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Vulvar cysts pictures: Bartholin’s cyst – Symptoms and causes

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Bartholin Gland Cysts – Women’s Health Issues

If a Bartholin gland cyst causes little or no pain, women under 40 may treat it themselves. They can use a sitz bath or soak in a few inches of warm water in a tub. Soaks should last 10 to 15 minutes and be done 3 or 4 times a day. Sometimes cysts disappear after a few days of such treatment. If the treatment is ineffective, women should see a doctor.

In women under 40, only cysts that cause symptoms require treatment. Draining the cysts is usually ineffective because they commonly recur. Thus, surgery may be done to make a permanent opening from the gland’s duct to the surface of the vulva. Thus, if fluids refill the cyst, they can drain out. After a local anesthetic is injected to numb the site, one of the following procedures can be done:

  • Placement of a catheter: A small incision is made in the cyst so that a small balloon-tipped tube (catheter) can be inserted into the cyst. Once in place, the balloon is inflated, and the catheter is left there for 4 to 6 weeks, so that a permanent opening can form. The catheter is inserted and removed in the doctor’s office. Women can do their normal activities while the catheter is in place, although sexual intercourse may be uncomfortable.

  • Marsupialization: Doctors make a small cut in the cyst and stitch the inside edges of the cyst to the surface of the vulva. Marsupialization creates a permanent opening in the cyst so that the cyst can drain as needed. This procedure is done in an outpatient operating room. Sometimes general anesthesia is needed.

After these procedures, women may have a discharge for a few weeks. Usually, wearing panty liners is all that is needed. Taking sitz baths several times a day may help relieve any discomfort and help speed healing.

If cysts recur, they may be surgically removed. This procedure is done in an operating room.

Office Management of Bartholin Gland Cysts and Abscesses

D. ASHLEY HILL, M.D., and JORGE J. LENSE, M.D., Florida Hospital Family Practice Residency Program, Orlando, Florida

Am Fam Physician. 1998 Apr 1;57(7):1611-1616.

 
See related patient information handout on Bartholin gland cysts, written by the authors of this article.

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

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

Anatomy

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

Differential Diagnosis

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

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TABLE 1

Differential Diagnosis of Bartholin Gland Abnormalities

Vulvar lesions

Sebaceous cyst

Dysontogenetic cyst

Hematoma

Fibroma

Lipoma

Hidradenoma

Syringoma

Endometriosis

Myoblastoma

Accessory breast tissue

Leiomyoma

Von Recklinghausen’s tumor

Adenocarcinoma

Vaginal lesions

Vaginal inclusion cyst

Endometriosis

Adenosis

Gartner duct cyst

Leiomyoma

Inguinal hernia

TABLE 1

Differential Diagnosis of Bartholin Gland Abnormalities

Vulvar lesions

Sebaceous cyst

Dysontogenetic cyst

Hematoma

Fibroma

Lipoma

Hidradenoma

Syringoma

Endometriosis

Myoblastoma

Accessory breast tissue

Leiomyoma

Von Recklinghausen’s tumor

Adenocarcinoma

Vaginal lesions

Vaginal inclusion cyst

Endometriosis

Adenosis

Gartner duct cyst

Leiomyoma

Inguinal hernia

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

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

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

Management of Bartholin Gland Cysts

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

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

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

Word Catheter

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


FIGURE 1.

Word catheter.

After local anesthesia and sterile preparation with povidone-iodine or a similar solution, a no. 11 scalpel is used to make a stab incision 1. 0 to 1.5-cm deep into the cyst, preferably just inside or, if necessary, just outside the hymenal ring (Figure 2). The stab wound should not be made on the outside of the labium, however, since a permanent fistula may develop. A hemostat or similar instrument is inserted to break up any loculations, and then a Word catheter is placed. The Word catheter is a small rubber catheter with an inflatable balloon tip that is inserted into the stab wound after the cyst’s contents have been drained. The bulb is inflated with water or lubricating gel, and the free end of the catheter is tucked up into the vagina (Figure 3). (Using water or gel rather than air will prevent premature deflation of the balloon.)

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FIGURE 2.

Medial stab incision of Bartholin gland cyst, before placement of Word catheter.


FIGURE 2.

Medial stab incision of Bartholin gland cyst, before placement of Word catheter.

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FIGURE 3.

Placement of Word catheter in a patient with a Bartholin gland cyst.


FIGURE 3.

Placement of Word catheter in a patient with a Bartholin gland cyst.

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

Marsupialization

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

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FIGURE 4.

Marsupialization technique in the treatment of Bartholin gland cyst. The vulvar mucosa is incised, and an oval of skin is removed (left), followed by an incision in the cyst wall (right).


FIGURE 4.

Marsupialization technique in the treatment of Bartholin gland cyst. The vulvar mucosa is incised, and an oval of skin is removed (left), followed by an incision in the cyst wall (right).

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FIGURE 5.

Interrupted, delayed-absorbable sutures are used to secure cyst wall to vulvar mucosa.


FIGURE 5.

Interrupted, delayed-absorbable sutures are used to secure cyst wall to vulvar mucosa.

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TABLE 2

Instruments for Two Procedures
Word catheter Marsupialization

Povidone-iodine solution Anesthetic solution Word catheter 18- or 20-gauge needle and 5 mL-syringe plus water or gel for inflation of catheter tip No. 11 scalpel Hemostat (for breaking up loculations) Culture media for gonorrhea, Chlamydia and routine cultures Silver nitrate sticks Gauze pads

Povidone-iodine solution Anesthetic solution No. 11 scalpel

3-0 or 4-0 delayed-absorbable suture on small cutting needle Small needle driver Scissors Hemostats Forceps Culture media Silver nitrate sticks Gauze pads

TABLE 2

Instruments for Two Procedures
Word catheter Marsupialization

Povidone-iodine solution Anesthetic solution Word catheter 18- or 20-gauge needle and 5 mL-syringe plus water or gel for inflation of catheter tip No. 11 scalpel Hemostat (for breaking up loculations) Culture media for gonorrhea, Chlamydia and routine cultures Silver nitrate sticks Gauze pads

Povidone-iodine solution Anesthetic solution No. 11 scalpel

3-0 or 4-0 delayed-absorbable suture on small cutting needle Small needle driver Scissors Hemostats Forceps Culture media Silver nitrate sticks Gauze pads

Other Techniques

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

Other techniques include incision of Bartholin gland abscesses followed by curettage of the abscess cavity,8 application of silver nitrate to the cyst or abscess cavity9,10 and use of a carbon dioxide laser.11 One team compared excision with silver nitrate application for the treatment of Bartholin gland abscesses and cysts and concluded that silver nitrate was as effective as excision.9 It would be valuable to compare silver nitrate application with a treatment option less morbid than excision, such as marsupialization or placement of a Word catheter. The carbon dioxide laser is also an effective method of treating Bartholin gland cysts or abscesses.11 We believe, however, that the laser usually offers no advantage over the less expensive and less technically difficult procedures described above.

