Bartholinitis is said to be inflamed when the large gland vestibular gland is inflamed (aka bartholin gland), which is a paired organ and is located in the labia majora. Bartholinitis mainly affects women of childbearing age.
Bartholinitis is divided into acute and chronic form. In turn, in the acute process a false abscess is distinguished, it is also a canaliculitis and a true one.
Chronic process often recurs. Also a manifestation of chronic Bartholinitis is a Bartholin gland cyst.
Typically, the disease is caused by pathogens of genital infections (gonococci, trichomonas, chlamydia , mycoplasma ). But most often there is an association of pathogens. Not so often Bartholinitis can be caused by nonspecific flora (staphylococci, streptococci), which penetrate the gland duct from the inflamed urethra and / or vagina.
A number of factors contribute to the development of the disease:
- reduced immunity;
- the presence of chronic foci of infection in the body (inflamed tonsils or carious teeth);
- the period of menstruation or the second phase of the cycle;
- treatment with certain drugs (antibiotics, hormones, cytostatics);
- promiscuous sex life;
- too tight underwear;
- injuries, including micro-in the perineum;
- operative interventions (abortions, etc.);
- lack of vitamins;
- neglect of personal hygiene.
The disease begins with canaliculitis – inflammation of the external duct of the gland. Local symptoms are mild: there is a slight swelling in the area of the labia majora and a small reddened spot. At this stage, many patients are still in no hurry to see a doctor and take inflammations for a pimple, trying to squeeze it out (in this case, a drop of purulent discharge appears).
With no further treatment, the external duct becomes clogged, and the secret of the Bartholin gland accumulates in its thickness. Then the local phenomena become more pronounced, the labia swollen, reddens, and symptoms of general intoxication appear (low-grade fever – up to 38 ° C, fatigue, decreased appetite). The inflamed gland spreads the tissues of the labia, in addition there are signs of local inflammation, which provokes pain in the patient when walking.
With a true Bartholin gland abscess, its parenchyma and surrounding fiber is melted. There is a pronounced hyperemia, a significant increase in the size of the gland, pain at the slightest movement. In such cases, patients cannot even walk. Phenomena of general intoxication increases, the temperature “jumps” up to 38.5 – 39 ° C. Dyspeptic symptoms, lack of appetite, headache and fatigue, emotional lability join.
Chronic bartholinitis tends to worsen frequently, but local inflammatory reactions and signs of general intoxication are not very pronounced. With a long-existing chronic Bartholinitis, exudate accumulates in the gland and a capsule is formed – the Bartholin gland cyst.
Bartholinitis during gestation threatens spontaneous abortion, preterm delivery, intrauterine infection of the fetus, and the risk of postpartum complications increases many times over.
If possible, a false abscess during pregnancy is treated conservatively. A true abscess is opened immediately. If acute Bartholinitis was diagnosed during labor, the autopsy of the abscess is delayed for the postpartum period. In order to avoid spontaneous opening of an abscess during attempts, an episiotomy is performed on the healthy side (to relieve head pressure on the abscess). In the case of spontaneous opening in the sore period of the abscess, it is prohibited to conduct a vaginal examination (only rectal).
A Bartholin cyst during pregnancy is not an indication for urgent removal. Surgery postponed for the postpartum period.
Differential diagnosis of bartholinitis should be carried out
- with suppuration of the labia majora (when pararectal and paravaginal fiber is infected) during rectal and vaginal examination, seals in the vagina and rectum are determined;
- with perineal furunculosis (the focus of inflammation is not one and in the center of the abscess one can see rod hair).
To diagnose the disease is quite simple, already on the first examination, the gynecologist makes the correct diagnosis. But in any case, an additional examination is appointed:
- complete blood count (leukocytosis, monocytosis, accelerated ESR);
- urinalysis (to detect signs of inflammation of the bladder and urethra: leukocyturia, cylindruria, microhematuria is possible);
- tests of vaginal and cervical smears;
- swab of the gland discharge;
- bakposev on microflora at the opening of the abscess and the determination of sensitivity to antibiotics;
- PCR diagnostics for genital infections;
- blood for HIV infection and syphilis.
The sooner treatment is started, the better the prognosis of the disease. When canaliculitis (the initial stage of Bartholinitis), applications with antiseptics (Miramistin, chlorhexidine, furacilin) or with infusions of medicinal herbs (chamomile, calendula, and coltsfoot) are prescribed. Also as a local therapy using medicinal ointment (Levomekol, Vishnevsky). Antibiotics are prescribed orally (amikacin, ceftriaxone, kefzol, sumamed), together with metronidazole. The course of such therapy is 7 days, the process begins resorbed.
In case of false and true abscesses of the Bartholin gland, it is necessary to open the abscess with subsequent drainage (3-5 days). The wound is washed with hydrogen peroxide and drainage is introduced. Ligation is carried out daily. In parallel, intramuscular antibiotics (fluoroquinolones, cephalosporins, penicillins) are administered. The whole process of treatment lasts no more than 10 days. In addition, a course of multivitamins and immunostimulants is prescribed.
Bartholin gland cyst is removed only by surgery during the “cold” period. There are 2 types of operations: marsupalization or removal (extirpation) of the gland. During marsupalization, a new false duct of the gland is formed.
Bartholinitis is dangerous by frequent relapses, the formation of a fistula at the site of the gland and the transfer of infection to nearby organs (vagina and urethra). With severe and late treatment of the disease may be complicated by sepsis .
The prognosis for the correct and timely treatment of Bartholinitis is favorable.