2015 with a Bartholin’s cyst and was scheduled to have a quick outpatient procedure to drain it. (Editor’s note: The Bartholin’s [BAHR-toe-linz] glands are located on each side of the vaginal opening. These glands secrete fluid that helps lubricate the vagina. Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin’s cyst.) However, when the doctors cut into the cyst, no liquid came out, and instead they found a solid mass. They decided to biopsy the tissue, and I feared the results would come back indicating I had cancer. A few days later, the biopsy results showed I had a ruptured polyp—no cancer!

Because the mass was about 6 cm, we decided to do outpatient surgery and send it to pathology. I had my surgery on February 2, 2016, and two weeks later I had a follow-up appointment to ensure I was healing properly. I had been skiing since the surgery and was looking forward to an upcoming vacation to the Caribbean. I was hoping to get good news, so I could go swimming. My doctor told me I was healing well, but that he wanted to talk about my pathology results. I was not worried because I had already been told it wasn’t cancer.

As it turned out, my margins tested positive for sarcoma of the vulva and I was referred to a specialist. (Editor’s note: Soft tissue sarcoma is a cancer that starts in soft tissues of the body, including muscle, tendons, fat, lymph vessels, blood vessels, nerves, and tissue around joints.) Less than a month later, I had a radical, partial vulvectomy. Part of my vulva was removed as well as some tissue around it. Luckily the cancer had not spread. Since the surgery, I have received good results during medical checkups.

I am still learning to deal with my vulvar cancer diagnosis every day. Not a day has gone by that I have not thought about what happened or researched it more to see if there’s any new information about it. While all women are at risk for vulvar cancer, very few will get it. I have had a hard time dealing with the why and how did it happen to me. Besides being a woman, I did not have any of the factors generally associated with a higher risk for vulvar cancer, nor have I ever had an abnormal Pap test.

Since my diagnosis, I have shared my story with others and have tried to advocate as much as possible to bring awareness to this cancer. I was lucky. I was able to return to work and strengthen my relationships with those closest to me. I will always have that fear this cancer could come back or that I get a different type of cancer, but I am living in the here and now.

When I tell my story, my message to other women is that you know your body better than anyone. If there are any changes that you cannot possibly connect the dots to how or why something happened, get it checked out. I am a strong believer that early diagnosis saved my life.

Causes, Treatment, Symptoms & Removal

Overview

A Bartholin cyst developing on the Bartholin gland on the labia.

What is a Bartholin cyst?

A Bartholin cyst (or vulvar cyst) is a type of vaginal cyst that forms on either side of the labia (vaginal lips) near the opening of the vagina. It’s named after the Bartholin glands, which are two small glands that produce the fluid (mucus) that help lubricate the vagina. The labia and Bartholin’s glands are part of the vulva in the female reproductive system.

A Bartholin cyst occurs when a blockage happens at the openings of one of these glands, causing the mucus to build up and form a lump. It typically only occurs on one of the two Bartholin glands. Some Bartholin cysts are small and don’t cause any pain. If the cyst becomes infected with bacteria, an abscess can form. When infected, Bartholin cysts can be painful and may require medical treatment.

What does a Bartholin cyst look like?

Bartholin cysts will look like round bumps under the skin on the lips of your vagina (labia). They’re often painless. Some may become red, tender and swollen if an infection occurs. Other Bartholin cysts may look like they are filled with pus or fluid. Bartholin cysts can be as small as a pea or grow as large as a golf ball. The cyst may make one side of your labia appear larger or look lopsided.

Who gets Bartholin cysts?

Bartholin cysts will occur in about 2% of all women at some time in their life. They are more common in women of reproductive age. The chance of developing a Bartholin cyst decreases after menopause.

Symptoms and Causes

What causes a Bartholin cyst?

Healthcare providers do not know why some women are predisposed to getting Bartholin cysts. Some causes of Bartholin cysts are:

What are the symptoms of a Bartholin cyst?

Many Bartholin cysts are small and do not cause symptoms other than minor irritation. If a Bartholin cyst forms an abscess (infection), symptoms may include:

Discomfort and pain during sex, walking, sitting, or when inserting a tampon or wiping after using the restroom.
Swelling and tenderness in the area.
Fever or chills.
Redness.
Drainage from the cyst.
Change in size (the cyst gets larger).

Is a Bartholin cyst contagious?

Most Bartholin cysts do not become infected and can’t spread during skin-to-skin contact. Sexually transmitted infections (STIs) could be a cause of Bartholin cysts. These are contagious.

Are Bartholin cysts caused by an infection?

Bartholin cysts can be caused by E. coli and other bacterial infections or sexually transmitted infections (STIs) like gonorrhea and chlamydia. These bacteria can clog the Bartholin gland and lead to a cyst.

Diagnosis and Tests

How is a Bartholin cyst diagnosed?

To diagnose a Bartholin cyst, a healthcare provider will do a physical exam. They will look at the size of the cyst and look for signs of infection. If the cyst produces discharge, your healthcare provider may test the fluid for sexually transmitted infections (STIs) or other bacterial infections.

Are there any other tests done to diagnose Bartholin cysts?

In women older than age 40, healthcare providers may perform a test called a biopsy to rule out cancer of the vulva. During this test, your healthcare provider will remove a small sample of tissue from the cyst and look at it under a microscope.

A Bartholin gland cyst may need to be surgically removed if your healthcare provider feels it may be cancerous. It’s rare for cancer to develop in the Bartholin gland, however, it’s more common if you are over the age of 60.

Management and Treatment

What are the treatments for a Bartholin cyst?

Treatment for Bartholin cysts depends on the symptoms. If a cyst is small, painless and doesn’t appear infected, it may not need treatment.

If symptoms persist or the cyst grows, then you may be developing an abscess (infection). In severe cases, abscesses may need surgically drained.

Treatment options may include:

Sitz baths: Sit in a bathtub with 3 to 4 inches of warm water a few times a day for several days. This can provide comfort and promote healing. It could also help the infected cyst to burst and drain on its own.
Over-the-counter pain medications: Take as directed for pain relief and discomfort.
Antibiotics: If your cyst becomes infected or tests show you have a sexually transmitted infection (STI), your healthcare provider may prescribe antibiotics.
Surgical draining: If your cyst is large and infected, surgery may be done to drain the fluid. A small tube called a catheter will be inserted into the cyst. The catheter is usually left in place for several weeks to allow for complete drainage.
Marsupialization: The cyst is surgically opened and drained. Then, the surgeon will stitch the edges of the cyst wall to form a permanent open pocket or “pouch” for continuous drainage. This is often helpful for recurrent Bartholin cysts.
Removal of the Bartholin’s gland: In extremely rare cases where treatment is not working, your healthcare provider may surgically remove the Bartholin glands.

Treatment for a Bartholin cyst should be directed by your healthcare provider. Even if it’s a treatment option that can be done at home, it’s best to talk to your provider first. Do not try to drain or squeeze a cyst as this could cause infection and make your symptoms worse.

How do I manage the symptoms of a Bartholin cyst?

To manage the symptoms of a Bartholin cyst, at-home remedies like soaking in a warm bath several times a day (a sitz bath) and taking over-the-counter pain relievers can help with discomfort. Bartholin cysts have a good chance of resolving on their own without medical treatment. If the cyst becomes painful or infected, contact your healthcare provider.

Do Bartholin cysts go away on their own?

It is common for Bartholin cysts to resolve on their own. Most healthcare providers will recommend sitz baths to manage symptoms. If a cyst drains or bursts on its own, this is OK. Keep the area clean and dry to minimize the spread of infection. Do not squeeze or drain a Bartholin cyst yourself as this can cause infection. Contact your healthcare provider if the cyst becomes painful, infected or lasts several weeks without signs of improvement.

How long does a Bartholin cyst last?

The length of time you can expect to have a Bartholin cyst varies depending on its size and if becomes infected. Typically, cysts resolve completely within a few weeks. Once the cyst has been examined, your healthcare provider will be able to estimate how long your symptoms will last.

What comes out of a Bartholin cyst when it opens?

A Bartholin cyst could be filled with pus, mucus, bacteria, blood or other fluid. This discharge can be thick and range in color from light yellow to brown or red. Infected Bartholin cysts could have an unpleasant odor when it ruptures. It is important to keep the area clean and practice good hygiene in the affected area.

Should I pop a Bartholin cyst?

You should never squeeze, pop or insert sharp objects like needles into a cyst to force it to open. This can cause injury and spread infection. It is normal for a Bartholin cyst to drain on its own after several days of treatment (like after sitz baths or with antibiotics).

Prevention

Can a Bartholin cyst be prevented?

Healthcare providers don’t know why most Bartholin cysts occur, so you usually can’t prevent them. You can reduce your risk of developing a cyst caused by STIs (sexually transmitted infections) by using a condom during sex. Good hygiene practices can help prevent infection of a cyst before it forms an abscess.

How can I reduce my risk of getting a Bartholin cyst?

You can’t prevent a Bartholin cyst from developing, but you can reduce your risk for complications that cause infections like maintaining good hygiene practices and wearing condoms during sex.

Can a Bartholin cyst keep coming back?

Yes, there are some women who get recurring Bartholin cysts. Healthcare providers are not sure why this happens. Bartholin gland cysts are relatively easy to treat, but your healthcare provider may need more intense treatment for recurring cysts.

Living With

When should I call the healthcare provider?

Contact your healthcare provider if you have a painful lump on either side of your labia that does not resolve within a few days of at-home care — for example, taking a sitz bath. If you suspect infection or if your pain is severe, make an appointment with your healthcare provider.

If you are older than 40, a cyst on your vagina could be a sign of a more serious issue. In this case, contact your healthcare provider immediately.

Frequently Asked Questions

Can a hormone imbalance cause a Bartholin cyst?

Hormone shifts and imbalances due to menstruation (getting your period) can cause vaginal dryness and other symptoms. It does not appear that this can cause a Bartholin cyst.

Does endometriosis cause Bartholin cysts?

Bartholin cysts are not caused by endometriosis. If you have concerns about the side effects of endometriosis, talk to your healthcare provider.

Can stress cause a Bartholin cyst?

It is not known if stress can cause Bartholin cysts. The cause of Bartholin’s cysts can be bacterial infections, sexually transmitted infections or injury to the vaginal area.

Is a Bartholin cyst an STD?

A Bartholin cyst is not a sexually transmitted disease (STD). One of the causes of a Bartholin cyst is sexually transmitted infections (STIs), but the cyst itself is not considered an STI or STD.

A note from Cleveland Clinic

If you feel a painful lump in your vaginal area, contact your healthcare provider so they can examine you for infection. Be open about your symptoms and any concerns you have. They will be able to diagnose and treat you after an exam of the area.

Bartholin Cyst – Common Female Concerns – Virginia

Back to Common Female Concerns

What is a Bartholin’s gland cyst?