Excision

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

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

Management of Bartholin Gland Abscesses

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

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

Adenocarcinoma of Bartholin’s Gland

Adenocarcinoma of Bartholin’s gland is rare but should be considered in the differential diagnosis of labial masses.14 The incidence is highest among women in their 60s. Symptoms and signs can mimic those of benign Bartholin gland cysts and abscesses, although fixation of the gland to the underlying tissue may be noted. While some authorities have advocated excision of all Bartholin gland cysts or abscesses in women over age 40,1 others have suggested that excision is rarely necessary in these women. In a retrospective cohort study, investigators concluded that the incidence of Bartholin gland cancer in postmenopausal women is so low (0.114 per 100,000 woman-years) that routine excision is unwarranted; instead, women in this age group may benefit from drainage and selective biopsy. 15

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

Pregnancy

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

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

Bartholin’s cyst – Treatment – NHS

If you have a lump in your genitals, get it checked by your GP.

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

If the cyst is painful, your GP may recommend:

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

Always read the manufacturer’s instructions when using over-the-counter medication.

Treating an abscess

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

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

Draining cysts and abscesses

A number of techniques can be used to drain a Bartholin’s cyst or abscess and reduce the likelihood of it returning. The main procedures are described below.

Balloon catheter insertion

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

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

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

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

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

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

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

A few small studies have reported more than 80% of women healed well and their cysts or abscesses didn’t return after balloon catheter insertion.

Possible complications of balloon catheter insertion include:

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

Marsupialisation

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

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

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

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

Although complications after marsupialisation are rare, they can include:

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

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

Removing the Bartholin’s gland

Surgery to remove the affected Bartholin’s gland may be recommended if other treatments haven’t been effective and you have repeated Bartholin’s cysts or abscesses.

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

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

Alternative procedures

There are a number of alternative ways of treating a Bartholin’s cyst, but they’re less commonly used or aren’t widely available. These are described below.

Silver nitrate gland ablation

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

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

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

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

Carbon dioxide laser

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

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

Needle aspiration

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

Advice after surgery

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

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

Page last reviewed: 23 July 2018
Next review due: 23 July 2021

Recurrent Huge Left Bartholin’s Gland Abscess for One Year in a Teenager

Bartholin’s gland abscess is the commonest worldwide reported abscess in gynaecological outpatient clinics; it has also been reported that Bartholin’s gland abscess is three times more common in occurrences compared to Bartholin’s gland cyst. It is more common in women who are at risk of acquiring sexually transmitted infections; however, other causes of infection should be investigated to exclude other causes of disease. We present the case of an 18-year-old female patient, a teenager of the reproductive age group, with the recurrent development of huge Bartholin’s gland abscess in a period of one year. The marsupialization surgical technique of repair was performed successfully. She was discharged home and she was scheduled to visit STI’s clinic where she was receiving regular screening for STI’s and she was also given health education regarding preventive measures for STI’s.

1. Introduction

Recurrent Bartholin’s gland abscess among women of reproductive age is commonly associated with the risk of being in contact with the sexually transmitted polymicrobial infection.

The pathogenesis of Bartholin’s gland abscess starts slowly as the progressive swelling of the labia majora which later becomes painful, and finally it is accompanied by fever and massive swelling of the genital vulva on the affected side [1].

The risk of acquiring STIs is related to getting another associated genital tract infection. It is estimated that, among individuals who contract STIs, some of them would likely develop Bartholin’s gland abscess, and there is a high chance of acquiring other sexually transmitted infections [2].

It has been reported that Gram-negative bacteria was more commonly isolated than Gram-positive species that are found in the cultivated Bartholin’s gland abscess pus; however, the controversy has been observed among directly isolated suspicious species because the abscess is caused by multiple microorganisms [3].

In the pathogenesis of Bartholin’s gland abscess, directly induced inflammatory response caused by multiple microorganisms has been associated with the increased risk of acquiring other STIs including HIV and syphilis among the affected individuals [4].

There is high risk of acquiring sexually transmitted infection among individuals with multiple sexual patners and those who practice unprotected sexual intercourse which could be due to decreased body’s resistance of clearing the infection and infected individuals would develop persistent infection, which is the risk factor for recurrent sexually transmitted infections [5].

Bartholin’s gland is usually associated with secretion of normal presexual intercourse vaginal fluids, and rarely the gland is associated with infection, but it has the possibility of developing Bartholin’s gland cyst that can progress to an increased large-sized gland [6]. However, the modalities of treatment by surgical intervention for both conditions remain the same.

We report the case of an 18-year-old female teenager of the reproductive age group with a one-year recurrent huge Bartholin’s gland abscess whereby the marsupialization surgical technique of repair was successfully done.

2. Case Presentation

An 18-year-old female presented to the gynaecology clinic at Bugando Medical Centre, Mwanza, Tanzania, with a history of recurrent painful huge genital swelling in her left labia majora for one year which initially started as a small swelling, then increased in size, and became painful. She gave a history of pus discharge, and due to its recurrent and persistence swelling, it was associated with fever and inability to walk properly and was accompanied with painful micturition. She had a history of being treated unsuccessfully several times through suction with a needle syringe though she noted a temporary relief. However, she had a history of long-term use of antibiotics without getting relief. The swelling recurred at intervals of less than one or two months over the last year. She has no history of receiving counselling for HIV and testing.

On examination, there was tender large mass involving the left labia majora and minora, shiny and with a smooth surface, discharging pus at the small sinus, erythematous, fluctuant, and measuring approximately 10 cm in length and 6 cm in width. Her vaginal examination revealed normal vaginal wall, no any offensive discharge, with the healthy cervix; she had negative cervix excitation test and normal sized uterus; neither adnexal mass nor tenderness was elicited (Figure 1). She had a working diagnosis of huge left Bartholin’s gland abscess. On general examination, she had no peripheral lymph node enlargement. Her vital signs were a blood pressure of 120/70 mmHg, pulse rate of 88 beats per minute, and temperature of 37 Celsius. Other systemic examination was normal. Cardiovascular system examination revealed audible first and second heart sounds and no murmurs. Respiratory system examination showed a respiratory rate of 21 breaths/minute, normal chest contour, trachea centrally located, normal chest expansion, and normal breath sound on auscultation. Per abdominal examination, abdomen was flat, moving normally with respiration, and there were no visible superficial veins. The abdomen was soft and nontender. The liver, spleen, and kidneys were not palpable. No shifting dullness and bowel sounds were normal on auscultation.

The patient was counselled for emergency marsupialization, and informed consent was obtained. Preoperative antibiotics were given: ciprofloxacin 500 mg orally 12 hourly for 5 days, metronidazole 400 mg orally 8 hourly for 7 days, and doxycycilline 100 mg orally bid for 7 days. In theatre, surgical intervention by marsupialization was done under spinal anaesthesia (5% lidocaine 50 mg preparation). The patient was placed in the lithotomy position, and left huge Bartholin’s gland abscess was exposed. The incision was made through the gaped skin covering the abscess whereby pus was drained and cleaned with normal saline until the underlying fresh tissue edge of a gland was identified and was oozing fresh blood. A lot of foul-smelling pus was drained from the abscess, approximately 30 ml. The edges of the gland were grasped gently using a forceps. The sutures material used was a vicryl number 2-0, and repair by the marsupialization method was done. In the postoperative care, she continued with already prescribed antibiotics, and the analgesia given was paracetamol 1 g orally 8 hourly for 3 days. The patient was discharged on the 3rd day and linked to reproductive health clinics for counselling about the knowledge of sexually transmitted infection prevention and treatments.

3. Discussion

In our case, the patient presented with a history of recurrent left huge labial swelling for the past one year. The reason of recurrence probably was suggested to be the previous treatment by incision and drainage rather than treatment by marsupialization-type incision and followed by unknown prolonged course of oral antibiotics [7].

