Treatment of bartholinitis in women: how to avoid surgery and forget about the disease forever

Contrary to popular belief, bartholinitis is not only for girls suffering from sexually transmitted infections or neglecting intimate hygiene. Inflammation of the gland can occur even in "neat" with a combination of adverse factors. The frequency of this pathology is about 5%. According to ICD-10 it is classified under the code N75.

Gland anatomy

Bartholin gland is located in the thickness of the labia minora below. It consists directly of the glandular tissue and excretory ducts from 1 cm to 4-5 cm long. The mouth of the tubules opens in the groove located between the labia minora and the remnants of the hymen. Sometimes Bartholin's gland is surrounded by bundles of muscle fibers. It has small dimensions - not more than 1 cm in diameter. In a calm state, it is not possible to test it; changes are noticeable only with inflammation or the formation of a cyst.

The Bartholin gland secretes a viscous, jelly-like secret, especially during a woman's arousal. A small amount is excreted in a calm state, so women do not feel tightness, dryness in the vagina and other unpleasant sensations. With pressure on the gland and duct, you can get a small amount of secretion. Doing this yourself is not necessary, since inflammation can be provoked.

On the surface of the labia minora and labia majora there is a large number of sebaceous and sweat glands. They are located relatively evenly over the entire surface. Sometimes their inflammation (boils) is confused with bartholinitis. A distinctive feature of the latter is that the process begins at the bottom of the labia majora, while the boil can be located anywhere.

Causes of occurrence

Inflammation of the Bartholin gland occurs if the outflow of secretion is disturbed due to the active reproduction of microbes inside. Active infection leads to tissue edema, which further exacerbates the passage of mucus. There is a vicious circle.

Pathogenic microorganisms enter the bartholin gland in several ways:

• retrograde current - E. coli, enterococci and other pathogens from the rectum; chlamydia, gonococci, trichomonads can also provoke bartholinitis, come from the vagina in the presence of these genital infections;
• hematogenously - there is an assumption that pathogenic microbes can enter the gland with a blood stream from other foci, including a chronic infection.

We can distinguish risk factors for inflammation of the bartholin gland:

• poor hygiene - Especially non-observance of regularity during critical days, blood is the most “pleasant” environment for the active growth and reproduction of bacteria;
• microtrauma - may appear with constant irritation, itching, after sexual intercourse;
• decreased immunity - Bartholinitis can worsen after acute respiratory viral infections, influenza, after hypothermia;
• synthetic underwear - with regular wearing tight and synthetic underwear, anaerobic conditions with high humidity are created, which provokes the multiplication of pathogens;
• genital infections - usually bartholinitis has a non-specific nature, but can be caused by trichomonads, gonococci, chlamydia;
• gynecological manipulations - most often exacerbations occur after abortion;
• chronic infections - the presence of foci in the kidneys (pyelonephritis), teeth (caries), proctitis, hemorrhoids.

What happens

Depending on the duration of the process and the presence of exacerbations, the following forms of bartholinitis are distinguished:

• acute - with a vivid clinical picture;
• subacute - when symptoms are lubricated, complaints are moderate;
• chronic recurrent - in the presence of periodic exacerbations of bartholinitis.

Bartholinitis begins with a slight inflammation and can progress significantly in just a few hours. Depending on this, the stages are distinguished:

• canaliculitis - while the infectious process is limited to the excretory ducts;
• infiltration - the gland itself is affected, severe swelling, pain occurs, but there is no clear restriction of the focus;
• abscess - at the same time, “softening” inside the dense tissues is palpated, it is a cavity with pus that “seeks” a way out.

Symptoms of bartholinitis in women

The main symptoms of bartholinitis in women include the following:

• pain in the vestibule of the vagina;
• fever;
• swelling, redness of the labia majora.

The severity of symptoms changes as the inflammation worsens.

• Canaliculitis. The temperature is normal or subfebrile. Most worrying is not a very sharp pain in the labia majora. Itching is often felt, burning in the area of ​​the vestibule of the vagina due to inflammation and irritation of the tissues with a pus-like secret that is secreted from the tubules.
• Infiltration. It is called a “false abscess”. The clinical picture is in many ways similar to true tissue abscessing, the differences are literally in the details, they can only be determined by a specialist. Body temperature rises, sometimes up to 39-40 ° C, a woman notes severe chills, weakness, headaches. The area of ​​the labia majora with an inflamed gland is sharply painful when touched, it hurts to move around. Severe tissue edema, often the entrance to the vagina is completely blocked and vaginal examination is impossible. The labia majora is bright red in color, with gloss due to stretched tissues, when touched it is hot. Enlarged lymph nodes in the groin.
• Abscessing. All symptoms of inflammation characteristic of infiltration are pronounced. On palpation of the labia majora in the area of ​​inflammation, dense tissues are determined, and in one of the areas softening is detected - this is an already formed cavity with pus. A woman may notice a “ripple” in this place. Inguinal lymph nodes are enlarged.