A Bartholin’s gland cyst is a fluid-filled swelling of a Bartholin’s gland. Bartholin’s glands are two small glands located on each side of the opening of the vagina (birth canal). They each have a small duct (tube) that opens to the outside. The glands produce a fluid that helps protect the tissues around the vagina and provides lubrication during sexual intercourse. Normally these glands cannot be felt or seen.

How does it occur?

A cyst may develop when the duct of one of the glands becomes swollen and blocked. Injury, irritation, or infection may cause a buildup of fluid and swelling that blocks the duct.

What are the symptoms?

The symptoms are swelling, tenderness, discomfort during sexual intercourse, or sometimes pain.

How is it diagnosed?

You will need to have a pelvic exam. The symptoms that you notice will be a swollen area at the opening of the vagina. The swelling will be diagnosed as a cyst if it is not painful. If it is painful and infected, it is called a Bartholin’s gland abscess.

How is it treated?

Sometimes the cyst will go away if you put warm, moist cloths (compresses) on it or sit in warm baths. The moist heat can help unblock the opening so that the fluid can drain out. Nonprescription medicine such as aspirin, acetaminophen, or ibuprofen may help relieve the pain. You should not try to squeeze or lance the cyst as that could cause an infection.

Dr. Hardy may decide to create a small cut over the gland, making an opening so fluid can drain out from the cyst. He may then sew the opening in a way that leaves it open but helps prevent it from tearing and getting bigger. This is usually done with a local anesthetic so that you don’t feel pain during the procedure. This treatment is called marsupialization.

Dr. Hardy may make a tiny cut in the cyst and insert a catheter (a very small tube) into the cyst for a few weeks. The catheter helps form a way for fluid produced by the gland to drain. The catheter may fall out on its own or Dr. Hardy will remove the catheter in 4 to 6 weeks. The passageway should stay open after the catheter is removed, preventing another cyst.

A cyst may become infected. It may form an abscess and become very painful. If a cyst is infected, Dr. Hardy may drain it and prescribe an antibiotic.

Sometimes the whole gland needs to be surgically removed, especially if the cyst often comes back. The Bartholin’s gland can be removed without damage to that area of the vaginal opening. You can have sexual intercourse without the gland. This will be done as an outpatient surgery.

How can I help take care of myself?

Follow all instructions given by Dr. Hardy

Call the office if you have any of these signs of infection:

redness around the cyst

fever

pain

more swelling.

How long will the effects last?

With the treatment of warm compresses, the cyst may go away in 3 to 5 days. Sometimes the cyst does not go away with this treatment.

The cyst usually goes away almost immediately after Dr. Hardy makes an incision for drainage. A cyst may recur over and over again if the whole gland is not removed.

How can I help prevent a Bartholin’s gland cyst?

Make sure you keep the area of the vagina clean with mild soap and warm water.

Avoid hard or deep rubbing in the area around the opening of the vagina.

If you take long bike rides or ride horses a lot, try to protect your genital area by cushioning it with soft padding.

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symptoms, causes, treatment and surgery

Concerned about a soft lump near or inside your vagina? Finding a lump anywhere on your body can be disconcerting, but try not to worry. Vaginal cysts are a common type of vaginal lump and they’re usually harmless. There are several types of vaginal cysts and they don’t usually cause any symptoms. They can sometimes become painful or infected, in which case they need medical treatment.

We spoke to Dr Shirin Lakhani from Elite Aesthetics and Dr Deborah Lee, sexual and reproductive healthcare specialist at Dr Fox Online Pharmacy about vaginal cyst symptoms, types, treatment and surgery options:

What is a vaginal cyst?

Vaginal cysts are sac-like pockets of air, fluid, or pus located on or just under the vaginal lining and while they sound ominous, they’re usually nothing to worry about. ‘Vaginal cysts are just another type of growth that people get’, says Dr Lakhani.

Vaginal cysts can be present from birth, or develop in childhood or adulthood. The good news is vaginal cysts are benign, non-cancerous and rare, with a prevalence of less than 1 per cent. Whether or not your cyst develops into a larger growth or remains undetected is largely luck of the drawer. ‘Some are so small you can hardly see them and some can grow to the size of a tennis ball,’ says Dr Lakhani.

Vaginal cyst symptoms

Most people will not experience any symptoms if they have a vaginal cyst. You might discover a cyst by chance. It might also be something that a doctor or nurse spots when examining you for another reason such as during a cervical screening (smear) test.

Vaginal cysts can however cause any of the following symptoms:

Discomfort or difficulty inserting a tampon.
Discomfort when having sex.
A feeling of pressure or fullness from a large cyst.
Pain if a cyst has become infected.

Should you see your doctor about a vaginal cyst?

If you suspect you have a vaginal cyst or are experiencing any pain or discomfort in your vaginal area, make an appointment with your GP so that it can be investigated.

Your doctor will ask you how long the cyst has been present and whether it is causing any symptoms. They may also ask whether you have had any changes in your menstrual cycle, any unusual discharge or bleeding and whether you have had any new sexual partners. ‘Your doctor or specialist will usually carry out an examination to ascertain what type of cyst it is,’ says Dr Lakhani.

If you suspect you have a vaginal cyst or experience any discomfort, make an appointment with your GP.

If the cyst is on the outside, then an external examination may be sufficient. However, if the cyst is inside the vagina, a device called a speculum may be inserted into the vagina to open up the tissues slightly and give a clear view of the vaginal walls. This type of examination should not cause pain but can sometimes feel a little uncomfortable, especially if you feel nervous and tense. Be sure to let the doctor know how you are feeling.

The doctor or nurse may take some swabs to check for vaginal infections. If they are unsure about the diagnosis they will refer you to a specialist who has further access to tests such as scans or biopsies where a small sample of the cyst tissue is taken and looked at under the microscope to reach a diagnosis.

Vaginal cysts types and causes

There are several types of vaginal cysts and they can be caused by a number of factors including injury during childbirth, fluid buildup in the glands of the vaginal and vulval tissues, or benign (non-cancerous) tumours within the vagina, according to Dr Lakhani.

While vaginal cysts are nothing to worry about, finding a lump anywhere on your body can be disconcerting so if you’re not sure, make an appointment with your GP.

The following are the most common types of vaginal cysts and their specific causes:

• Vaginal inclusion cysts

Vaginal inclusion cysts are the most common type of vaginal cysts, they can result from injuries sustained in childbirth. They are usually very small so you might not even notice if you have them.

• Gartner duct cysts

Gartner’s duct cysts are benign lesions that are found in about 25 per cent of adult women and sometimes develop into a cyst. ‘These are due to the embryonic remnants of Gartner’s duct when your body was formed in utero,’ says Dr Lee.

• Bartholin’s cysts

The Bartholin’s glands, of which you have two, are found on each side, towards the posterior aspect of the vagina, inside the labia (lips of the vulva). ‘Normally you are unaware of this, however, sometimes one of your Bartholin’s glands may fill up with fluid, and this fails to discharge leaving a fluid-filled cyst,’ says Dr Lee. ‘This can become infected to produce a Bartholin’s abscess. ‘ Different types of bacteria can cause a Bartholin’s abscess including E.Coli from the bowel and also STIs, notably gonorrhoea.’

• Mullerian cysts

Mullerian cysts are another common type of vaginal cyst that result from embryonic remnants. They can develop ‘when your body was formed in utero and can occur anywhere in the vaginal walls,’ says Dr Lee.

• Soft tissue lumps

Any soft tissue lumps which occur anywhere in the body can also be present in the vagina, ‘for example, lipomas or fatty lumps, and sebaceous cysts,’ says Dr Lee. ‘Vaginal cancers can present as lumps in the vagina, but these are not usually cysts,’

Fabrice PoinceletGetty Images

Vaginal cyst risk factors

The age group most at risk of vaginal cysts are sexually active women aged between 20 and 30. Cysts are also less common in post-menopausal women. Dr Lakhani explains this is because ‘by then the gland has started to shrink’.

Children are not typically at risk of vaginal cysts. ‘As the Bartholin’s glands don’t start working until a person hits puberty, Bartholin’s cysts don’t usually affect children,’ Dr Lakhani adds.

Can you reduce the risk of vaginal cysts? ‘While I’m not aware of any research directly linking vaginal cysts with lifestyle factors such as smoking and drinking alcohol, it goes without saying that an overall healthy diet and lifestyle is always beneficial when trying to avoid health complications,’ adds Dr Lakhani. ‘So ensuring you try to eat a healthy balanced diet and aren’t overweight will also be advisable in order to try and reduce your risk.’

Vaginal cyst treatment and surgery

Vaginal cyst treatment options vary depending on the type of cyst you have. ‘Sometimes the doctor will decide to keep an eye on a cyst and see if it gets bigger or disappears by itself. Other times, they may decide it should be surgically removed,’ says Dr Lee.

‘If it’s an abscess, which is usually painful, then you’ll likely be prescribed antibiotics to address the infection. After it’s been treated you’ll probably need a follow-up appointment and in some cases the cyst will need to be drained.’

Sometimes the doctor will decide to keep an eye on a cyst and see if it gets bigger or disappears by itself.

An infected cyst such as a Bartholin’s abscess is likely to require treatment including incision and drainage. ‘For Bartholin’s gland cysts, the specialist may recommend surgery to remove the affected gland. This is usually done under general anaesthetic and carries the usual risks associated with surgery,’ Dr Lakhani explains.

‘Carbon dioxide lasers can be used to create an opening in the skin of the vulva so that the cyst can be drained. Alternatively, needle aspiration involves using a syringe to drain the cyst. ‘ Lee adds that if you remove a cyst, there is ‘a small risk as there always is with surgery, of infection, and scarring.’

Vaginal cyst prevention

Can you deter vaginal cysts from developing? It’s virtually impossible to prevent a vaginal cyst growing, according to Dr Lakhani. However she does suggest some lifestyle tips that may reduce the chance of getting one. ‘These include keeping the vagina clean and practising safe sex, to eliminate the chance of catching a sexually transmitted infection.’

Dr Lee adds that if you experience a Bartholin’s cysts and receive treatment for it, the way in which they are treated prevents them from reforming. ‘After incision, the skin flaps are sewn diagonally using a technique called marsupialisation to prevent recurrence,’ she says.

Vaginal cyst complications

Complications or long-term health effects due to vaginal cysts are rare. ‘The main long-term effects of cysts are the pain and discomfort they cause and the impact this has on a person’s physical and mental health, as well as their ability to enjoy sex,’ Dr Lakhani explains. ‘Sometimes they can become infected – but this isn’t common.’

If you leave a cyst untreated, there is a risk that it can get bigger over time, says Dr Lee. This may become uncomfortable ‘as it stretches the skin and presses on other tissues,’ she adds.

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Bartholin’s Cyst and Abscess and Bartholin’s Duct Cyst. Patient

Bartholin’s glands are a pair of glands, each about the size of a pea, whose secretions maintain the moisture of the vestibular surface of the vagina. They are situated at about the 4 o’clock and 8 o’clock position of the vestibule and normally cannot be palpated. Damage or infection of the ostium of the duct causes blockage and a cyst occurs that may become infected.