The microorganisms causing recurrent Bartholin’s gland abscess are polymicrobial and often commensal microorganisms that are not sexually transmitted. In our case, the likely hood that, there was high chance the Batholin’s gland abscess was caused by a sexually transmitted infection was the fact most teenagers are sexually active [8].

Treatment of Bartholin’s gland abscesses depends on the presenting symptoms that may indicate the cause of that abscess; however, if it happens that it started to present asymptomatically, it may require marsupialization only without issuing the polymicrobial antibiotic treatment [9].

Bartholin’s gland cysts and abscesses may present with different symptoms, and the required surgical management should be marsupialization and not incision and drainage. Though the incision and drainage procedure was shown to be relatively quick and easy to perform and was proven to be quick on cure rate, among patients receiving this type of surgical technique, it has been shown to have increased tendency of recurrences in a patient with Bartholin’s gland abscess [10].

The use of systemic broad-spectrum antibiotics in this patient aimed to cover polymicrobial species of bacteria. However, it has been reported that some of the bacteria isolated from Bartholin’s gland abscess are normal vaginal flora in origin, and therefore prescribing antibiotics increases the risk of infections in susceptible immuno-incompetent individuals [11].

In our case, there was a history of recurrent Bartholin’s gland abscess, and this might be due to the repeated exposures to the infections or improper use of strong broad-spectrum antibiotics together with incision and drainage instead of management by marsupialization, as we know that incision and drainage have been shown to increase risk of Bartholin’s gland abscess recurrences [12].

Having a huge Bartholin’s gland abscess as the case in this patient and prescribing multiple antimicrobial agents with incision and drainage alone may generally not solve the issue of recurrent Bartholin’s gland abscess. The marsupialization surgical technique done in this patient has been shown to be a successful surgical repair, on the progressive follow-up of the patient through the gynaecological clinic. However, additional use of broad-spectrum antibiotics has also shown to support the improvement of the recurrent Bartholin’s gland infection [13].

4. Conclusion

Bartholin’s gland abscess should be distinguished from other vulvar masses. A simple management by marsupialization and broad-spectrum antibiotics has been proved to be effective rather than management by surgical incision and drainage alone.

Consent

A written informed consent was obtained from the patient for publication of this case report.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

Athanase Lilungulu performed the surgery and wrote and drafted the first manuscript. Dismas Matovelo performed the surgery and reviewed the manuscript. Albert Kihunrwa reviewed the patient prior to surgery and revised several drafts of the manuscript. Balthazar Gumodoka revised several drafts of the manuscript. All authors read and approved the final manuscript. Bonaventura C. T. Mpondo and Abdallah Mlwati involved in the treatment of medical conditions and revised drafts of the manuscript.

Acknowledgments

The authors acknowledge the help of the gynaecological ward nurse team and medical team together with theatre operating room staffs who tirelessly assisted in the care of this patient and counselling.

Bartholin’s cyst | Health Navigator NZ

Bartholin’s cysts are soft painless lumps that can occur in the lubricating glands found at the opening of a woman’s vagina. If the cysts become infected they can form a painful abscess. See your GP if you develop a lump in the area around your vagina, so they can confirm a diagnosis and rule out more serious conditions.


Key points

  1. Bartholin’s glands are a pair of pea-sized glands found either side of the opening to the vagina. They secrete fluid that acts as a lubricant during sex.
  2. If the opening (ducts) in the glands become blocked, they can fill with fluid and expand to form a soft, painless lump or Bartholin’s cyst.
  3. This doesn’t usually cause any problems, but if it grows or becomes infected it will form an abscess. If this happens, you may feel pain in the area when you walk, sit down or have sex.
  4. Treatment depends on the size of the cyst, how painful it is and whether it is infected.
  5. Around 1 in every 50 women will develop a Bartholin’s cyst or abscess. It is most common in sexually active women aged between 20 and 30.

Source: Primary Care Dermatology Society, UK.

What are the causes of Bartholin’s cyst and Bartholin’s abscess?

It’s usually not known why Bartholin’s ducts become blocked, but once a lump (cyst) has developed, the fluid inside can easily become infected. Usually, the infection is from bacteria commonly found in the vagina. However, sometimes bacteria that can cause sexually transmitted infections (such as gonorrhoea or chlamydia) cause the infection.

What are the symptoms of Bartholin’s cyst?

You might feel a lump or fluid-filled mass near your vaginal opening. This is usually painless but it can be tender. If the cyst becomes infected, you may experience:

  • a tender, painful lump near your vaginal opening
  • discomfort while walking or sitting
  • pain during intercourse.

How is Bartholin’s cyst diagnosed?

Always see your GP if you find a lump in your vaginal region so they can confirm a diagnosis and ensure appropriate treatment is received. If your GP thinks the cyst may be infected, they may swab it and send a sample to the lab for analysis to identify the bacteria responsible. In some cases, your GP may recommend you have a biopsy (sample of tissue removed) so it can be checked for signs of a rare cancer, called Bartholin’s gland cancer.

How is Bartholin’s cyst treated?

Depending on the size of the cyst or abscess, and the severity of your symptoms, treatment options range from self-care and medication to drainage or surgical removal of the cyst.

Self-care

If you can feel the cyst, but it is not growing, sore or infected, it’s unlikely you need any treatment. If the cyst is painful, your GP may recommend some simple self-care measures, such as:

  • soaking the cyst in warm water several times a day for three or four days using a sitz bath
  • taking over-the-counter painkillers.
  • if you are prescribed antibiotics, taking the full course.

Medication

If the cyst is infected (developed into an abscess), your doctor may prescribe antibiotics. If the abscess does not respond to antibiotics, you may need to have one of the following procedures.

Word catheter balloon insertion (procedure)

This procedure takes around 15 minutes and is carried out under a local anaesthetic. It involves making a channel from the cyst or abscess through which the gland can drain. A small cut is made in the abscess and a small flexible tube (catheter) with a small balloon at its tip is inserted to create a passage. It is usually offered to women under 40.

Marsupialisation (surgery)

This surgery is done under general anaesthetic and takes about 10–15 minutes. The doctor makes a small cut in the abscess and gland to release the fluid, sewing the edges to the surrounding skin. This keeps the cut open, so it can heal and for the abscess to drain out. This prevents another abscess from forming later. The small cut will completely heal by itself.

Excision (surgery)

This surgery involves the removal of the cyst or abscess under general anaesthetic. It is carried out so that the area can be fully examined when the cyst or abscess is removed. During excision, the entire gland is removed. This procedure is only considered in women over 40 who have had abscesses recur on several occasions. As result of excision, the gland will no longer function which means that your body will produce less lubricant. 

This loss of lubrication can make having sex uncomfortable. To improve lubrication, you can use lubricants or vaginal moisturisers. If these are not effective for you, talk to your doctor about whether vaginal oestrogen and hormone replacement therapy (HRT) are suitable for you.

How can I prevent Bartholin’s cyst?

Because it’s not clear exactly why Bartholin’s cysts develop, it isn’t usually possible to prevent them. However, some cysts are thought to be linked to sexually transmitted infections, so practising safe sex (using a condom every time you have sex) might help reduce your chances of developing one.

