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  • Bartholinitis. Abscess and bartholin gland cyst - Causes, symptoms and treatment. MF.

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    Bartholinitis is an inflammation of the large bartholin gland. Bartholin gland is a paired organ that is found in the subcutaneous fat of the large labia. With inflammation of the large gland of the vagina, microorganisms affect the excretory duct of the gland( canal), as well as the gland itself.

    The main function of the Bartholin gland is to develop a secret that maintains a constant moisture in the vagina. What is it for? This secret is released in large quantities during excitation during sexual intercourse to facilitate the entry of the penis. In addition, secretion is very important during labor. Thanks to him, the muscles of the vagina stretch well and the baby can be born without damaging the walls of the vagina. If the Bartholin gland does not produce the secret in the right amount, then the vagina will become dry, and there will be discomfort, itching and burning in the perineum and pain during sexual intercourse. In the norm this is possible only with menopause due to the age-related decline of female hormones-estrogens.

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    Causes of Bartholinitis

    Bartholinitis is caused by infection in the Bartholin gland through a narrow opening of the excretory duct on the inner surface of the labia minora. Once inside the gland, microorganisms actively multiply. This leads to inflammation and suppuration of the Bartholin gland.

    Not all infections of the genitourinary sphere cause bartholinitis. In the vast majority of cases, bartholinitis is provoked by sexually transmitted infections. Most often gonorrhea, less often trichomoniasis and chlamydia. Very rare bartholinitis nonspecific etiology - in this case, the role of pathogen are bacteria - staphylococcus, E. coli, streptococci and so on. This is possible if the rules of personal hygiene are not respected.

    It should also be borne in mind that even with sexually transmitted infections, bartolinite does not develop at all and not always. Immunity plays an important role in the development of the disease, if it is weakened, then the chances of getting sick with bartholinite are increased.

    Symptoms of bartholinitis with photos of

    Depending on the clinical course of the disease, bartolinite can be acute or chronic. Acute bartholinitis is characterized by the formation of a true or false abscess of the Bartholin gland( a restricted focus with pus).

    In the formation of a false abscess, an excretory duct of the gland( "canal" in a scientific way) is inflamed at first. Skin over the focus of inflammation blushes and swells. If you press on the inflamed area, then there will be pus. Then there is a blockage of the excretory duct of the gland and pus is no longer secreted, but accumulates in the Bartholin gland. Because of this, the iron greatly stretches and protrudes, forming a painful formation in the form of a "cone".During movements, when walking, running, with sexual act, pain intensifies, burning in the perineum appears. Sometimes the body temperature rises slightly. If you do not go to the gynecologist for a long time, the disease goes into a chronic form.

    With a true abscess, the infection penetrates directly into the Bartholin gland and the parenchyma of the gland melts. Moreover, the symptoms of the disease are more pronounced than with a false abscess. Large and small labia greatly swell. Body temperature rises above 38 degrees, inguinal lymph nodes increase, chills, weakness, "throbbing" sharp pain in the area of ​​the large labia. Possibly, spontaneous dissection of the abscess with the release of yellow-green pus, which leads to a weakening of the symptoms of the disease. But in the absence of treatment, the inflammation again recurs and gives complications or, like a false abscess, goes into a chronic form.

    In the chronic form of bartholinitis, the symptoms of the disease temporarily subsided and once again become aggravated. Instead of an abscess in the gland, a cyst is formed( fluid formation with inflammatory exudate).

    In any form of Bartholinitis, in no case should you engage in self-medication, try to squeeze out an abscess or cyst - this can lead to blood poisoning. If such symptoms occur, you should immediately call your gynecologist.

    Canaliculitis( false bartholin gland abscess)

    With canal path( false Bartholin gland abscess), the overall condition of a woman changes insignificantly. A red spot is observed around the outer opening of the excretory duct, surrounded by a protruding inflammatory ridge, with pressure on the duct a droplet of pus is extracted, which is taken for bacteriological examination.

    When the excretory duct is clogged, pseudoabscess of the gland arises. In this case, a swelling of the ovoid form appears on the border of the middle and lower third of the labia majora, hyperemia, the skin over the swelling is mobile.