Bartholin’s glands are named after the Danish anatomist Casper Bartholin, who described them in the 17th century.

Epidemiology

Cysts or abscesses are usually unilateral. Bartholin’s cysts occur in about 3% of women^[1]. They most commonly present in women of childbearing age. If they present after the age of 40 a malignant cause must be considered, although this is rare.

Risk factors

They usually occur in women who are nulliparous or of low parity.
For some women the risk factors for Bartholin’s abscess are as for the risks of sexually transmitted infections if the infection is caused by, for example, gonorrhoea.

History

Small cysts may be asymptomatic and discovered incidentally – for example, when performing a routine cervical smear.
Onset of an abscess is rapid over a matter of days or even hours.
There is initially labial oedema before a swelling forms.
The swelling may be very painful. The woman may find it uncomfortable to walk or sit. There may be superficial dyspareunia.
If the cyst or abscess bursts spontaneously there is sudden relief of pain.
Vaginal discharge may be present, especially in women with sexually transmitted infections.

Examination

The patient’s gait may be wide-legged if the cyst is large; it may be uncomfortable for her to sit.
There is usually a unilateral labial mass; it may be soft and fluctuant and non-tender (cyst) or tense and hard with surrounding erythema (abscess). Size varies from pea-sized to several cm.
Inguinal nodes may be palpable if it is infected and there may be fever.
If the cyst or abscess bursts, there may be little to find.

Investigations

^[2]

A swab should be taken from the contents of the cyst; often the organisms that are cultured, even from the contents of an abscess, are skin commensals rather than pathogens.

Women over the age of 40 presenting with a Bartholin’s cyst or abscess should have a biopsy to rule out carcinoma. This is uncommon but a number of types of malignancy of the vulva can occasionally present in this way^[3]. Carcinoma of the Bartholin’s gland accounts for around 5% of vulval carcinoma^[4].

Infecting organisms

^[5]

It is common for Bartholin’s abscesses to involve more than one type of organism. Aerobic organisms are the usual pathogens, with Escherichia coli being the most common. Organisms that cause sexually transmitted infections such as chlamydia and gonorrhoea may also be cultured.

Differential diagnosis

^[2]

Management

^[2]

Conservative treatment

If the cyst is small and not causing a problem no action should be taken. The exception is in patients over 40 years of age in whom histology must be obtained to exclude malignancy. If there are no features of infection, antibiotics are not required and culture is usually sterile. Simple incision of the cyst often results in recurrence and is not recommended.

For an abscess, incision and drainage may be required. However, this is not ideal, as recurrence is common and it may make subsequent definitive treatment more difficult.

Warm baths may encourage spontaneous rupture and symptomatic relief.

Antibiotics may be effective to treat smaller abscesses whilst awaiting definitive treatment. Ideally culture is obtained and the appropriate antibiotic used. However, where this is not possible, or while awaiting results, a broad-spectrum antibiotic such as co-amoxiclav would be appropriate^[5]. It is not known, however, which is the optimum initial treatment. Flucloxacillin is often prescribed. Local guidelines should be followed where available.

Marsupialisation

This has been the definitive procedure of choice for many years and many gynaecologists still regard it as the best technique.

It can be performed under local anaesthesia although general anaesthetic is often used.
A vertical elliptical incision is made just inside or just outside the hymenal ring.
An oval wedge of skin from the vulva and cyst wall is removed.
Loculations are broken down with the gloved finger and the cyst wall is sewn to the adjacent skin using interrupted sutures.
A large cyst may be packed with ribbon gauze in flavine. The cyst is laid open and will shrink and epithelialise over the following 7 to 14 days. This prevents recurrence.

Catheter insertion

A more recent technique that is gaining popularity is a balloon catheter^[6].

After the usual preparation and infiltration with local anaesthetic, a stab is made into the cyst, 1-1.5 cm deep.
An instrument is used to break up loculations and, after the cyst has been drained, the Word catheter is passed into it; this is a small rubber catheter with an inflatable tip.
The balloon is inflated with water or lubricating gel, as it holds its pressure better than air, and the other end is passed into the vagina.
The catheter is left in situ for up to four weeks for complete epithelialisation of the new tract.
The catheter is removed by deflating the balloon and, over time, the resulting orifice will decrease in size and become unnoticeable.

Other techniques include incision and curettage of the cavity, application of silver nitrate to the abscess cavity, insertion of a plastic (Jacobi) ring or use of a carbon dioxide laser^[7]. All these techniques are less popular.

Complete excision of the gland should be avoided unless malignancy is suspected. This can cause considerable blood loss and should be performed in an operating theatre. Bartholin’s gland cancer is exceedingly rare in all women, including postmenopausal women.

Prognosis

There is a high rate of recurrence which varies from 0-38%, depending on the type of surgery used. Recurrence is highest after incision and drainage and is low after marsupialisation^[7].

Complications after marsupialisation include haematoma, dyspareunia and infection^[2]. Complications after balloon catheter insertion include infection, abscess recurrence, bleeding, pain from having the catheter in situ, scarring, expulsion of the bulb of the catheter and dyspareunia^[6].

Labia Minora, Labia Majora, and Clitoral Hood Alteration: Experience-Based Recommendations | Aesthetic Surgery Journal

Abstract

Aesthetic alteration of the genitalia is increasingly sought by women unhappy with the size, shape, and appearance of their vulva. Although the labia minora are usually the focus of concern, the entire anatomic region—minora, labia majora, clitoral hood, perineum, and mons pubis—should be evaluated in a preoperative assessment of women seeking labiaplasty. Labiaplasty is associated with high patient satisfaction and low complication rates. The three basic labia minora reduction techniques—edge excision, wedge excision, and central deepithelialization—as well as their advantages and disadvantages are discussed to assist the surgeon in tailoring technique selection to individual genital anatomy and aesthetic desires. We present key points of the preoperative anatomic evaluation, technique selection, operative risks, perioperative care, and potential complications for labia minora, labia majora, and clitoral hood alterations, based on a large operative experience. Labiaplasty competency should be part of the skill set of all plastic surgeons.

Although ranked relatively low on volume lists of overall cosmetic surgery procedures in the United States,¹ aesthetic alteration of the genitalia is increasingly sought by women unhappy with the size, shape, and appearance of their vulva. There was a 44% increase in labiaplasty procedures performed in the US between 2012 and 2013.² Labia minora reduction is the most commonly requested and performed procedure on the female external genitalia.^2-4

It is estimated that greater than 90% of female genital procedures performed involve alteration of the labia minora.⁴ Although the labia minora are usually the focus of patients’ concerns, achieving a desirable cosmetic outcome often requires additional external genital alterations. It is therefore essential that the entire anatomic region—labia minora, labia majora, clitoral hood, perineum, and mons pubis—be evaluated in the preoperative assessment of women seeking labiaplasties.

Descriptions, reviews, and illustrations of female external genital anatomy and labiaplasty procedures and techniques are abundant, and readily available in the recent literature.^4-8 Therefore, a discussion of vulvar anatomy or a detailed description of the various operative techniques available are not the focus of this paper. Rather, I offer what I have learned in performing over 600 labiaplasties. Key points of preoperative anatomic evaluation, technique selection, operative caveats, and perioperative care for labia minora, clitoral hood, and labia majora alterations are presented.

Female external genital cosmetic surgery procedures are viewed by many plastic surgeons and gynecologists as being technically simple operations. They often are. Many women, however, present with anatomic challenges that make achieving good aesthetic outcomes difficult.⁹ Labia majora redundancy, deflation and ptosis, vertical and/or horizontal clitoral hood excess, and redundant labial tissue posterior to the introitus (in addition to unlimited labia minora size, shape, and pigmentation variations) may be present and require attention. ^4,9,10 Such women need more nuanced procedures to achieve aesthetically acceptable, natural-appearing outcomes. Simply reducing the labia minora in women with complex anatomic issues may result in unnatural-appearing genitalia and the perception of genital deformity as unintended consequences. Prominent lateral clitoral hood folds or labial remnants between the introitus and anus (Figures 1 and 2), proportional to large labia minora before surgery, may appear more unnatural after a simple labia minora reduction, regardless of the labiaplasty technique employed. Patient dissatisfaction and an augmented sense of genital embarrassment may occur.^9,10

Figure 1.

A 32-year-old woman with prominent bilateral lateral clitoral hood folds.

Figure 1.

A 32-year-old woman with prominent bilateral lateral clitoral hood folds.

Figure 2.

A 28-year-old woman with thick, hyperpigmented labia minora and redundant labia minora tissue extending between the introitus and anus.

Figure 2.

A 28-year-old woman with thick, hyperpigmented labia minora and redundant labia minora tissue extending between the introitus and anus.

Accurate evaluation of anatomic issues, surgical planning, and technical execution are essential in achieving optimal aesthetic outcomes. For labia minora reduction, reported patient satisfaction rates are remarkably high (greater than 90%) in published surveys involving various techniques.^6,11 It therefore appears that, when competently performed, most labiaplasty techniques result in high patient satisfaction rates and low complication rates.^2,7,12-14 Furthermore, to date no published operative technique has proven superior to the others described in the literature.^6,15

LABIA MINORA ALTERATION

As previously stated, reduction of the labia minora is by far the most commonly requested female external genital cosmetic procedure (Figures 3 and 4). Those seeking surgery, in my experience, have labia minora that, albeit large, fall within the normal minora size range. Very few women have minora that can be considered abnormally large. Female genital cosmetic surgery is overwhelmingly sought for aesthetic reasons. Although minor functional complaints (ie, irritation) are common, significant issues are rare. This experience mirrors the published findings of Crouch et al.¹⁶ They report that all women in their study had “normal-sized” labia, with the majority of complaints being related to genital appearance or minor discomfort issues. The main indication for labiaplasty, therefore, is overwhelmingly the same as for other aesthetic procedures: patient preference.¹⁵ Although uncommon, one must be aware that underlying psychological issues may be present in those women presenting with major functional or sexual complaints (ie, disabling pain or severe irritation) out of proportion with observed genital anatomic findings. Veale et al¹⁷ found that labiaplasty patients did not differ from controls on measures of depression or anxiety, but reported a significantly greater frequency of avoidance behaviors. Eighteen percent of women in their study met the diagnostic criteria for body dysmorphic disorder.

Figure 3.

(A) Preoperative photograph of a 25-year-old woman with large labia minora. (B) Postoperative photograph obtained 3 months after bilateral labia minora reduction (edge excision).

Figure 3.

(A) Preoperative photograph of a 25-year-old woman with large labia minora. (B) Postoperative photograph obtained 3 months after bilateral labia minora reduction (edge excision).

Figure 4.

(A) Preoperative photograph of a 29-year-old woman with large labia minora and right lateral clitoral hood fold. (B) Postoperative photograph obtained 3 months after bilateral labia minora reduction (wedge excision) and right clitoral hood fold excision.

Figure 4.