Learn more

The following links provide further information about Bartholin’s cyst. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Bartholin’s cyst and abscess Patient Info, UK, 2017
Bartholin’s cyst NHS, UK, 2015
Sitz bath Healthline, US, 2017

References

  1. Haider Z, Condous G, Kirk E, Mukri F, Bourne T. The simple outpatient management of Bartholin’s abscess using the Word catheter: a preliminary study Aust N Z J Obstet Gynaecol. 47 (2): 137–140.
  2. Treating a Bartholin’s cyst or abscess Guys’ and St Thomas’ NHS Foundation Trust, UK, 2017
  3. Bartholin’s cyst Mayo Clinic, US, 2015
  4. Vaginal dryness NHS Choices, UK, 2016

Reviewed by


Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland.


Information for healthcare providers on bartholin’s cyst

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Resources

Although incision and drainage is the most frequently performed procedure, it is associated with a high rate of recurrence. Oral antibiotics are not indicated unless there is associated cellulitis or systemic symptoms. If required, broad-spectrum antibiotic cover is necessary as the infection is usually polymicrobial. Carcinoma of the Bartholin gland is rare (approximately 1% of genital malignancies in women), however, this diagnosis should be considered in a woman aged over 40 years. Vulvovaginal health in premenopausal women BPAC, NZ, 2011

Because the Bartholin’s glands usually shrink during menopause, a vulvar growth in a postmenopausal woman should be evaluated for malignancy, especially if the mass is irregular, nodular, and persistently indurated. Omole F, Simmons BJ, Hacker Y. Management of Bartholin’s duct cyst and gland abscess Am Fam Physician. 2003 Jul 1;68(1):135-140.

Bartholin’s cyst BMJ Best Practice, UK, 2017

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Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

Conservative treatment and follow-up of vaginal Gartner’s duct cysts: a case series | Journal of Medical Case Reports

Case 1 – follow-up for 17 years

A 38-year-old woman of mixed ethnicity was initially referred to our service at 21 years of age for evaluation before starting contraceptive use. She reported menarche at 13, first sexual intercourse at 21 and regular cycles. No abnormalities were observed during a breast examination. A speculum examination revealed an epithelialized cervix and the presence of a paracervical cystic lesion on the right wall of her vagina, painless to manipulation, measuring approximately 2 × 2 cm, with translucent content and soft consistency (Fig. 1). An ultrasound revealed a cystic lesion. She continued regular annual monitoring. She became pregnant at age 32 and delivered by cesarean section. The cyst remained approximately 1.5 to 2.0 cm in size and did not change during pregnancy. She has received follow-ups since that time, and the Gartner’s cyst has exhibited no change in its characteristics.

Fig. 1

Paracervical cystic lesion with translucent content on the right wall of the vagina, measuring approximately 2 × 2 cm

Case 2 – follow-up for 13 years

A 53-year-old G3P3 woman of mixed ethnicity sought our service at 40 years of age for a routine visit. She had no significant history of medical illness. Upon speculum examination, a cystic lesion in the right wall of her vagina with translucent content and extensive vascularization was found (Fig. 2). A transvaginal ultrasound revealed a hypoechoic nodule in the vaginal fornix measuring 4.2 × 3.8 × 2.1 cm, with thick content, and was consistent with a cyst. Removal was advised due to the thick content and exuberant vascularization, but she declined. She has been followed to date with no alterations.

Fig. 2

Cystic lesion in right wall of the vagina with translucent content, but with exuberant vascularization

Case 3 – follow-up for 5 years

A 37-year-old black woman presented to our service at age 32 for a Pap test. Her obstetric/gynecological history was significant for menarche at age 13, first sexual intercourse at 15, and regular menstrual cycles. Her pregnancies included one natural delivery, one tubal and one anembryonic pregnancy. She had a left salpingectomy. She also had a history of urethral stricture that led to recurrent urinary tract infections (UTIs). Her family history notes an aunt with unspecified urethral alterations. Her speculum examination revealed a healthy cervix and the presence of a cyst measuring approximately 2.5 × 2 cm in the proximal third of the right wall of her vagina (Fig. 3a). Touch revealed a lesion with cystic consistency. She underwent an ultrasound that showed a thin-walled cyst with anechoic content on the right posterolateral wall of her vagina (Fig. 3b). The findings, along with measurements of 2.2 × 1.8 × 1.9 cm, are consistent with the diagnosis of a Gartner cyst. No changes in the cyst have been found during follow-up to date.

Fig. 3

a Cystic lesion in the right wall of the vagina close to the fornix. b Ultrasound showed a thin-walled cyst with anechoic content on the right posterolateral wall of the vagina

Case 4 – follow-up for 2 years

A 49-year-old woman of mixed ethnicity, para 2, was referred to our gynecological clinic because of a nontender mass inside her vagina. The mass had been evident for approximately 2 years, without any symptoms. She had a history of endometrial polyps and uterine fibroids. A pelvic examination revealed a 2 × 2 cm cystic lesion in the right wall of her vagina (Fig. 4). The mass was soft and could be compressed manually without difficulty. A pelvic ultrasound confirmed a cystic lesion in this region of her vagina. She was treated conservatively and had no interval cyst growth or change in cyst characteristics at follow-up.

Fig. 4

Cystic lesion of 2×2 cm in the right wall of the vagina

Bartholin’s cyst and abscess treatment

Options of treatment:

The goal of any treatment is to make a new opening near the original one, so that lubricating fluid can keep the area healthy and make sex easier. This is the lubrication that is secreted when you are aroused.

Never allow a physician to make the opening over the most prominent area of the cyst or abscess if it is not right next to the hymen ridge, on the inside of your inner lips! This mistake, which is common, can result in the new opening being on the outside, so whenever you get aroused, the lubricating fluid runs down your thigh, rather than at your vaginal opening, where it is needed for lubrication during sex.

A few options and our comments:

Word Catheter: This is the best treatment. A small 6 cm long tube with a tiny balloon on one end is used. (See the photo and diagram below). Once we have opened the abscess or cyst, we put the catheter tube into the opening to make sure that the skin does not close again. This is very successful. (80 – 90%). At Meridia, we use a LASER to make the opening, and our success rates are excellent using this method.

Antibiotics: Using antibiotics for the abscess is not recommended because it is unlikely to work. For antibiotics to work there needs to be a good blood supply to the infection to kill the bugs. An abscess does not have a good blood supply. At Meridia Gynecology, we generally do not use antibiotics unless there is a complicated situation and surrounding skin infection.

Incision and Drainage: This is simply opening the abscess or cyst and letting it drain. This works immediately, but unfortunately, this form of treatment has a high chance of the abscess / cyst coming back as soon as the opening closes again.

Marsupilization: This is an old, standard treatment that makes a large opening and then sutures the inside edges of the duct to the skin to keep it open. The results of this method and the Word Catheter are the same. At Meridia Gynecology, we rarely use this method because it is unnecessary, causes a lot of discomfort and heals slowly. There are times when we need to do it, but those are very rare.

90,000 Breast cysts. Symptoms and treatment of breast cysts in the clinic Intime

Complex treatment and progressive technologies

The main cause of breast cysts is a change in the level of female sex hormones in the body: prolactin and estrogen. The risk group includes nulliparous women of reproductive age after 30 years.