If during pregnancy

Bartholinitis occurs during gestation.This may be the first episode of the disease or a relapse of a chronic form. The tactics of conducting a woman largely depends on the clinical picture. If possible, conservative therapy should be followed.

Bartholinitis is dangerous during pregnancy as follows:

• intrauterine infection of the baby - it provokes a threat, interruption, leakage of amniotic fluid, premature birth;
• infectious complications after childbirth - if a woman gives birth through the natural birth canal, the likelihood of purulent conjunctivitis, suppuration of the umbilical wound in a baby increases; for mom, the risks increase endometritispoor healing of sutures.

Diagnostics

Under bartholinitis, other problems of the external genitalia in the intimate zone can be masked (see table). Typically, the diagnosis is established on the basis of examination, as well as during surgical treatment, since the condition is mostly acute and requires immediate treatment, even if the initial stage.

Table - How not to confuse bartholinitis and other diseases

How to treat

Until the formation of an abscess, the treatment is only conservative, aimed at reducing inflammation. With the progression of the infectious process and the appearance of a clear symptom of "fluctuations" (softening), one of the options for surgery is performed.

Conservative therapy

Treatment without surgery is to use various compresses, baths to reduce inflammation. The following procedures will help relieve inflammation of the Bartholin gland and the associated symptoms:

• baths with camomile, calendula;
• lotions and baths with hypertonic salt solution;
• applying a cold compress;
• the use of Vishnevsky ointment, Levomekol.

In addition, physiotherapy may be used. For example, magnetotherapy on the labia, UHF. Hirudotherapy (treatment with leeches) is used in the "cold" period with chronic bartholinitis to prevent relapse or a few days after opening the abscess to accelerate healing.

The main treatment includes the following drugs.

• Antibiotics. They are selected taking into account the sowing of vaginal contents or already according to the results of sowing pus from the abscess. If this is not possible, the drugs are prescribed empirically. The most commonly used are Metronidazole, cephalosporins (Cefazolin, Cefotaxime), macrolides ("Azithromycin"), Penicillins (" Amoxiclav "), fluoroquinolones (" Ciprofloxacin "). The duration and dose are determined by the doctor individually.
• Painkillers. To reduce pain and fever analgin, aspirin, Ibuprofen, Ketorolac,No-shpa».

With concomitant inflammation in the vagina, suppositories can be prescribed, including from candidiasis colpitis, which can develop against the background of antibacterial treatment.

Operation Options

For the treatment of bartholin abscess or recurrent bartholinitis, the following methods exist:

• opening and drainage;
• removal of the gland completely;
• Vord catheter surgery.

Dissection of suppuration

This is a standard and fairly common method of surgical treatment, but it has many disadvantages. The main one is relapse soon in 99% of cases. During the operation, the following is carried out:

• the skin over the abscess is dissected;
• purulent contents are removed;
• the cavity is washed with antiseptics;
• rubber conductors are installed to drain the contents.

The operation is performed under local anesthesia or under intravenous anesthesia. Laser can be used. Its duration is no more than 10-15 minutes. It can be performed on an outpatient basis, while it is necessary to carry out dressings twice a day for two weeks. The entire rehabilitation period is about a month, during which you should refrain from sexual activity.

Surgical removal

This method of treatment is used in the "cold" period of chronic bartholinitis, when there is no acute inflammation. At the same time, iron is removed from the side where relapses of the disease occur, the second remains untouched.

A clear advantage of the operation is that repeated episodes of the disease are not possible. The disadvantages of the method are as follows.

• Difficult operation. The Bartholin gland has good blood supply and is shrouded in venous plexuses, as a result of which there is a high risk of bleeding. The duration of removal of the gland is about one to two hours under general (endotracheal anesthesia) or local (spinal anesthesia) anesthesia. In the postoperative period, large hematomas can form, which must be additionally drained.
• Ugly seams. Ligatures are superimposed on the outside and inside, sometimes they can change the appearance of the genitals.
• Iron is lost. Due to the fact that the Bartholin gland is completely removed, subsequently, a woman may be disturbed by dryness during sexual intercourse. However, many who have had the surgery claim that the remaining gland copes with the function and there are no such problems.
• Hospitalization required. To perform, you need inpatient treatment lasting two to three days.

Sometimes after a complete removal of the gland, women notice pain in the area of ​​the operation during sexual intercourse, physical activity.

Ward Catheter

This is the most promising and less traumatic method of treating not only acute bartholinitis, but also gland cysts. The essence of the operation is as follows:

• an abscess is performed - Bartholin gland on the labia;
• pus is removed - And the cavity is washed with antiseptics;
• Vord catheter is installed - at the end of it a balloon is inflated, which helps to fix it;
• catheter is removed - in a month and a half.