Labia minora size and shape show almost unlimited variations. Surgical procedures must be tailored to individual anatomy and preference. Labia thickness, pigmentation, and pigment variation, if present, must be considered. Clitoral hood redundancy, in either a vertical (hood too long) or horizontal (redundant lateral folds) dimension, should be addressed if present. Significant pigmentation variation from the labia free edge inward, if present, may warrant edge preservation. This situation is most often encountered in women of color. Excising the pigmented edge in this cohort may result in unnatural-appearing labia. Many women, however, have hyper-pigmented, irregular, and/or thickened labial edges that they find aesthetically undesirable. Edge excision techniques are preferable for these patients. Prominent lateral clitoral hood folds and redundant labial tissue posterior to the introitus, when present, should be excised (Figure 5). Failure to do so may yield an unacceptable result.^9,15

Figure 5.

(A) Preoperative photograph of a 23-year-old woman with large labia minora, bilateral lateral clitoral hood folds, and labial tissue posterior to introitus. (B) Postoperative photograph obtained 3 months after bilateral labia minora reduction (edge excision), lateral clitoral hood fold excision, and excision of posterior labial tissue.

Figure 5.

Labiaplasty technique selection should be based on the patient’s unique anatomy and aesthetic preference. Generally, the minora should remain at least one centimeter in length from free edge to base (inter-labial sulcus) in its central portion.⁴ The three most widely employed labia minora reduction techniques (and their various iterations)—edge excision,^2,7,12,13 wedge resection,^14,18 and central deepithelialization/excision¹⁹—each have advantages and disadvantages (Table 1).

Table 1.

Labia Minora Reduction Techniques: Advantages and Disadvantages

Reduction Technique
.

Advantages
.

Disadvantages
.

Edge Excision

Wedge Excision

Steep learning curve
Wound dehiscences require revision
May shorten introitus
Labial edge issues, if present, not addressed

Central Excision/ Deepithelialization

Reduction Technique
.

Advantages
.

Disadvantages
.

Edge Excision

Wedge Excision

Steep learning curve
Wound dehiscences require revision
May shorten introitus
Labial edge issues, if present, not addressed

Central Excision/ Deepithelialization

Table 1.

Labia Minora Reduction Techniques: Advantages and Disadvantages

Reduction Technique
.

Advantages
.

Disadvantages
.

Edge Excision

Wedge Excision

Steep learning curve
Wound dehiscences require revision
May shorten introitus
Labial edge issues, if present, not addressed

Central Excision/ Deepithelialization

Reduction Technique
.

Advantages
.

Disadvantages
.

Edge Excision

Wedge Excision

Steep learning curve
Wound dehiscences require revision
May shorten introitus
Labial edge issues, if present, not addressed

Central Excision/ Deepithelialization

Edge excision, with its many variations, was the first popularly reported labiaplasty technique.¹² Its major advantage is its technical simplicity and adaptability to virtually any labial size or shape. Overzealous resection, however, is possible, and can result in labial amputation: a disastrous outcome. Excision of the minora edges can result in unnatural-appearing labia in women with significant pigmentation variation. Although commonly reiterated in the literature, but rarely, in my opinion, observed in clinical practice, edge excision techniques can be complicated by tender scars or scar contractures. Edge scalloping may also occur and, if significant, compromise the aesthetic result. It has been suggested that it may be mitigated by minimizing tension when tying sutures.² Minor wound dehiscences, usually as a consequence of edema or hematoma, occasionally occur, but rarely require operative treatment. The clitoral frenula, if detached during excision, should be reapproximated during closure to avoid frenula remnant protrusion, and possibly anterior/cephalic migration of the clitoral hood.¹⁰

Wedge excision techniques, first described and popularized by Alter,^14,18 preserve labia edges and edge pigmentation. As previously stated, this is often desirable in those women with significant pigmentation variation from the free minora margins inward. Wedge excision, if overzealously performed, can cause constriction of the introitus/vagina. Incision line dehiscence, usually a consequence of excess tension, can be problematic. When it occurs, repair is required to avoid notching of the labium with persisting deformity. Wedge excision techniques also frequently require modification to adequately address clitoral hood issues or other anatomic variations.¹⁸

Central deepithelialization or excision procedures are, in my opinion and practice, less commonly utilized than either edge excision or wedge resection techniques.¹⁹ The major advantage, as with wedge resection, is the preservation, when desired, of the minora edge. The procedures have several shortcomings. They result in multiple incision lines (medial and lateral surfaces of the labia) and prolonged postoperative minora edema. Inclusion cyst formation, as a consequence on incomplete deepithelialization, can occur. Central deepithelialization can increase labia minora thickness, which, in my experience, is usually undesirable. Furthermore, it is difficult to make the minora as small as is possible with the other, aforementioned labiaplasty techniques.

CLITORAL HOOD ALTERATION

Clitoral hood redundancy, when present, may be in the horizontal or vertical planes, or both. Horizontal excess, in the form of extra hood folds parallel and lateral to the central portion of the clitoral hood, is most commonly observed (Figure 6). Clitoral hood folds may be unilateral or bilateral, and result in a widened appearance. Multiple and/or asymmetric folds may be present. Vertical excess manifests as a ptotic, elongated clitoral hood.

Figure 6.

(A) Preoperative photograph of a 30-year-old woman with prominent bilateral lateral clitoral hood folds and hyperpigmented, thick labia minora. (B) Postoperative photograph obtained 3 months after bilateral labia minora reduction (edge excision) and excision of bilateral lateral clitoral hood folds.

Figure 6.

When present, clitoral hood redundancy should be dealt with during labiaplasty. Not doing so may yield unnatural-appearing genitalia.^9,10 In my experience, failure to address clitoral hood folds and redundant labial tissue posterior to the introitus are the most common motivators for labiaplasty revision.⁹ Horizontal redundancy is treated by vertically-oriented excision of lateral clitoral hood folds. Excision is generally oriented parallel to the sulcus between the clitoral hood and the labia majora (Figure 7A). Vertical hood excess is addressed by transverse excision of a portion of the hood, usually as an inverted V wedge, across its full width. Excision is usually done cephalic to the free margin of the hood (Figure 7B).^9,10 In case of very elongated hoods, significantly overhanging the clitoral glans, the hood may be conservatively shortened by excision at the free margin itself. In no circumstance, in my opinion, should the clitoral glans be exposed (if covered) or further exposed (if partially covered). Doing either will result in an unpredictable, and perhaps undesirable, effect on clitoral sensation. In all cases, excision must be superficial.

Figure 7.

Photographs of a 27-year-old woman with digitally-added clitoral hood alteration markings. (A) Lateral vertically-oriented excision markings for horizontal excess, with digitally-added wedge excision minora reduction markings (patient’s left labium) and edge excision minora reduction markings (patient’s right labium). (B) Horizontally-oriented “inverted V” excision markings for vertical clitoral hood excess.

Figure 7.

LABIA MAJORA ALTERATION

Labia majora alteration is sought by women bothered by puffy, prominent majora at one extreme, and deflated, sagging majora at the other (Figure 8). Fatty fullness without skin redundancy may occasionally be effectively treated by liposuction. Improvement is usually modest. Small diameter cannulas (<3 mm) should be used, and superficial plane maintained. Prolonged postoperative edema is common.

Figure 8.

Photograph of a 29-year-old woman with deflated, redundant labia majora.

Figure 8.

Photograph of a 29-year-old woman with deflated, redundant labia majora.

Women with flat majora, or deflated majora with minimal skin excess, may seek augmentation. It is easily achieved utilizing standard autologous fat grafting techniques. Usually several grafting sessions are necessary to achieve the desired result. In general, no more than 20 cc of fat should be injected into each labium at one sitting. ⁴ One must use caution in augmenting majora with significant skin redundancy, as an unacceptable degree of bulging and labial prominence may result.

Ptotic, deflated labia majora, in my opinion, are best treated by reduction rather than augmentation. Surgical excision of redundant majora, in my experience, yields consistently excellent results and high patient satisfaction. Although others suggest that excision should be from the central portion of the majora²⁰ or laterally at the vulva-thigh crease,⁵ I disagree. I see no benefit in placing the resulting excision scar in the thigh crease or on the labia majora itself. I always resect the medial segment of the majora. The medial incision is in the sulcus between the minora and majora, with the lateral incision in the majora. Incisions are made along the full anterior-posterior length of the majora. Cresenteric excision of the redundant width of the majora is performed. The resulting scar, located within the interlabial sulcus, is virtually imperceptible. ^4,21 The extent of resection should be conservative to avoid pulling the introitus/vaginal orifice open. It is therefore determined with the patient supine in maximum frog leg position. Pinching of redundant majora, without tension on the introitus, is done. The lateral incision line is then marked. In my experience, up to 50% of the horizontal width of the majora may be safely excised in women with marked majora ptosis or redundancy (Figures 9 and 10). Resection should always be in a superficial plane: skin and subcutaneous tissue only. The labia majora are very vascular. Absolute hemostasis prior to closure is essential to avoid hematoma formation.

Figure 9.

(A) Preoperative labia majora reduction markings on a 33-year-old woman with ptotic labia majora and moderately large, asymmetric labia minora. (B) Immediately postoperative photograph after bilateral labia majora and labia minora (edge excision) reduction and left clitoral hood fold excision.

Figure 9.

Figure 10.

(A) Preoperative photograph of a 35-year-old woman with redundant labia majora. (B) Postoperative photograph obtained 3 months after bilateral labia majora reduction using the described technique (note the absence of visible scars).

Figure 10.

LABIA ALTERATION: PERIOPERATIVE CONSIDERATIONS

Although many recommend general anesthesia,^2,14 I perform virtually all labiaplasty procedures, including combined majora and minora reductions, using local anesthesia, with mild oral sedation (10-20 mg of diazepam). Topical anesthetic ointment or cream is applied at the same time oral sedation is administered. Approximately half of women undergoing minora procedures will not experience injection pain if 45 minutes elapse between topical anesthetic application and injection. Anesthetic buffering with sodium bicarbonate, if utilized, will further reduce infiltration discomfort. One dose of a cephalosporin oral antibiotic (or clindamycin for Beta-lactam allergic patients) is taken 2 hours preoperatively. Procedures are performed with the patient supine, in frog leg position. Lithotomy position, although commonly recommended by many authors for labiaplasty procedures,^2,14 should be avoided in my opinion, as external genital anatomy can be distorted. All surgical markings must be made before local anesthetic injection. Deviation from markings should be avoided. Incision lines are injected with 2% lidocaine with epinephrine 1/100,000 mixed 50:50 with 0.5% bupivicaine. Tissue distortion should be avoided. Adequate time should be allowed for vasoconstriction to occur. Twenty minutes is ideal for maximum effect, but a minimum of 10 minutes is suggested.