In the initial stages, the disease is asymptomatic, then painful sensations occur before the onset of menstruation and during menstruation.The inflammation intensifies and is accompanied by suppuration of the cystic cavity. The disease rarely degenerates into a malignant tumor, but there is an increased risk of neoplasm. Removal of a breast cyst is carried out according to indications and depends on the size of the formation and on the results of a cytological examination of its contents.

InTime family planning clinic uses the most informative diagnostic methods to identify pathology at an early stage of development. Ultrasound of a breast cyst is performed using the latest expert-class diagnostic devices and allows you to obtain high-quality images with high resolution.Consultation for primary clients is free.

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Benefits of treatment in our clinic

Progressive technical base

For ultrasound diagnostics, advanced digital equipment with wide imaging capabilities is used.Ultrasound machines from well-known and reputable manufacturers of medical equipment (American GE Logiq C5 ultrasound machine, Mindray DC-3 ultrasound machine with 3D function) allow you to obtain three-dimensional models of an organ or pathological area and detect the disease at the earliest stages.

Qualified Doctors

Our doctors are specialists of the highest and first categories, many of whom have a scientific degree and certificates of international level.

Convenient location

The clinic is located in a well-accessible location, there are three metro stations nearby – Sportivnaya, Frunzenskaya, Park Kultury.By car, you can quickly and without traffic jams travel along the Third Ring Road.

Diagnosis and treatment of breast cysts

The main symptom of a breast cyst is a lump, which is detected on self-examination. With the further development of inflammation, the appearance of sharp soreness and redness of the skin over the formation is characteristic. The cyst is clearly visible on ultrasound; it is more difficult to determine it during mammography. A simple and informative method of diagnosis is puncture of the breast cyst, with its help the nature of the formation is clarified.

Fibrous cyst, a background disease in the development of breast cancer, occupies the central place in oncology. The pathogenesis of this type of mastopathy has not yet been fully understood, but most often its appearance provokes hormonal disruption in the climacteric period.

Another type of formation – a ductal cyst of the mammary glands, is a small growths inside the mammary gland. The pathology is quite rare (1% among all breast neoplasms) and belongs to the group of benign diseases.

Treatment of small cysts of the mammary glands (no more than 0.5 mm) – conservative. This is, first of all, the normalization of hormonal balance, pumping out fluid through the puncture and introducing a solution to destroy the capsule.

For atypical cysts of the mammary glands, surgical intervention is prescribed. The tissue removed during the operation of the breast cyst is sent for histological examination.

Your health is our concern!

What to do when breast cysts appear? The only correct answer to this question is an immediate visit to the doctor.Contact the clinic “InTime” – you will be helped thanks to the high level of professionalism of doctors and progressive technologies.

Aesthetic gynecology at the Medical Center in Kolomenskoye

future parents

cryo-material within 1 month

rectoscopy

900.00

7000.00

lips

Gynecological services
Appointment (examination, consultation) of an obstetrician-gynecologist, primary 2500.00
Reception of an obstetrician-gynecologist without examination
Appointment (examination, consultation) of obstetrician-gynecologist repeated 2200.00
Reception (examination, consultation) of a pregnant obstetrician-gynecologist 2900.00
Reception (examination, consultation) of an obstetrician-gynecologist Ph.D. primary 2800.00
Appointment (examination, consultation) of an obstetrician-gynecologist Ph.D. repeated 2500.00
Ovulation stimulation with ultrasound control (1 cycle) 17000.00
Intrauterine anesthesia 1900.00
Carrying out iodine test (Schiller test) 1200. 00
Video colposcopy 2490.00
Colposcopy 1800.00
Carrying out functional diagnostics tests (TFD School) 1200.00
7010.00
Introduction of Rg contrast into the uterine cavity 11000.00
Polypectomy of the cervical canal 7000.00
Vaginal microclysters 1500.00
Medical tampon of the vagina 1100.00
Medical bath 1200.00
Medical drug bath 1500.00
Application

1200.00
Postoperative treatment of the cervix, vagina, vulva, suture removal 1200.00
Insertion of an intrauterine device 4000.00
Insertion of IUD (Mirena) with a spiral 24000.00
Insertion of an IUD (Mirena) without a spiral 7000. 00
Insertion of Implanon (including the drug) 19110.00
Introduction of Implanon (without preparation) 12100.00
Removal of the intrauterine device 2800.00
Dissection of the hymen 14000.00
Chemical destruction of cervical ectopia (without drug) 5500.00
Drug abortion (drug Mifegin) 25000.00
Drug abortion (domestic drug) 23000.00 1200.00
Artificial insemination with husband’s sperm 15280.00
Artificial insemination with donor sperm 31830.00
Gynecological interventions
Diagnostic hysteroscopy + WFD 35000.00
Hysteroscopy 2000062
Hysteroresectoscopy 15000. 00
Sonosalpingography 9000.00
Lancing of the abscess of the bartholin gland 10000.00
Marsupilization, removal of the bartholin gland cyst 20000.00
Separate diagnostic curettage of the uterus and cervical canal 1555.0062
10000.00
Diagnostic curettage of the cervical canal 10000.00
Cervical biopsy 8500.00
Laparoscopic removal of ovarian cyst (parovarian cyst) 55000.00
Laparoscopic removal of fallopian tubes (hydrosalpinx) 55000.00
Laparoscopic surgery

55000.00
Laparoscopic surgery for adhesions of the small pelvis 55000.00
Laparoscopic conservative myomectomy 55000.00
Excision of cysts, papillomas, polyps of the genital tract, 1 unit 7000. 00
Conization of the cervix 30000.00
Artificial termination before pregnancy 7 weeks 25000.00
Artificial termination of pregnancy (medabort) (from 8 to 10 weeks) 28000.00
Artificial termination of pregnancy (medabort) (from 11 to 12 weeks) 30000.00
Reconstruction of the hymen 24840.00
Correction of the labia 35000.00
Correction of the vulva with Bellcontour Gvisk 1 degree 15930.00
Correction of the vulva with the preparation 2 Bellcontour
Correction of the vulva with Bellcontour Gvisk 3rd degree 28660.00
Correction of the vaginal walls with Bellcontour Gvisk 1st degree 17190.00
Correction of the vaginal walls with Bellcontour Gvisk 2 degrees 23560.00
Correction of the vaginal walls with Bellcontour Gvisk 3 degrees 28660.00
Vacuum aspiration of the endometrium
10000.00
Gynecological programs
Pregnancy program A 175000.00
Pregnancy Program B 165000.00