    False abscess protrudes the inner surface of the large labia and closes the entrance to the vagina.

    The temperature is usually subfebrile( 37.2 - 37.5 ° C), there are sharp pains when walking.

    The true abscess of the bartholin gland

    Penetration of microorganisms into the parenchyma of the gland and the surrounding tissue leads to the appearance of a true abscess of the Bartholin gland, its parenchyma melts. The big and small sexual labiums swell up. The inguinal lymph nodes increase. The patient even in bed notes sharp soreness in the area of ​​the labia vulgaris, can not walk. Body temperature febrile( above 37.5 ° C), there is an increase in ESR, leukocytosis.

    From a false abscess true differs constant pain, sharp puffiness of the labia, immobility of the skin above the abscess, high temperature.

    Attention! Do not start the disease, because even with a spontaneous dissection of the abscess, there is usually no complete emptying and surgical intervention is necessary.

    Attempts to squeeze out an abscess are very dangerous, and infection in the blood and development of sepsis can occur. Therefore, the sooner you seek help from a specialist, the sooner the disease will be cured.

    Chronic bartholinitis

    Chronic bartolinite often recurs( repeats), characterized by mild inflammation, minor pain, denser gland structure.

    With the prolonged existence of chronic bartholinitis, liquid exudate accumulates in the gland cavity, a painless tumor is formed - the cyst of the Bartholin gland.

    Diagnostics of bartholinite

    Diagnostics of bartolinite is not particularly difficult. The doctor can diagnose the diagnosis at the first reception. In the presence of an abscess, puffiness and redness of the Bartholin gland is determined, palpation of the formation causes severe soreness. In the chronic form of bartholinitis( in the presence of the bartholin gland cyst), a tumor-like formation, painless upon palpation, is revealed.

    In addition to the examination, it is necessary to take tests:

    - a normal swab from the vagina;
    - PCR diagnostics of the main sexual infections( chlamydia, gonorrhea, trichomoniasis, mycoplasmosis, ureaplasmosis, herpes, human papilloma virus);
    - bacteriological culture of vaginal discharge to establish sensitivity to anitibiotics;
    - bacteriological examination of pus with breakthrough abscess or secret can be obtained from the excretory duct of the gland by light pressure.

    Treatment of bartholinitis

    Treatment of bartholinitis depends on the stage of the disease. Unfortunately, due to the rapid progression of the disease and late treatment, surgical treatment is used much more often than conservative treatment.

    Conservative treatment of canaliculitis

    Conservative treatment is used to treat canaliculitis in the acute phase of the disease for the rapid elimination of the inflammatory process.

    To this end, apply:

    - an ice pack on the inflamed area;
    - topically apply anti-inflammatory therapy: on the inflamed area apply tampons with levomelem, Vishnevsky ointment or ichthyol;use solutions with chlorhexidine, miramistin, etc.
    - antibacterial therapy. Depending on the type of pathogen, preference is given to one or another group of drugs. In most cases, antibiotics of the cephalosporin series( Ceftriaxone, Cyphran), penicillin series( Amoxiclav), fluoroquinolones( Ofloxacin, Ciprofloxacin) and imidazoles( Trichopolum, Tinidazole) are prescribed. The course of antibiotic treatment is no more than 7-10 days;
    - multivitamins.

    Surgical treatment of bartholinitis

    In the presence of an abscess or Bartholin gland cyst, the treatment is strictly surgical.

    Surgical treatment of Bartholin gland abscess

    In asbestos, a purulent focus is opened and its contents removed. The cavity is treated with disinfectant solutions( 3% hydrogen peroxide).A drainage rubber tube is inserted into the cavity to drain out the pus that is separated, which is removed on the 5th-6th day after the operation. In parallel with surgical treatment, antibiotics, vitamins are prescribed. The surgical wound is washed daily with hydrogen peroxide, a gauze swab with levomelem or Vishnevsky ointment is injected into the abscess cavity.