In combined labiaplasty procedures, the majora should be done first. For labia minora edge excision techniques, use of a traction suture placed in the most prominent portion of the labium is helpful. Clitoral hood folds, if present, should be excised first, followed by minora excision. Resection of redundant labial tissue posterior to the introitus may occasionally be difficult with the patient in frog leg position. It can be facilitated, if necessary, by placing gauze pads between the buttocks (posterior to the anus) to separate them and increase visualization of the posterior perineum. The operating table may also be placed in a slight Trendelenburg position if further exposure is needed. I perform the procedures using number 15 scalpel blades and a needle-point electrocautery. Absolute hemostasis is essential. A single-layer closure with interrupted 4. 0 Vicryl Rapide (Ethicon, Somerville NJ) in a “close as you go” fashion is advised. For wedge resection techniques, a two-layer closure is suggested to reduce incision dehiscence risk. I recommend 4.0 Monocryl (Ethicon, Somerville NJ) for the subcutaneous layer.

Labia majora excision defects are also closed in two layers: 4.0 Monocryl interrupted sutures for the deep dermis and 5.0 Prolene (Ethicon, Somerville NJ) continuous sutures for skin. The skin sutures are removed 1 week after surgery.

Aftercare is similar for both labia majora and minora procedures: minimal ambulation, ice compacts, and narcotic analgesia for the first 2 days and topical antibiotic ointment application and sanitary pads as dressing for 1 week. Daily tepid showers are permitted. Routine follow-up visits occur at 1 week, 2 weeks, 4 weeks, and 12 weeks. Vicryl Rapide sutures, if still present, are removed at 2 weeks. Vaginal penetration is not permitted for 4 weeks.

LABIAL ALTERATION: COMPLICATIONS

Labiaplasty procedures have low complication rates. ^2,4,12,13 Most complications are minor and self-limited. Hematoma and wound dehiscence are most commonly reported.^2,6 In a recent study of 113 women undergoing labiaplasty, only one (0.8%) experienced a complication (bleeding).² Self-limited postoperative edema, bruising, and/or pain, resolving within 2 weeks of surgery, were reported in 13.3% of patients in that study.² In my experience, wound dehiscence rarely requires repair after labial edge excision, but usually must be corrected after wedge resection to avoid minora notch deformity.^2,15 Underreduction of the minora, or postoperative labial asymmetry, may also occur. Lista et al² reported a 3.5% revision rate for persisting labial excess. Unaddressed clitoral hood redundancy and labial remnants posterior to the introitus, as indicated earlier, may also motivate revision requests.^9,10 Prolonged edema and inclusion cyst formation, as previously indicated, can complicate central deepithelialization technique procedures. Overzealous resection with partial or complete amputation of the labium, although rare, is perhaps the most dreaded complication observed. Labial edge scalloping, usually minor, can occur after edge excision techniques. Scar contractures, although reported, are very rare.

Persisting postoperative dyspareunia is extremely rare. I have never observed it. This has also been the experience of others.² Rouzier et al,²² in a study of 163 labiaplasties, however, reported a 1.8% incidence of dyspareunia persisting greater than 1 month postoperatively.

CONCLUSION

External genital cosmetic surgical procedures are increasingly being requested by women today. Competently performed, all labiaplasty techniques appear to yield excellent aesthetic results, with high patient satisfaction and very low complication rates. To date, no technique has proven to be clearly superior to the others described. Plastic surgeons should develop competence in performing female external genital aesthetic surgery. Several different operative techniques, to permit tailoring to each woman’s unique genital anatomy and aesthetic desires, should be part of the skill set of all surgeons performing labiaplasties.

Disclosures

The author declares no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

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Author notes

Removal of the Bartholin gland cyst in Moscow

What is a cyst of the Bartholin gland

Bartholin’s gland is a paired organ, i. e. every woman has two such glands. They are located on the eve of the vagina, in the thickness of the labia majora. The gland produces a secretion, a protein-rich, viscous, grayish liquid that serves to moisturize the vagina.At the time of sexual arousal, the amount of secretion produced increases, which contributes to a favorable course of sexual intercourse.

The secret enters the vagina through ducts that open on the inside of the labia minora. An inflammatory process in the vagina can lead to a blockage of the duct. In this case, the fluid produced by the gland begins to accumulate in the subcutaneous fat, and a cyst occurs.

The cyst of the Bartholin gland looks like a rounded swelling of the labia.If the size is small, the cyst may be invisible. A large cyst (1 cm or more) causes discomfort and pain during movement and during intercourse.

Removal of bartholin gland cyst

A cyst that does not cause anxiety is not operated on. Surgical treatment is used when discomfort is felt. Opening a cyst, in which the contents of the cyst are simply removed, as a rule, is not a solution to the problem, since after a while the cyst will form again.Recurrent cysts must be removed. In the process of removing the cyst, the gland itself is also removed. With a unilateral cyst, such a solution does not lead to negative consequences, since the vaginal moisture is provided by the remaining gland.

The operation is recommended after menstruation. In the presence of an inflammatory process, the operation is not performed. In case of detection of inflammation, the operation should be preceded by drug treatment.

Where can I remove a cyst of the Bartholin gland in Moscow

It is possible to remove a cyst of the Bartholin gland in Moscow at JSC “Family Doctor”.The operation is performed in the company’s surgical hospitals.

The cyst removal operation is performed under intravenous (full) anesthesia. The planned operation time (taking into account anesthesia) is 2 hours. After the operation, you need to be under medical supervision within 24 hours.

Full recovery after removal of the Bartholin gland cyst usually occurs 3-4 weeks after surgery. During the recovery period, sexual intercourse should be avoided.

90,000 Vulvar diseases

Vulvar diseases

Lesions and diseases of the vulva are manifold.These include dematosis: atopic dermatitis, atrophic changes against the background of a hypoestrogenic state, neurodermatitis, allergic contact dermatitis, intertrigo (mechanical dermatosis), psoriasis, lichen sclerosus, lichen planus and others; vulvar cysts, vestibular papillomatosis, benign vulvar tumors, systemic diseases, vulvar infections and others. All of these diseases are accompanied by hyperemia (redness) and itching, burning, but the correct diagnosis is possible only upon examination by a doctor and sometimes using an additional method – vulvoscopy.

Treatment and examination of dermatoses include the consultation of two specialists – a gynecologist and a dermatologist.

Let’s consider each disease separately.

Atopic dermatitis of the vulva

is the most common type of dermatitis. About 20% of the population suffers. It usually occurs in young girls who have inherited or suffer from an atopic disorder (bronchial asthma, allergic reactions, hay fever, urticaria).Atopic dermatitis is prone to recurrence and is accompanied by severe itching. The disease became clear recently, when a hereditary defect of keratinization was found in those suffering from it, which increases the permeability of the epidermis and leads to its dryness. Allergens, irritants and pathogenic microorganisms easily penetrate into small cracks of the dried epidermis. Soap or hygiene products, increasing the damage to the barrier function of the epidermis, contribute to the penetration of other irritating substances and allergens into its defects. Atopic dermatitis occurs as a result of a complex interaction of irritating and allergenic chemicals or drugs against the background of a hereditary immunodeficiency state, in some cases against the background of a hereditary defect in the barrier function of the epidermis, skin infections, fungal, bacterial, protozoal or viral, lead to exacerbations of atopic dermatitis due to direct action and additional allergization. Most often causes and maintains exacerbations of atopic dermatitis Staphylococcus aureus.The main symptoms of atopic dermatitis – “itching – scratching – itching” and oozing (moisture), lead to a sharp thickening of the skin with impaired pigmentation and the appearance of a rash. Scratching becomes the gateway to secondary infection. Often the cause of an exacerbation is alkaline soaps and personal hygiene products, fragrances that are part of them, and even wet sanitary napkins. Skin changes depend on the age of the process. Most often, the labia majora are affected, somewhat less often the small or inner thighs and the intergluteal fold.

In treatment, first of all, it is necessary to eliminate the causes and triggering factors of dermatitis.

Neurodermatitis of the vulva

is a disease that is a transition from atopic dermatitis, which leads to a vicious circle of “itching – scratching – itching”. Synonyms for vulvar neurodermatitis are “simple chronic lichen”, “hyperplastic dystrophy”, “scaly hyperplasia”. Skin changes are the same as in atopic dermatitis, but mental stress is an important trigger.The most common symptom of vulvar neurodermatitis is persistent pruritus, often over the years, aggravated by warmth, menstruation and stress. Combing is habitual, almost intrusive. The skin of the vulva thickens, becomes more or less pigmented, the process constantly spreads to the groin folds and thigh. Treatment is multifaceted and complex. There are frequent relapses.

Atrophic changes against the background of a hypoestrogenic state

Are accompanied by a drop in the level of the hormone estrogen in the blood, due to the onset of natural menopause and other conditions: removal of the ovaries, resection of the ovaries, ovarian dysfunction, the use of antiestrogens, selective suppression of estrogen receptors.

Before menarche (the formation of the menstrual cycle, puberty) and during breastfeeding, estrogen levels are relatively low. This leads to thinning and dryness of the vulvar and vaginal epithelium, with a weakening of its barrier function, predisposing to irritation and infection.

Atrophic vulvovaginitis, as this disease is called, is accompanied by symptoms such as burning and itching, soreness of the vulva, difficulty urinating associated with increased frequency and soreness, the appearance of pain during intercourse.The epithelium of the vulva and vagina becomes thinner and pale. Sometimes there is a narrowing of the entrance to the vagina, cracks and hemorrhages. In severe cases, there is a profuse discharge with an unpleasant odor.

Treatment includes hormonal therapy and antibacterial therapy in case of secondary infection.

Contact dermatitis of the vulva

is an inflammation of the skin caused by an exogenous irritant. It is important to distinguish simple contact dermatitis from allergic dermatitis. Both the one and the other can have an acute, subacute and chronic course. Vulvar contact dermatitis occurs as a result of permanent direct, non-immune-related chemical or physical damage to the skin. Its reasons are manifold, for example, the effects of urine, bowel movements. It is predisposed to it by a low level of estrogen, concomitant skin diseases, infection, trauma – everything that weakens the barrier function of the epithelium and makes the skin more sensitive to damaging influences.However, repeated contact with chemicals leads to the development of true allergic contact dermatitis.
Vulvar contact dermatitis is a very common disease. Concerned about increased sensitivity of the skin, itching and burning of the vulva. Patients often resort to self-medication with antifungal drugs, antipruritic or anesthetic ointments, applying them already on the inflamed skin, and the medical workers who turn to these patients already find it difficult to establish the cause of contact dermatitis. Therefore, you should consult a doctor at the first concerns that arise, so that the doctor can identify the cause and prescribe the correct treatment. So, the most common causes of simple contact dermatitis of the vulva: soap and soap substitutes, urinary and fecal incontinence, sweating, vaginal discharge, irritation with pads and underwear.

Treatment is phased, with the exclusion of the cause of the disease.