Gynecology Primorsky Moscow District

Operative Gynecology
Removal of an endometriosis focus of a postoperative scar with plastic anterior abdominal wall 28750
Diagnostic curettage of the uterine cavity and cervical canal 10580
Myomectomy (enucleation of myomatous nodes) using video endoscopic technologies (hysteroscopic) 1 category of complexity (with a single myomatous node up to 2 cm in size) 32940
Myomectomy (enucleation of myomatous nodes) using video endoscopic technologies (hysteroscopic) 2nd category of complexity (with a single myomatous node measuring 2-3 cm or several myomatous nodes) 38880
Myomectomy (enucleation of myomatous nodes) using video endoscopic technologies (hysteroscopic) 3rd category of complexity (with a single myomatous node 3-4 cm in size) 48060
Diagnostic laparoscopy with chromosalpingoscopy 39840
Sterilization of fallopian tubes using video endoscopic technology 45530
Ovarian resection using video endoscopic technologies using coagulator 51220
Oophorectomy with video endoscopic technology 51220
Salpingectomy using video endoscopic technology 51220
Salpingo-oophorectomy with video endoscopic technology 51220
Removal of an ovarian cyst using video endoscopic technologies I category of complexity 51220
Removal of an ovarian cyst using video endoscopic technologies, II category of complexity 62610
Operations for infertility on the uterine appendages I category of complexity 51220
Operations for infertility on the uterine appendages II category of complexity 62610
Operations for adhesions of the pelvic organs, I category of complexity 56920
Operations for adhesions of the pelvic organs, II category of complexity 68300
Laporoscopy, removal of the fallopian tube (tubectomy) Category 1 45140
Laporoscopy, removal of the fallopian tube (tubectomy) Category 2 56430
Laporoscopy, salpinovariolysis (dissection of adhesions of the pelvic organs) 1 category 45140
Laporoscopy, salpinovariolysis (dissection of adhesions of the pelvic organs) Category 2 56430
Salpingectomy with video endoscopic technology Category 2 49900
Laparoscopic hysterectomy with appendages 107140
Removal of an endometrioid ovarian cyst of the 1st category (cysts up to 3 cm) 54000
Removal of an endometrioid ovarian cyst Category 2 (cysts from 3 cm to 5 cm) 64800
Removal of Category 3 endometrioid ovarian cyst (cysts> 5 cm or bilateral cysts) 75600
Removal of the cyst of the round ligament of the uterus with plastic of the inguinal canal 38840
Laparotomy subtotal hysterectomy 75600
Laporotomy total hysterectomy 91800
Laparoscopic myomectomy Category 2 (from 2 to 5 nodes, up to 8 cm in size) 78500
Diagnostic curettage of the endometrium 10150

Prices in the MEDEOR medical center in Chelyabinsk

62 170000

IgE to the allergen amoxicillin 450E

ampicillin allergen

900 62 IgE to eggplant allergen

7

9006 0

550

9 0060

Total immunoglobulin E (Ig E) 390
Eosinophilic cationic protein (ECP) 600
Diagnostics of latent food intolerance
IgE to the allergen Dermatophagoides farinae 450
IgE to the allergen Dermatophagoides pteronyssinus 450
IgE to the allergen of ragweed 450
450
IgE to pineapple allergen 450
IgE to orange allergen 450
IgE to peanut allergen 450
IgE to watermelon allergen
450
IgE to banana allergen 450
IgE to lamb allergen 450
IgE to birch allergen 450
IgE to grape allergen 450
IgE to elm allergen 450
IgE to beef allergen 450
IgE to grapefruit allergen 450
IgE to walnut allergen
IgE to buckwheat allergen 450
IgE to pear allergen 450
IgE to melon allergen 450
IgE to green pea allergen 450
IgE to allergen willow white 450
IgE to allergen ind yki 450
IgE to cabbage allergen 450
IgE to potato allergen 450
IgE to ash-leaved maple allergen 450
IgE to strawberry allergen
IgE to spikelet allergen 450
IgE to cow’s milk allergen 450
IgE to coffee allergen 450
IgE to cat allergen (epithelium) 450
IgE to shrimp allergen 450
IgE to rabbit allergen 450
IgE to cornmeal allergen 450
IgE to chicken allergen 450
IgE to chicken allergen (feather) 450
IgE to latex allergen 450
IgE to lemon allergen 450
IgE to salmon allergen 450
IgE to carrot allergen 450
IgE to guinea pig allergen 450
IgE to meadow grass allergen 450
IgE to oatmeal allergen 450
IgE to cucumber allergen 450
IgE to dandelion allergen 450
IgE to sea bass allergen 450
IgE to alder allergen 450
IgE to Atlantic halibut allergen 450
IgE to baker’s yeast allergen 450 IgE to penicillin allergen 450
IgE to plantain allergen 450
IgE to wormwood allergen 450
IgE to bee venom allergen 450
IgE to wheat flour allergen
450 IgE to rye flour allergen 450
IgE to rice allergen 450
IgE to pork allergen 450
IgE to dog allergen (epithelium) 450
IgE to soybean allergen 450
IgE to white pine allergen 450
IgE to timothy allergen 450
IgE to tomato allergen 450
IgE to topol allergen

450
IgE to cod allergen 45 0
Pumpkin allergen IgE 450
Trout allergen IgE 450
Hamster allergen IgE 450
Cauliflower IgE 450
IgE to chocolate allergen 450
IgE to apple allergen 450
IgE to egg white allergen 450
IgE to egg yolk allergen 450
IgE to ash allergen white 450
IgE to barley flour allergen 450
Inhalation panel expanded (feather dermatophage mite, cat epithelium, dog dandruff, pork finger, timothy grass, molds
Panel of TP5 tree allergens (alder, common hazel, elm, willow white, poplar) 550
Panel of TP9 tree allergens (alder, birch, common hazel, white willow, oak) 550
Panel of animal allergens (cat epithelium, dog dandruff, cow dandruff, horse dandruff ) 550
Panel of allergens cereals (wheat flour, oat flour, corn flour, sesame, buckwheat flour) 550
Panel of allergens of microscopic fungi (mold) (penicillium notatum, aspergillus fumigatus, alternaria cladosporium herbarum, candida albi 550
Meat allergen panel (pork, beef, chicken, lamb) 550
Bird allergen panel (parrot, canary) 550
Dust allergen panel (house dust, dermatophagoides farinae, dermatophagoides pteronyssinus, Prussian cockroach) 550
Panel of allergens of weeds and flowers WP1 common ragweed, common wormwood, plantain, white gauze, ash-pan / hodgepodge 550
Panel of allergens of weeds and flowers WP2 Western ragweed, common wormwood, plantain, white gauze, quinoa 550
Panel of grass allergens GP1 hedgehog, meadow fescue, perennial rye, timothy grass, meadow bluegrass 550
Panel of allergens of lingonberry berries (blueberries, blueberries, lingonberries) 550
Panel of tick-borne allergens (feather dermatophage mite, flour dermatophage mite, dermatophagoides microceras, lepidoglyphus destructor, tyrophagus putres 550
Food panel (cow’s milk, wheat flour, egg white, soybeans, peanuts)
Rotavirus, antigen detection 590

Obstetrics and gynecology of dogs and cats

Obstetric and gynecological are some of the most common diseases of non-infectious etiology in pets.In some cases, they only become the cause of infertility, in others, they can lead to the death of a beloved four-legged family member.

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It is very important to know what gynecological diseases are most common in dogs and cats, why they develop, how they manifest themselves, how they are dangerous for the pet and how to cope with them.

Classification of obstetric and gynecological diseases

What obstetric and gynecological diseases in pets are most often recorded? Why do they develop, how do they manifest themselves? And most importantly, how to help your pet?

Disturbed Heat

Anaphrodisia

This is a complete absence of estrus (the owner will not see any symptoms for a long time) or too long breaks between them.It is very important to exclude lesions of the endocrine glands (pituitary gland, adrenal glands, thyroid gland), for this our veterinary specialists will conduct all the necessary additional studies. If the diagnosis of anaphrodisia is confirmed, experts will prescribe a treatment regimen with follicle-stimulating hormonal drugs.