    Surgical treatment of bartholin gland cyst

    Treatment of bastolin gland cysts is performed outside the aggravation of the inflammatory process. In this case, two options for surgical intervention are possible-marsupialization of the cyst( the creation of an artificial duct for the outflow of secretion) or extirpation( removal) of the bartholin gland.

    When performing the marsupilization, the doctor opens the capsule of the cyst in a linear incision. The edges of the capsule are hemmed with separate sutures to the edges of the cutaneous wound, forming an external opening. A drainage tube or catheter is inserted to drain the contents of the cyst. After the operation, the external opening narrows for two months, a new outlet duct is formed.

    Extirpation of the gland is carried out in case of recurrence of bartholinitis. To do this, a longitudinal incision is made on the inner side of the labia majora. The gland is carefully isolated with a scalpel and removed, and the catgut sutures are applied to the wound.

    For any types of Bartholinitis after the operation and complete elimination of the inflammatory process on 3-4 days appoint physiotherapy - magnetotherapy and ultraviolet irradiation.

    All patients are advised to abstain from sexual intercourse until they are completely cured, as the probability of infection of the sexual partner is high. In order not to allow repeated relapse of bartholinitis, it is important to eliminate the cause of the disease, completely recover from the concomitant infection( chlamydia, gonorrhea etc.), otherwise bartholinitis may occur again. All patients must follow the rules of personal hygiene: wash twice a day;wear comfortable underwear, preferably of cotton;during menstruation, change pads and tampons every 3-4 hours to avoid re-infection.

    In the period of recovery, it is important to use drugs that enhance immunity. These include vitamins, nutrition, and some plant immunomodulators.

    Folk remedies for bartholinitis

    Traditional medicines can also be used in bartolinite - they have an anti-inflammatory effect and for a time relieve disturbing symptoms. In the chronic form of bartholinitis, exacerbation shows sedentary baths with infusion of chamomile, calendula, eucalyptus for 15-20 minutes. When the symptoms of the disease worsen, they can be used in combination with basic treatment( for example, in combination with antibiotics) for rapid relief of symptoms. However, it should be remembered that all folk remedies have only a temporary effect and do not cure bartolinite. Complications of Bartholinitis:

    - recurrence of the disease;
    - the formation of a non-healing fistula( an unnatural opening);
    - spread of the infectious process to the neighboring organs of the genitourinary system( colpitis, urethritis);
    - sepsis( a serious infectious disease) can develop if the infection gets into the blood with weakened immunity.

    Bartholinitis prophylaxis:

    - regular visit to the gynecologist;
    - protection against genital infections - condom use, monogamous lifestyle;
    - timely treatment of infections;
    - strengthening of immunity: nutrition, physical exercise, rejection of bad habits.

    Consultation of obstetrician-gynecologist on the subject of bartholinitis:

    1. I have found a bastolin gland cyst during pregnancy. What to do? Delete now or wait until childbirth?
    Remove after delivery.

    2. I have an abscess of the Bartholin gland, it was opened and everything went away. Then a month later he appeared again and the gynecologist offered to lie down for an operation. Can he wait and he will again open himself and pass?
    You should not wait at all. Abscess without surgery will not work and will appear again and again.

    3. Removal of Bartholin gland abscess is performed under anesthesia ?Yes, under general or local, but more commonly under general.

    4. I have a cyst of the Bartholin gland. Can I do hair removal on this site?
    You can, just before epilating, treat the skin with an antiseptic Miramistin or Chlorhexidine, so as not to provoke inflammation.

    5. Can I get pregnant after removing the Bartholin gland?
    It is possible, removal of the bartholin gland does not affect the childbearing function.

    6. To me 3 months ago have removed an abscess of Bartholin's gland, but till now sometimes I feel sharp pains at the sexual certificate or act. What is it? So it should be?
    This is not normal, contact a gynecologist. Perhaps you have a bartholin gland cyst.

    7. Can I take antibiotics myself with canal water?
    No, you can not. Antibiotics can be prescribed only by a gynecologist after the examination.

    Obstetrician-gynecologist, Ph. D.Christina Frambos