Allergic contact dermatitis of the vulva

It is a severe allergic reaction to small amounts of a chemical.Allergic contact dermatitis of the vulva usually begins acutely, as opposed to simple contact dermatitis. Itching and burning occurs suddenly. Sometimes the patient herself indicates the reason. Itching can be combined with a burning sensation. The reason may be some kind of irritating factor: highly alkaline or highly scented soaps and soap substitutes, highly scented pads and other allergens, the list of possible allergens is very large. Often, by the time of treatment, the disease takes on a subacute or chronic phase of the course. A severe acute inflammatory reaction is accompanied by hyperemia (redness), the formation of vesicles (vesicles), and even blisters, oozing (moisture), scratching with bloody or yellow crusts, sometimes a secondary infection joins.

Treatment is based on different methods, but first of all, the elimination of the main allergen, otherwise it is unsuccessful.

Intertriginous dermatitis of the vulva

Is an inflammation of the skin in the folds caused by friction, exposure to heat, sweating, moisture accumulation under clothing.The disease is especially common in women with deep skin folds.
Its main reason is the friction of the contacting surfaces of the skin and their maceration then in the heat. Inflamed, weeping surfaces are easily infected with bacteria and fungi of the genus Candida (popularly called “thrush”). Moisture, tight-fitting clothing made of synthetic fibers, urinary and fecal incontinence predispose to the disease. Patients with obesity and diabetes mellitus, in particular the elderly, in whom obesity is combined with immobility and incontinence of feces and urine, are especially often affected by intertriginous dermatitis of the vulva.Such dermatitis is characterized in the femoral – genital and inguinal folds, and in the overhanging fold in the lower abdomen, and on the skin under the mammary glands, increased skin sensitivity, burning, and an unpleasant odor expressed to one degree or another. The skin in all of these folds is subject to constant friction. This type of dermatitis should not be confused with psoriasis, lichen sclerosus, benign familial pemphigus.

Complex treatment, with the addition of a secondary infection, antibiotic therapy is also indicated.

Psoriasis of the vulva

– Chronic hereditary dermatosis, which is characterized by reddish papules and plaques, covered with tightly attached silvery-white scales. Psoriasis affects 2% of the population. The defeat of the vulva with it is often observed, but in many cases it remains unrecognized, since patients and doctors do not notice it. When referring to dermatologists, patients do not present corresponding complaints.
The provocateur of vulvar psoriasis are minor injuries (friction, scratching), infections (bacterial or fungal), chemical irritants (cosmetics), and some medications.Mental stress weakens the barrier function of the epidermis (skin). Rash of psoriasis at the site of scratching due to itching accompanying depression and anxiety. Promotes the manifestation of psoriasis and fluctuations in hormone levels. The most common occurrence of vulvar psoriasis occurs during puberty and menopause. It provokes the development of alcohol consumption and smoking. The rash of psoriasis of the vulva is mainly promoted by trauma to the skin. The main concern in psoriasis is itching of varying intensity.It causes scratching, which in turn leads to burning and pain.

Treatment of vulvar psoriasis is complex and consists of local and systemic therapy.

Lichen sclerosus of the vulva

One of the chronic inflammatory dermatoses most commonly affecting the vulva.
It is characterized, including on the vulva, by thinning and depigmentation of the skin and scarring, anxiety about itching, burning, less often pain. Lichen sclerosus leads to deformation of the vulva and related functional disorders.The prevalence of this disease is unknown, since the disease is not always accompanied by complaints, as a result of which some patients do not go to doctors. Lichen sclerosus occurs at any age, from 6 months to old age, but mainly between 40 and 70 years. The causes and development are due to many factors: hereditary, related to cellular immunity (T and B-lymphocytes) and autoimmune, hormonal, infectious, local. It has been linked to certain HLA class II antigens, antibodies to certain tissue antigens, and autoimmune disorders.The role of hormonal factors is confirmed by the fact that the disease often begins against the background of estrogen deficiency – in childhood or postmenopausal women. It has been suggested, but not proven, androgen metabolism disorders. However, the etiological role of hormones has not yet been proven. The development of lichen sclerosus is also associated with pathogenic microorganisms, especially the spirochete Borrelia burgdorferi, but apparently it is not the true causative agent of the disease. The role of other microorganisms has not been confirmed either. However, there is no doubt about the importance of local impacts, from scratching to radiation exposure, as triggering factors.The clinical picture is varied. Typical complaints of itching or its combination with raw pain, increased skin sensitivity, difficulty urinating associated with increased frequency and soreness, pain during intercourse.
In 20% of cases, foci of lichen sclerosus are found in other areas of the skin, usually on the neck, in the armpits, and on the mammary glands. The vaginal mucosa is not affected. Occasionally, there is a lesion of the oral mucosa.

Treatment includes local and general therapy.

Lichen planus of the vulva

Relatively common dermatosis and mucositis (inflammation of the oral cavity), mediated by the mechanisms of cellular immunity. Usually the skin and oral mucosa are affected, in 25% of cases only mucous membranes. Damage to the oral mucosa in women in 57% of cases is accompanied by damage to the vulva and vagina. The true prevalence is unknown, as it often remains undiagnosed. Even in patients with lesions of the oral mucosa and skin, the genitals are not always examined.Synonyms: erosive lichen planus, desquamative inflammatory vaginitis, vulvovaginal – gingival syndrome.

The causes of lichen planus are unknown, but many data clearly indicate its autoimmune nature, mediated by mechanisms of cellular immunity. Recent evidence suggests there is a link between HLA antigen DQB1 * 0201 and lichen planus of the vulva, vagina and gums. There is a widespread damage to the basement membrane zone of the epidermis, apparently of an autoimmune nature.

Clinical options:

Classic – itchy polygonal papules and plaques on the wrists and ankles, on the pubis and labia, but not accompanied by atrophy and scarring;
Vulvovaginal – gingival syndrome – erosive damage to the mucous membranes of the mouth, vulva, conjunctiva and esophagus with atrophy and scarring.

Damage can be on the scalp, and on the nails, eyes, mucous membranes of the mouth, nose, esophagus, larynx, bladder, anus.In most cases, the disease develops between the ages of 30-60 and is accompanied by a variety of complaints. The most common of these are soreness to touch and pain, and itching, singly and in combination. However, complaints, even with characteristic changes, are not always the case. Sometimes itching can join, which manifests itself in different ways depending on the form.
The picture of changes in the vulva depends on the variant of the disease. In most cases, there are red erosion with scalloped “lacy” whitish edges.Their surface is often shiny, glassy. But there may be small papules and plaques, purple with peeling, localized on the pubis, labia majora, and thighs. Scratching promotes the spread of rashes and is accompanied by secondary changes. With these pictures, the vulva loses its normal structure over time and untimely treatment. Often, damage to the vulva and vagina is preceded by damage to other areas of the skin and mucous membranes. Diagnosis is clinical and biopsy.Sometimes lichen planus is accompanied by lichen sclerosus.

Treatment includes local and general systemic therapies.

Vulvar cysts

On the vulva, cysts of various sizes and origins can sometimes be found, which appear as a result of inflammation or injury.
Bartholin gland cysts can be seen with the naked eye.
The clinical picture of the inflammatory process of the Bartholin gland and its excretory duct depends on the anatomical structure.The Bartholin gland is located deep in the thickness of the muscles of the perineum. Several small excretory ducts emerge from it, merging into an ampulla, from which then the main excretory duct of great length comes out, but narrowing towards its outer opening. The excretory duct of the gland is affected more often than she herself. Diseases of the Bartholin gland and its duct – Bartholinitis – include: canaliculitis, Bartholin gland abscess, Bartholin gland cyst, rarely endometriosis.
Small sebaceous retention cysts are observed over the entire surface of the labia, more often between the area of hair growth and the labia minora.They contain a yellowish content. As a rule, only itching is troubling. Often, when viewed through a colposcope, small erosive surfaces are found. Sometimes cysts are large.

Treatment is conservative, operative in advanced cases.

Vestibular papillomatosis

It is a collective term that clinically includes typical small acute warts caused by human papillomavirus infection and micropapillomas (pseudocandylomas), which are not associated with human papillomavirus infection.It is often asymptomatic, discovered by chance, although sometimes accompanied by leucorrhoea, pain and burning sensation of the vulva, the manifestation of pain during intercourse.

Treatment is indicated for anxiety. A biopsy followed by surgery is sometimes required, depending on the situation. The approach is individual. The main tactic for this disease is observation by a gynecologist.

Benign tumors of the vulva

Tumors of the vulva are diverse and require surgical treatment followed by histological examination.

Systemic diseases

The most pronounced changes on the vulva are observed in Behcet’s disease and Crohn’s disease.

Vulvar infection

These are various inflammatory diseases, the symptoms and colposcopic picture of which depends on the type of pathogen.
Vulvar infections include genital herpes, chlamydia, ureaplasmosis, condylomas, molluscum contagiosum, mycoses, scabies, enterobiasis, pediculosis, furunculosis, donovanosis, syphilis, tuberculosis, venereal granuloma, human papillomavirus.

Treatment depends on the type of pathogen.

Bartholin gland cyst treatment in St. Petersburg

The author of the article: KMN, gynecologist-endocrinologist, reproductologist, ultrasound specialist, head. Department of Gynecology Dzhashiashvili M.D.
Work experience: 24 years

Published: 21-12-2020

Updated: 21-10-2020

A cyst of the Bartholin gland is a benign formation that appears due to blockage of the ducts of this organ.An abscess occurs when a clogged duct multiplies pathogenic microbial flora, an inflammatory process develops with the formation of purulent contents.

The Bartholin gland is a large paired gland near the entrance to the vagina, located in the lower third of the labia majora. The ducts open onto the inner surface of the labia minora.

The task of this organ is to release natural physiological lubricant. The secret of the gland moisturizes the vestibule of the vagina, prevents it from drying out, protects against injuries and genital infections, maintains a harmonious microflora, and ensures the comfort of intercourse.

Causes and symptoms

The cyst of the Bartholin gland usually develops slowly – from several weeks to months. Therefore, it is difficult to notice it yourself in the early stages. However, the doctor will pay attention to the atypical visual or tactile state of the area during the examination.

The gland gradually increases in size – up to 6 centimeters in diameter. This is usually the only symptom she displays. There are no unpleasant sensations and pains.If the cyst is large, the woman may feel discomfort in the perineal area.

In the case of an abscess, the Bartholin gland increases in size sharply and quickly – in 2-4 days it can reach up to 8 centimeters in diameter. It also becomes painful, inflammation appears. A woman may have a high fever, an uncomfortable or painful sensation when walking. Due to the pressure of pus or external exposure, the abscess can open on its own, releasing pus outside.

The cyst does not affect pregnancy and conception, but it can lead to a gaping of the perineum, and this, in turn, to inflammation in the vagina. The inflammation can spread higher, causing blockage of the fallopian tubes and infertility.