Prolonged estrus

Prolonged estrus is a condition characterized by an extended stage of estrus or proestrum (in general, the sexual cycle is lengthened).Because of this, the concentration of the hormone estrogen in the blood increases, which leads to the development of endometritis (which becomes chronic), hyperplasia of the vaginal mucosa and uterus. Boxers and small poodles are most susceptible to this pathology. This condition is treated only under the supervision of veterinary specialists, because hormone therapy is needed.

Diseases of the uterus, ovaries, vagina

Vaginitis

This is an inflammation of the vaginal mucosa.It develops due to a raging infection (bacterial, fungal, viral), trauma, trapped foreign bodies, congenital abnormalities, neoplasms, “descended” infection from the genitourinary system. At the same time, the infection can “pass” from the vagina to other organs of the genitourinary system (uterus, ovaries, bladder and kidneys).

The pet owner may suspect vaginitis in the animal due to some symptoms: discharge appears (mucopurulent, yellowish, bloody), licking of the loop, the skin around the vulva is red and swollen.The animal begins to urinate frequently, is very anxious. Often animals of the opposite sex show interest in such a mustache.

Juvenile vaginitis is sometimes recorded in domestic beauties. It develops in those pussies who have not yet reached puberty. Unlike vaginal inflammation of bacterial etiology, juvenile vaginitis resolves on its own as soon as the animal reaches puberty.

Endometritis and pyometra

Inflammation of the mucous layer of the uterus is scientifically called endometritis.If, in addition to the mucous membrane, the remaining layers of the uterus are included in the inflammatory process, and pus accumulates in its cavity, we are talking about pyometra. Animals of any breed and age can get sick, but most often females who have given birth or participate in mating suffer from endometritis. There are many reasons for inflammation of the uterus: hypothermia, bacterial infection, large fruits, ruptures and other complications that have arisen after childbirth, and others.

Pyometra is often caused by hormonal imbalances. Because of this, the pathogenic microflora begins to “rage” in the uterus, which becomes the cause of the development of purulent inflammation.Symptoms can be so blurred that the owner will not notice that the pet is sick. However, leaving a dog or cat without veterinary care can lead to the loss of a pet due to the development of sepsis.

Perhaps the owner of a sick animal will notice a slight increase in the abdomen (with pyometra), as well as discharge from the loop (purulent, bloody, mucous and other abnormal). However, if the cervix is ​​already closed, then there may be no discharge or a very meager amount is recorded, which complicates the timely detection of the disease.Our veterinarians will conduct additional examinations (ultrasound of the pelvic organs, take blood for tests, and, if necessary, mucous discharge from the loop for research). Only with a proper internal examination can an accurate diagnosis be made, an effective and correct treatment can be prescribed.

Ovarian cysts

Again, this pathology develops due to hormonal imbalance (most often due to the uncontrolled and improper use of hormonal drugs to calm the animal during estrus).With it, neoplasms form on the ovaries (most often they look like bubbles filled with liquid, but there are also heterogeneous contents). This pathology will manifest itself as a violation of the cycle. This is a visible change in behavior.

Confirmation of the same diagnosis is possible only through ultrasound, which can be carried out in our veterinary clinic. Often the only way out is surgery – removal of the reproductive system.

Other diseases of the reproductive system

False delivery (pseudolactation)

Pseudolactation develops more often in dogs (it is extremely rare for cats to suffer from this ailment).Pathology can develop both after mating, and without it at all. The disease is more of a psychological etiology, in which the hormonal background is disturbed, and all the same changes occur in the body as in normal pregnancy. The animal begins to carry soft toys, equip a nest, take care of “imaginary” babies.

An animal with a false pregnancy begins to produce milk, but since there will be no babies, mastitis (inflammation of the mammary glands) may develop.Unfortunately, pathology is inherited. Dogs that have been reported to be falsely pregnant are excluded from breeding. In addition, pseudopregnancy can be repeated, therefore, after the pet recovers, it is necessary to sterilize it. The specialists of our clinic will explain in detail how to take care of the animal and carry out the necessary treatment.

New growths

Tumors can develop both outside (on the mammary gland, bumps and lumps appear on the chest) and inside (on the ovaries, in the uterus, in the vagina).It is imperative to go to the veterinary clinic to see an oncologist in order to start treatment on time. A number of studies should be carried out to exclude malignant tumors.

90,000 photos, symptoms and causes, treatment and reviews

Author Maria Semenova Reading 10 min. Published on

A cyst in the vagina is a tumor-like formation that can be located in the vestibule of the vagina.The difference between a cyst and a dangerous malignant neoplasm is its inability to proliferate into the surrounding organs and tissues.

Cyst is a developing formation that contains a cavity filled with a fluid of a serous nature, as it grows, it can displace and squeeze the tissues of the vagina and nearby organs, but not grow into them. It can be felt at the entrance to the vagina.

Reasons for the formation of

There are many causes of cysts in the human body, but the vagina has a communication with the external environment, and the appearance of cysts in this area is less common.

The etiological factors that provoke the appearance and growth of cysts in the vagina include:

  • anomalous structure of the walls of the vagina , which is formed during the intrauterine development of the girl;
  • traumatic effects of on the perineum, aggressive sex;
  • surgical interventions in connection with artificial termination of pregnancy , and other types of endoscopic procedures;
  • complications in the birth or the postpartum period;
  • inflammatory processes due to infection with bacterial infections;
  • non-observance of cleanliness and care of the intimate area .

Today, trauma is considered to be the most common cause of cyst formation in the vagina. In areas of damaged tissue, hematomas remain, which eventually transform into cysts.

Symptoms of the presence of a cyst

A small cyst does not provide any particular inconvenience to a woman, does not cause pain and does not interfere with sexual intercourse. Such neoplasms, as a rule, are found during routine examinations by a gynecologist.

As the cavity formation increases, women begin to feel discomfort and the following symptoms:

  • pain during and after sexual intercourse;
  • the appearance of discomfort in the lower abdomen after prolonged physical exertion;
  • a feeling of the presence of a foreign round formation in the vaginal cavity;
  • violation of the act of urination and defecation;
  • in the presence of purulent contents in the cavity of the cyst, the patient’s general body temperature rises and signs of intoxication of the body appear;
  • symptoms of the disease may worsen against the background of menstrual bleeding or colds.

A cyst formed in the tissues of the Bartholin gland develops due to the presence of congenital malformations. Its formation is facilitated by the blockage of the lumen of the gland and the accumulation of an excessive amount of secreted fluid with impaired outflow into the vaginal cavity. The outflow of the glandular secretion is formed against the background of blockage or overgrowth of the excretory ducts.

Discomfort in a woman manifests itself when straining, a woman begins to notice that a formation similar to a bubble is felt in the vaginal cavity, it disappears after complete relaxation in a horizontal position or with manual reduction of the defect.Although this pathology does not cause pain in a woman, it causes her anxiety.

What are the types of cysts in the vaginal walls?

In clinical practice, it is customary to subdivide cystic formations in the vaginal walls into three main groups:

  1. Cyst of the congenital type. Its most favorite localization is the lateral wall of the vagina, a neoplasm in girls begins to form at the stage of embryonic development and grows already in the process of life and puberty.
  2. Acquired type of pathology. The cause of cysts in this type is traumatic effects and other exogenous factors that affected the female body during the period of life. Such cavity formations are localized on the anterior and posterior walls of the vagina, mainly in the muscular membrane.
  3. Implant type. This type of pathology is much less common. The structural component of the cyst is the epithelial cells after implantation of the embryo into the uterine cavity.The formation of such neoplasms is facilitated by surgical intervention with the aim of artificial termination of pregnancy, as well as restoration of the integrity of the perineum after ruptures during labor. Preferential location, posterior wall of the vagina.
  4. Retention type. The causes of this type of cyst are inflammatory processes in the glandular tissue of the Bartholin gland. Infection occurs when the rules of intimate hygiene are not followed and when infected with sexually transmitted diseases during promiscuous sexual intercourse.