Relapses after such interventions occur in no more than 10% of cases (compared with 99% with a conventional autopsy). The mechanism of action is that during the time the catheter is in the cavity of the former abscess, a new channel is formed for the outflow of secretion. Iron is intact, its function is not impaired. The operation is carried out under intravenous anesthesia, lasts no more than 20 minutes, can be performed in a day hospital with no more than two hours in it.

5 common questions

Given that bartholinitis is a common disease, the process of diagnosis and treatment is always accompanied by a lot of questions. The most relevant are the following five.

1. When can I resume sex?. An intimate relationship should be continued no earlier than a month after any surgical treatment. In the event of a relapse of the chronic form and successful conservative treatment, sexual contact is resolved after the disappearance of all symptoms.
2. What is the difference between treatment during pregnancy. A range of drugs, it is selected taking into account safety for the baby.
3. What to do if bartholinitis is suspected. Seek medical attention immediately. In an extreme case, start taking antibiotics, but in the absence of improvement, immediately seek medical help.
4. What to do if an abscess is opened. An independent breakthrough of suppuration without proper treatment will lead to an early relapse. Therefore, you should consult a doctor, despite some improvement.
5. Does removal of the gland affect pregnancy. The probability of conception of iron is not affected. The consequences can only affect the quality of a woman’s intimate relationship.

Is it possible to avoid the disease

Prevention of inflammation of the bartholin gland is as follows:

• condom use;
• wearing linen made from natural fabrics;
• regular hygiene using baby soap;
• timely treatment of inflammatory processes in the vagina.

Self-treatment of bartholinitis, even in the event of an abscess breakdown or a decrease in symptoms, will lead to an early relapse. You can look on the Internet in the photo what it looks like and where the Bertoletova iron is located. Removing the Bartholin gland is an effective treatment, but has many drawbacks. The optimal treatment is the installation of a Word catheter or its analogues. This is a less traumatic operation that is performed on an outpatient basis, has the lowest risk of relapse.

Reviews

I’ve been suffering with bartholinitis for 15 years, 2-3 times a year. After giving birth, I forgot for 3 years what it is. But soon again. Doctors did tests, opened the gland constantly, but didn’t cure anything. Now I am saving only Vishnevsky. They told me to remove the gland when it is inflamed, but it can become inflamed on the other hand. One more thing, I don’t know if it is a coincidence or not, but ... the doctor attributed to me birth control JanineThey’re going on and they’re healing, he said that he would help. The truth, while I was drinking for 1 year, didn’t remember about bartholinitis, but she just stopped, and so did inflammation. I wish you health.

Victoria, http://www.woman.ru/health/woman-health/thread/3939747/

I had many times, as soon as immunity falls, it climbs out. I constantly smeared Vishnevsky ointment (ointment was abundantly squeezed onto a cotton pad and glued with a surgical plaster on a paper basis to a sore spot). If the abscess is small, well, just beginning to swell, then it will resolve after the ointment, but if it is already large, then the ointment will stretch and burst!

Pasha, http://www.babyplan.ru/user/4813-pasha/

I have such a problem, bartholinitis is called. before that was once in a lifetime
in-in! They did it to me, they treated me with a laser 3 times without any hospital, removed the gland, and I don’t remember about it anymore. and the first time when it was inflamed, she lay in the seven * dill * opened under general anesthesia, antibiotics pricked * dill *

Varyusha, http://eka-mama.ru/twitter/%D0%92%D0%B0%D1%80%D1%8E%D1%88%D0%B0

The girls. I read you and want to cry. I was just saved from surgery. Reached a severe abscess, maybe my gynecologist was sure that it was a boil. I found a good gynecologist-surgeon, he is the only one in St. Petersburg who solves this problem without opening the abscess from the outside and preserving the function of the gland !!!
I opened an abscess from the inside of the vagina, installed a Fole catheter, washed it with an antiseptic a day later and installed a tiny American word-catheter.It was all terribly painful, but it is 100 times better than surgery under anesthesia, there is no suture on the outside, the catheter stands for several weeks and forms a new passage from the gland, and during surgery it remains clogged, so the abscesses come back !!! If you do not reach the abscess, then generally the installation is painless!

Marina, http://www.medicalj.ru/diseases/female-illness/9-bartolini

Good day to all. I encountered bertolenitis during my first pregnancy. You climbed a bump but did not hurt the entire pregnancy. I gave birth without complications. Because problems began. The bump started to hurt terribly. She could not walk, sit, stand, or even lie. There were terrible pains. Once every six months she opened it. Then she decided on an operation. Removed the cyst. The operation lasted 4 hours 30 minutes. As my daughter-in-law, who at that time worked in gynecology, said that I was covered in blood. Somehow found this cyst. That was in 2004. It would seem that all the torment ended. But again, after 12 years, she again made herself felt. I moved to live in another city, got a job and here you are again healthy. Tomorrow I'll go to the doctor again. So girls do not flatter yourself that removing her she will not appear again after years.

Hope, http://www.medicalj.ru/diseases/female-illness/9-bartolini