A number of reasons can provoke the appearance of a Bartholin gland cyst. Here are the main ones:

microorganisms, including elements of normal or opportunistic microflora: bacteroids, peptostreptococci and Escherichia coli,

90,096 sexually transmitted diseases – for example, gonorrhea, chlamydia and other

irritation and trauma to the labia area during epilation and depilation, wearing tight underwear made of synthetic materials, neglecting the rules of intimate hygiene, hypothermia,
gynecological operations, childbirth with rupture and closure of the vagina,
in rare cases – cancer of the Bartholin gland.

Diagnostics

The Altermed clinic uses an integrated approach to the diagnosis of diseases, including the genital area. In addition to the standard gynecological examination, the doctor prescribes tests:

general blood test,
enzyme immunoassay and PCR to detect possible genital infections that cause or complicate the course of the disease,
bacteriological analysis of genital swabs to determine the causative agent of the infection and to find out the presence of sensitivity to antibiotics.

Also, if necessary, the doctor prescribes an ultrasound examination of the perineum and pelvic organs in order to exclude the spread of inflammation to the internal organs.

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Bartholin gland cyst treatment

The doctor selects a suitable method of treatment depending on the exact location of the neoplasm, size, stage of development, and the period from the moment of appearance. In total, two types of treatment are used: conservative without surgery with the use of medications and local therapy, or surgical.

Conservative treatment is suitable in the early stages of the development of the disease, when the cyst has not yet started, there is no inflammation and abscess. To do this, use antibacterial drugs and ointments, local cooling.

After the removal of acute symptoms, physiotherapy is connected: electrophoresis, magnetotherapy, laser treatment and electrical stimulation.

If the cyst has reached a large size or an abscess has appeared, conservative treatment is ineffective and surgical intervention is recommended.

The operation is recommended in the following cases:

90 095 90 096 the tumor is benign, but growing rapidly,

inflammation with a purulent abscess appeared, an increase in body temperature is observed,
severe pain in the perineal region at rest, when walking, during intercourse,
aesthetic or physical discomfort of the patient.

If the patient is pregnant at the time of diagnosis of the cyst, then treatment is postponed until after childbirth or in case of inflammation.

In case of suppuration in Russia, an abscess is often opened in a regular or day hospital. The method requires postoperative care and dressings for several days after the intervention. This method is considered outdated, as it is traumatic. In addition, relapses and exacerbations of the patient’s condition, difficult healing of the incision are possible.

The operation is as follows: the tumor is cut along the widest diameter, after which the fluid is removed and gauze-glove drainage is placed.

Surgery to remove the cyst is also common. To do this, an incision is made in the mucous membrane of the vestibule of the vagina, tumor tissue is separated, suitable vessels are closed, and the neoplasm is removed.

Abroad, the widespread method of setting a word catheter. To do this, first make a small incision, remove the contents of the gland, disinfect and install a catheter inside.

The catheter is worn from 20 to 60 days, depending on how long it takes to form the duct in each case.This method is less traumatic, but the cost of placing a catheter is high, and you need to walk with it for a long time. Therefore, the method is not suitable for all women.

In the Altermed clinic, in the early stages of the disease, conservative treatment is prescribed without surgery. However, if the tumor is neglected, the doctors of the clinic offer an effective modern method of treatment – laser dissection of the cyst.

In this case, the cyst is opened by the action of a contact laser beam in such a place as to preserve the aesthetic appearance of the labia.After that, a natural drainage is formed, which will become a duct after healing. The operation is painless thanks to the use of modern local anesthesia and is performed on an outpatient basis. Laser dissection allows you to recover from the intervention with minimal pain, reduces the risk of bleeding, scarring and recurrence of inflammation.

The method of marsupialization is also effective, during which the cyst is opened along the largest diameter in the lower third of the vaginal vestibule, the wound is emptied and sutured by connecting the mucous membrane with separate or twisted sutures.

This method helps to form the natural duct of the gland, avoid relapses and abscesses, and facilitate recovery from surgery.

The clinic Altermed will select the most suitable treatment method for your case. We treat on an outpatient basis using modern instruments and materials and use the most effective methods that provide the best result with maximum patient comfort.

Doctors

All doctors

90,000 to be tested in the KDLmed laboratory

Bartholin’s glands are located in the thickness of the labia majora, at their base, one on each side of the vaginal opening.Their excretory ducts open on the inner surface of the labia minora. They secrete a viscous fluid that lubricates the inside of the vagina during intercourse. When the excretory duct is blocked, fluid begins to accumulate in the gland, which leads to the formation of a cyst. Outwardly, it looks like a rounded swelling, usually on one side of the vagina.

Cyst of the Bartholin’s gland occurs in 2% of women, more often between the ages of 20 and 29 years. Children do not have this disease, since the glands begin to function after puberty.In many cases, women are unaware of the presence of a Bartholin gland cyst; it is often detected during a routine preventive gynecological examination. However, with a large size, the cyst can cause discomfort, and the addition of an infection threatens with an abscess of the Bartholin gland.

Most often, the cyst of the Bartholin gland goes away on its own or after using outpatient methods of treatment. However, if the cyst is large or an abscess occurs, surgical and medical treatment may be required.

In general, the prognosis of the Bartholin’s gland cyst is favorable. This disease does not pose a threat to a woman’s life, although it can cause serious discomfort. In extremely rare cases, cancer of the Bartholin gland occurs.

Synonyms Russian

Cyst of the Bartholin gland.

Synonyms English

Bartholin’s cyst, Bartholin’s abscess, vaginal lump, vaginal cyst.

Symptoms

In most cases, the cyst of the Bartholin gland does not cause any unpleasant sensations.With large cysts, pain and discomfort when walking and during intercourse are likely. With the addition of an infection, a woman may be disturbed:

discomfort when walking and sitting,
pain during intercourse,
fever.

General information about the disease

The excretory ducts of the Bartholin glands are thin canals. When these channels are blocked, fluid accumulates in the gland, which leads to its stretching and enlargement.The cause can be trauma, infection, friction during intercourse. Outwardly, the cyst looks like a rounded swelling with a smooth surface, which is located at the entrance to the vagina. Most often, the size of the cyst does not exceed 1 cm. In some cases, the cyst can reach a size of 8 cm. With its small size, it does not cause discomfort to the woman, it can be detected on its own or during a gynecological examination. With a large cyst, a woman may experience discomfort or even pain when walking and during intercourse.The gland secretes fluid necessary for intercourse, so the size of the cyst may increase after intercourse.

In some cases, infection of the fluid in the cavity of the gland occurs – an abscess of the Bartholin gland is formed. The cause of an abscess can be both opportunistic microorganisms (that is, living in the human body normally, but causing the disease only under unfavorable circumstances), and sexually transmitted infections. An abscess usually develops within 3 to 4 days.In this case, a woman may experience pain when walking and during intercourse, discomfort in a sitting position, and the temperature may rise. If the cause is a sexually transmitted infection, the woman may be bothered by genital discharge and other symptoms that are characteristic of a particular infection.

Who is at risk?

90 095 90 096 Women aged 20-29.

Women with sexually transmitted infections.

Diagnostics

Most often, the diagnosis “cyst” or “abscess” is made already during the medical examination and on the basis of the patient’s complaints.However, sometimes additional laboratory and instrumental research methods may be required.

Laboratory diagnostics

General clinical trials

Complete blood count (without leukocyte count and ESR). The level of leukocytes may be increased, which indicates the addition of an infection and the formation of an abscess of the Bartholin gland.
ESR. Erythrocyte sedimentation rate. When the protein composition of the blood changes, the ESR may change. It increases with infections, including some sexually transmitted diseases (such as syphilis).
General urine analysis. With an abscess of the Bartholin gland, a large number of leukocytes can be found in the urine.

Diagnostics of sexually transmitted infections

Microscopy of a smear and subsequent culture of the vaginal discharge with determination of sensitivity to antibiotics. With an abscess of the Bartholin gland, a diagnosis of sexually transmitted infections is carried out as a possible cause of the disease. For this, a microscopic examination of the vaginal discharge is used, as well as sowing on a nutrient medium to determine the sensitivity of the identified microorganism to a certain group of antibiotics.This is necessary to prescribe the most effective treatment.
Enzyme-linked immunosorbent assay (ELISA) – allows you to identify antibodies (immunoglobulins) to certain infections, that is, specific proteins that are produced in response to the penetration of a microorganism.
Polymerase chain reaction (PCR) – allows you to identify the genetic material of the pathogen in biological material – blood, urine, urethral or vaginal discharge, tissue sample, cerebrospinal fluid.

Additional research

Bartholin gland biopsy.Taking a sample of the gland tissue with a needle after anesthesia. The sample is then examined under a microscope to detect changes in cellular composition. This is necessary to exclude cancer of the gland in women over 40 years of age with suspected malignant neoplasm.

Treatment

In many cases, the Bartholin gland cyst heals on its own. Sometimes outpatient treatment is sufficient, such as warm baths for 3-4 days. If the gland is large, surgical treatment may be required.In some cases, the so-called marsupilization of the cyst is performed – the doctor makes a small incision in the membrane (capsule) of the cyst, and then sews the edges of the membrane to the edges of the wound. An opening is formed, which gradually narrows over two months, forming a new excretory duct of the gland. In the first days after the operation, a flexible thin tube is inserted into the lumen of the wound for a better outflow of the contents of the cyst.

With

Synechia in girls – causes of appearance, first symptoms, methods of prevention

Synechiae is a congenital or acquired fusion of the labia minora, less often – of the labia minora and majora.Most often, fusion occurs over the outlet of the urethra, thereby disrupting the normal outflow of urine. This condition causes discomfort to the child. Most often, synechiae occurs in babies up to 2-3 years old.

Due to untreated synechiae, with the growth of the body, the external and internal genital organs may not form properly, which may even result in impaired fertility.

Reasons

Excessive activity during intimate hygiene of the girl – problems can arise with too active and frequent washing with soap.In babies, the mucous membranes of the genitals are very thin, and with frequent washing, especially with soap, the protective film is washed off, which can lead to injury and inflammation. During healing, adhesions occur at the site of the inflamed tissues of the labia. It is enough to wash the baby with soap only after a bowel movement (preferably with a special baby soap with an approximate pH value). The rest of the time, it is enough to wash the girl only with running water without soap, in the direction from the pubis to the anus.
Urinary infections.The presence of synechiae indicates the need for an examination of the urinary system. Dangerous microbes in the urine enter the mucous membranes and cause their inflammation, and at the site of inflammation, the labia are fused. In this case, a doctor’s consultation, urine analysis and urine culture are required.
Infections of the genital organs of the girl – with vulvitis and vulvovaginitis.
Allergy, because it affects not only the skin, but also the mucous membranes.
Complications of pregnancy and childbirth in the mother.

Symptoms

The entrance to the vagina is covered with a film. With complete synechiae, even the opening of the urethra is not visible.
Straining, discomfort in the child during urination.
Crying and unwillingness to sit on the pot.

At the appointment, the doctor will examine the baby, if the need arises, he will take smears, crops of flora for sensitivity to antibiotics in case infections are detected and an analysis for genital infections.