Diagnostics

  1. Experienced gynecologists can detect a cyst in the vagina even with a routine gynecological examination. Obligatory measures for diagnosis are examination using instruments for colposcopy.
  2. Quite an important point is the questioning of the patient for the presence of predisposing factors for the development of the disease. When interviewing the patient, the doctor specifies the severity of the symptoms that bother the woman.
  3. General analyzes of peripheral blood and urine, as well as bacteriological examination of a smear from the vaginal cavity are used as laboratory methods.
  4. Women and girls with a similar diagnosis must, without fail, attend a routine examination by a urologist and proctologist to exclude concomitant diseases.

Complications

If you do not take into account the fact that a cyst in the vagina does not have a negative effect on the menstrual cycle and on labor processes, it can provoke the development of the following complications:

  • infection of surrounding tissues with a purulent nature of the cystic contents;
  • relapses pathologists after treatment;
  • the cavity of the formation can burst.

As statistics show, most complications develop against the background of self-treatment or its complete absence. Many women neglect their health and do not even attend preventive examinations with a gynecologist for many years.

Treatment measures

There are two main methods to eliminate cystic formation in the vaginal cavity:

  1. Puncture method of aspiration of fluid contained in the cyst cavity using a syringe and a biopsy needle. This technique is temporary, since after a short amount of time, the cavity begins to fill back with liquid. This type of minimally invasive intervention is used only during pregnancy and childbirth, this is due to the fact that a woman in this position is not recommended to undergo surgery.
  2. Surgical intervention for the complete removal of the cystic formation is performed in the absence of contraindications such as pregnancy. In the process of surgery, the surgeon completely removes the contents of the cyst and its capsule within healthy tissues, which excludes the development of a relapse.The operation can be performed under general anesthesia, both routinely, urgently and during childbirth during the restoration of the perineum from ruptures.

Surgical intervention is performed only if the size of the cyst exceeds 2 centimeters and this condition provokes the onset of symptoms of discomfort.

During pregnancy, aspiration of the contents of the cyst is recommended without fail, as it can become an obstacle in the birth canal and lead to trauma to the child and even infection if a rupture of the cystic cavity occurs.

The course of surgery can be aimed at aspiration of fluid from the cyst cavity with further suturing of its membranes to the walls of the vagina. In a radical operation, the membrane is fully excised, followed by suturing of defects in the walls of the vagina.

If the pathological condition is neglected before the formation of an abscess, then in the process of surgery, the formed abscess is initially drained, its contents are aspirated and washed with antiseptic solutions.After washing the abscess, the capsule is excised and the defects formed on the mucous and muscular membranes are sutured.

After surgical manipulations, patients must undergo a course of antibiotic therapy as a preventive measure for the onset and spread of bacterial infection.

After exhausting procedures, the body weakens, including suppression of the immune system. To restore the functioning of the immune system, patients are advised to take immunostimulating drugs.

As an additional therapy, women in the postoperative period are advised to visit a physiotherapist’s office.

Complications after surgery

In the postoperative period, complications may develop that may occur against the background of incorrect tactics of the operation or the individual characteristics of the woman’s body:

  • trauma to the walls of the bladder and rectum during excision of the pathological process;
  • infection of the vaginal mucosa with purulent contents of a cystic neoplasm;
  • the occurrence of a relapse of the disease after surgery.

Given the fact that complications may develop after treatment, it should be noted that the menstrual cycle will not change and the resulting defects will not adversely affect pregnancy.

Even if specific complications or scars have developed in the postoperative period, pregnant women will be offered management of labor by caesarean section.

The neoplasm is surrounded by a capsule and has a cavity with serous fluid, does not pose a particular danger to the patient’s life and health, but can provoke an infectious process and discomfort.

In order to avoid complications, it is recommended to regularly attend preventive examinations on the gynecological chair. Preventive examinations should be carried out at least once every six months.

Treatment with folk remedies

Since ancient times, women have used folk methods of treatment to treat cysts in the vagina, today this method of treatment is called herbal medicine.

Traditional methods involve the use of infusions and decoctions from medicinal plants, without the addition of artificially synthesized drugs.

The technique is effective only if the neoplasm is small and does not exceed 1.5 cm.

The most common recipes from traditional medicine include:

  1. Prescription No. 1. Take plants such as shawley, St. John’s wort, string, dried wormwood leaves, yarrow leaves, dried dill leaves, and nettle root structures. All of these plants should be in equal amounts, about 50 grams of each, all herbs should be thoroughly mixed.Pour 300 milliliters of boiled water into a container, add 1 tablespoon of herbs here, mix the resulting mixture thoroughly and leave to infuse for 24 hours. An infusion of 100 grams is used 2 times a day 1 hour before meals. The course of treatment should be at least 1 month.
  2. Recipe No. 2 To prepare this recipe, you must take a string, nettle, violet leaves, wormwood, joster fruits, hazelnut leaves, oregano and burdock roots. Move all the herbs of 50-6 grams among themselves.Pour 500 milliliters of pre-boiled water into the container, add 2-3 tablespoons of the herbal mixture, put the resulting solution in a dark place for 48 hours. The infusion is used 150 grams 2-3 times a day before or after a meal. The course of treatment should continue until complete recovery.
  3. Recipe number 3. Take 200 grams of fresh burdock leaves, squeeze the juice out of them. The juice should be stored in a cool place, preferably in the refrigerator. The resulting juice is used 1 tablespoon 3 times a day, regardless of food intake.Burdock juice can also be used for topical application, it is moistened with a tampon and inserted into the vaginal cavity, this procedure is performed before bedtime.

Measures for prevention

Every woman is at risk of developing this disease, which is why one should not forget not only about passing preventive examinations by a gynecologist, and about carrying out preventive measures.

Prevention of the disease consists in:

  • compliance with the rules of intimate hygiene;
  • avoiding general hypothermia of the body;
  • undergoing preventive examinations at least once a year;
  • timely undergo treatment for inflammatory diseases;
  • observe an active lifestyle;
  • avoid casual sex;
  • completely eliminate the use of alcoholic substances and tobacco.

Women who follow all of the above preventive measures are never associated with similar problems and do not undergo surgery, which is always traumatic for the body.

Prognosis after treatment

A cyst in the vagina is a formation that in any size requires treatment.

The prognosis for recovery is favorable, since the cyst does not pose a particular danger to a woman’s health, it can only interfere with normal sex and the birth of a child through the natural birth canal.

Although the small size of the formation does not bother a woman, they tend to grow further, in order to avoid extensive surgical intervention, treatment should be started at the early stages of its development.

It is strictly forbidden to carry out self-treatment with drugs, before starting treatment, you must consult with your doctor.

If a minimally invasive surgical method of treatment was carried out, it should be borne in mind that as a result, over time, the pathological process may reappear and such women should pay frequent, special attention to their health in order to cure the pathology.