If treatment is necessary, then usually, before starting it, an examination for enterobiasis is carried out – does the girl have worms, and also exclude allergies. Then the effectiveness of the treatment increases.

Prevention

Regularly examine the baby’s genitals after hygiene procedures.
Remove all potentially dangerous allergens (cosmetics, diapers and other provoking factors) from the environment of a baby with allergies (rash, bronchial asthma, allergic rhinitis).
At the slightest manifestation of redness, rashes, peeling or discharge, you should seek the advice of a doctor.
Monitor the color of the skin in the perineum: the appearance of a bright pink strip may indicate a relapse (synechiae tend to relapse up to 6-9 years).

More about pediatric gynecology at the YugMed clinic

Bartholinitis, Bartholin gland cyst | Diseases of the Bartholin gland

Bartholin’s gland are paired glands in the vestibule of the vagina.It is located in the depths of the tissues between the large and small labia on the right and left. The contents of the gland are secreted along the duct into the area of the vestibule of the vagina, providing sufficient moisture to the entrance to the vagina. With poor patency of the duct or its complete closure, the contents accumulate in it and in the cavity of the gland itself.

Violation of the patency of the Bartholin gland duct occurs when:

infection of the gland and ducts with genital infections (such as gonorrhea, chlamydia, ureaplasma, mycoplasma or Trichomonas),
for vaginal candidiasis (thrush),
with the rapid reproduction of opportunistic flora due to weak immunity (Escherichia coli, streptococcus or staphylococcus).

How does a Bartholin gland cyst manifest?

An oval-shaped volumetric formation appears, which a woman herself or a gynecologist can notice when examined on a chair. The cyst of the Bartholin gland can increase in size over time, create discomfort when walking, sitting, wearing underwear, during sexual activity. With inflammation of the Bartholin gland cyst, an abscess is formed, which is accompanied by pain, swelling, and an increase in body temperature. In such cases, opening of the abscess is required, this is a temporary measure, since the abscess most often reoccurs.There is such a disease as chronic bartholinitis: the Bartholin gland is infected, it can periodically increase in size with pain.

Methods for the treatment of the bartholin gland and bartholinitis?

Small cyst (no more than 2 cm): detection and treatment of sexually transmitted infections, normalization of the flora in the vagina, recommendations for intimate hygiene, observation. Large Bartholin gland cyst, cosmetic defect, discomfort, pain, recurring Bartholin gland abscesses: surgical treatment is required.

The most effective treatment for a Bartholin gland cyst is to remove the capsule of the Bartholin gland cyst, sometimes together with the gland itself. In chronic bartholinitis, the infected Bartholin gland is removed. Sometimes the process can be two-way. The operation is performed after examining the patient, identifying and treating sexually transmitted infections. The incision is made in the least visible place along the mucous membrane of the labia. After the operation, the necessary treatment, wound treatment and physiotherapy procedures are prescribed.

For the treatment of diseases of the Bartholin gland, you can seek advice from A.N. Ignatiev. or Malmygin D.A.

90,000 causes, symptoms, diagnosis and treatment in Moscow

Inflammatory processes in the vagina and external genitalia are often found among women who are sexually active. One of these diseases is bartholinitis. An uncomplicated form of inflammation does not lead to a significant deterioration in well-being and a decrease in the quality of life.Women may experience problems associated with the formation of vaginal fistulas, the formation of a retention cyst of the Bartholin gland and the appearance of other complications.

What is bartholinite

Bartholinitis is based on inflammation of the Bartholin gland, which is located in the vestibule of the vagina. Most often, the pathological process is one-sided. The Bartholin gland secretes a clear liquid that provides optimal moisture to the mucous membrane and comfort and comfort for intimate contacts.

The peak incidence occurs at the age of 20-30 years. With highly contagious infections, the anterior genital tract, a significant decrease in the activity of the immune system, bilateral forms of bartholinitis are observed.

Causes of bartholinitis

Bartholinitis is based on the defeat of the Bartholin gland by specific or observed infectious microorganisms. The disease can cause gonococci, chlamydia, E. coli, staphylococci and other pathogenic pathogens.Infection occurs through unprotected intimate contact. It is also possible to develop diseases when using other people’s personal items and unsterilized medical instruments.

Predisposing factors for the development of bartholinitis:

if a woman or her sexual partner has urogenital infections;
acute or chronic course of bacterial vaginosis, cystitis, pyelonephritis, colitis and other diseases in which endogenous infection is possible;

90 096 damage to the external genital organs;

weakening of the immune defense;
chronic course of endocrine pathologies;
Frequent change of sexual partners.

The Bartholin glands moisturize predisposed vaginas, which have ducts that open on the inner sides of the labia minora. Under various different infectious agents, inflammation of the ducts and mucous tissue remains. In the presence of the necessary treatment for bartholinitis at an early stage, purulent complications may appear. The excretory duct of the Bartholin gland becomes impassable, resulting in an abscess or empyema.

Symptoms of bartholinitis

The inflammatory process of the Bartholin gland begins with a small labia and the formation of a dense nodule.A woman may feel a slight burning sensation that worsens while walking and urinating. The mucous membrane begins to swell, serous-purulent discharge appears. An increase in body temperature is possible.

Purulent complications are accompanied by active edema of the Bartholin gland with the appearance of intense pain syndrome and signs of general malaise. The symptoms of bartholinitis in women are especially pronounced during the formation of an abscess. Infectious complications, up to the progression of sepsis.

Acute bartholinitis

Acute bartholinitis has the most striking clinical manifestations.Cause of severe pain, especially while walking. With an exacerbation, there are favorable conditions for the active reproduction of opportunistic microorganisms. Therefore, the inflammatory process often leads to formal purulent diseases.

The specialist prescribes antibacterial agents, drugs that relieve pain and restore the normal state of health of a woman. At an early stage, local cold is used to relieve the acute process, which is applied to the external genital area.The inflamed area is located with antiseptics, ointments with ichthyol are applied.

The development of acute bartholinitis can provoke the following adverse factors and diseases:

non-observance of personal hygiene rules;
the use of tight underwear, especially important natural ventilation of the skin;

90 096 exacerbation of gynecological diseases, including thrush;

damage to the mucous membrane of the genitals, penetration of infectious pathogens from the rectum, vagina and urinary tract through small abrasions;
hypothermia of the body;
vitamin deficiency;
severe stress;
hormonal changes in the body.

Infectious pathogens penetrate the Bartholin gland, enter the bloodstream or through small injuries of the external genital organs.

It is important to prevent the transition of the disease into a chronic form. The long course of the disease leads to the formation of abscesses that require surgical intervention.

Chronic bartholinitis

If bartholinitis does not undergo effective treatment at the initial stage, the inflammatory process can take a relapsing course.Treatment of chronic bartholinitis is more difficult and often requires surgical interventions.

During the period of remission, the disease has no pronounced symptoms. An exacerbation can be provoked by sexually transmitted diseases, menstruation, hypothermia, infectious processes in the pelvic organs. The chronic form of the disease is manifested by the preservation of a small process in the labia. Periodically, pus may be released from it. The woman is tormented by dull pains in the genital area.The pain syndrome intensifies during active movements. During sexual intercourse, unpleasant sensations may arise and angerful separation from the inflamed Bartholin gland may increase.

Bartholinitis and pregnancy

In pregnant women, the activity of the immune system decreases, which can provoke inflammation of the Bartholin gland. Sometimes it recurs early or late. Gynecologists are involved in the treatment of bartholinitis during pregnancy. Professionals should apply immediately after the appearance of colored lips and any discomfort.

Any infectious process can lead to miscarriage and other adverse consequences. It is forbidden to independently select medications that can have a teratogenic effect on the developing fetus. The gynecologist will select the necessary local remedies that will stop the inflammatory process and the spread of infection.

Diagnostics of diseases

The diagnosis is made on the basis of the results of examination and laboratory tests. It is necessary to differentiate bartholinitis with paraproctitis, a furuncle of the labia, malignant formations of the Bartholin gland.Specialists carry out microscopic diagnostics, bacterial cultures of vaginal smears. The PCR study is carried out for the exact infectious agent.

A woman, in addition to a gynecologist, may need the help of other narrow-profile specialists, especially with frequent relapses of the inflammatory process, which may indicate a latent course of endocrine pathologies, autoimmune diseases. Bartholinitis occurs at a young and middle age, during the period of preservation of reproductive function, when there is an increased activity of the Bartholin glands, which moisturize the external genital organs.If gynecologists detect neoplasms in the labia area in postmenopausal women, it is imperative to carry out additional cytological diagnostics in order to exclude the likelihood of the growth of malignant tumors.

Treatment of bartholinitis

For bartholinitis, use both conservative and surgical methods of treatment. Complicated forms of the inflammatory process are indications for the use of antibiotics, the appointment of physiotherapeutic procedures and local remedies.Antibacterial drugs are selected based on the results of laboratory diagnostics. They must have a wide range of actions.

Local antiseptics are used several times a day. To eliminate signs of fever and pain, specialists prescribe non-steroidal anti-inflammatory drugs. From physiotherapeutic procedures, UHF, UFO are used.

In the chronic course of the gynecological disease of bartholinitis, women are prescribed an operation. It takes place in a hospital and involves the removal of the Bartholin gland or the opening of the pathological cavity with the artificial formation of a new duct.Surgical intervention prevents further relapses of the inflammatory process and abscess formation.

The indication for the operation is the frequent recurrence of bartholinitis. Brushes after removing it. The prolonged course of bartholinitis, especially in adulthood, is dangerous with complications and the frequent formation of abscesses.

What to do in case of exacerbation of bartholinitis

First of all, consult your doctor. He conducted an examination, appointed the results of laboratory tests and research results.At an early stage, you can limit yourself to local anti-inflammatory drugs, antiseptics and drugs with antibacterial properties.

Recurrence of diseases requires poor health. It is necessary, if possible, to observe bed or half-bed rest, avoid hypothermia and overheating. It is forbidden for a woman to take hot baths, since the high temperature of the water can provoke bleeding, spread blood flow to healthy organs and the system. Forbidden sexual intercourse until complete recovery and the disappearance of acute symptoms of the disease.

Prevention

Prevention of bartholinitis consists in eliminating the actions of the main predisposing factors. It is recommended to avoid exposure to the external genitalia. To prevent the spread of infection, it is necessary to use comfortable underwear made from natural fabrics. If endocrine diseases are detected, it is recommended to be examined by an endocrinologist, who will prescribe an effective treatment. Follow the completeness of the diet: a weakening of immunity against the background of a lack of nutrients is a provoking factor in bartholinitis.

Prevention also includes the use of reliable contraceptives that prevent infection with sexually transmitted infections. It is necessary to spread infectious agents.

Cost of treatment

The cost of bartholinitis treatment is determined by the methods used. The price includes drug therapy, diagnostic and physiotherapy procedures. In our clinic, bartholinitis treatment is available for most women. Specialists conduct consultations, examination, comprehensive examination and prescribe affordable and effective treatment methods.

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