Bartholin gland cyst

A Bartholin's gland cyst is a formation that occurs as a result of blockage of the gland duct and accumulation of its own secretion. The cystic formation can reach significant sizes (3-4 cm) and is manifested by swelling in the labia area, pain and discomfort when walking or during sexual intercourse.

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Causes bartholin gland cysts

The most common causes are urogenital infections. In case of infection of the cystic formation, a Bartholin gland abscess may develop. Treatment can be both outpatient and surgical, and also include such manipulations as marsupialization of the Bartholin gland cyst, installation of a word catheter, extirpation.

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Pathogenesis

A Bartholin's gland cyst is formed when the duct that removes the secreted secretion becomes blocked, thereby forming a cystic formation. The most common causes of duct blockage and gland inflammation are sexually transmitted diseases, such as gonorrhea, chlamydia, etc. Less often, the inflammation is caused by opportunistic flora - staphylococcal infection, E. coli, etc., as well as a decrease in the body's overall resistance. Infection can also be provoked mechanically - deep bikini area epilation, tight synthetic underwear and failure to observe personal hygiene rules often become the causes of a Bartholin's gland cyst. Traumatic gynecological manipulations, such as termination of pregnancy or hysteroscopy, can cause duct blockage, and therefore a cystic formation.

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Symptoms bartholin gland cysts

Symptoms are usually clearly expressed where the gland is located. With a Bartholin's gland cyst, the labia are swollen, a round formation can be felt under the skin, the size of which can vary from a small pea to a large egg. Often, small tumors remain unnoticed, and only when they increase in size, they become the cause of discomfort. Large formations are painful, causing discomfort during walking and sexual intercourse. The cystic formation can become inflamed due to infection, and thereby provoke an abscess of the Bartholin's gland. With an abscess of the cyst, the symptoms of the Bartholin's gland cyst are more pronounced - the labia are very swollen, the site of inflammation is sharply painful, the patient is bothered by a feeling of pulsation at the site of the abscess, the body temperature can rise to 38-39C. Since the cause of inflammation of cysts and abscesses is most often sexually transmitted infections, the symptoms of concomitant infectious diseases (cystitis, vaginosis, urethritis, etc.) are added to the above symptoms. Sometimes abscesses open spontaneously, but even then you should definitely consult a doctor - the opened cavity must be thoroughly washed to prevent further inflammation and relapse.

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Bartholin's gland cyst during pregnancy

A Bartholin gland cyst very often occurs during pregnancy, since at this particular time the immune system is weakened and susceptible to all kinds of infections. If the cystic formation is not inflamed, then it does not affect the course of pregnancy. But if the cyst does become inflamed, then depending on the type of infection that caused it and the severity of the symptoms, drainage of the cystic formation is preferred to be postponed until the postpartum period. The thing is that during pregnancy, the blood flow to the genitals increases sharply, which can provoke bleeding. If intervention is unavoidable, drainage is performed under local anesthesia, and the accompanying infection is treated with antibiotics approved for use during pregnancy. If a woman has frequent relapses of the disease with suppuration and abscesses before pregnancy, then when planning a pregnancy, the doctor may recommend a procedure to remove the Bartholin gland.

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Complications and consequences

Inflammation of the Bartholin's gland cyst

As noted above, inflammation of the Bartholin gland cyst occurs due to a concomitant infection. And if a non-inflamed cyst of a small size does not bother a woman and does not cause any discomfort, then an inflamed cyst is very painful. Inflammation of the Bartholin gland or bartholinitis can be acute or chronic. The acute form is characterized by the development of a false or true abscess, the chronic form is characterized by frequent relapses with mild symptoms. Often, in addition to pain, the inflammatory process is accompanied by an increase in body temperature to febrile values (38-39) in the acute form or to subfebrile (37-37.5) in the chronic form.

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Bartholin's gland cyst abscess

Acute bartholinitis is characterized by the presence of a true or false abscess of the Bartholin gland. A false abscess (canaliculitis) is caused by the fact that the excretory duct of the Bartholin gland first becomes inflamed and later blocked, which leads to the accumulation of pus in the gland itself, redness and soreness of the surrounding tissues and discomfort. Body temperature may increase slightly. Without consulting a doctor and prescribing adequate treatment, the disease can become chronic. A true abscess is characterized by the penetration of infection into the gland itself, which causes melting of the parenchyma, swelling of the labia (both large and small), enlargement of the inguinal lymph nodes, leukocytosis, increased ESR, and severe pain even without movement. Body temperature rises sharply to 38-39C. In case of a true abscess, you should immediately consult a doctor, because even if the abscess opens spontaneously, the cavity does not empty completely, which leads to a relapse of the disease and surgical intervention. You should not try to squeeze out the abscess, since sepsis may develop due to the infection getting into the bloodstream.

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Diagnostics bartholin gland cysts

It is not difficult to diagnose a Bartholin's gland cyst. A gynecologist can make a diagnosis at the first appointment. During the examination, the doctor notes unilateral swelling of the labia, asymmetry of the genital slit. A non-inflamed cystic formation is slightly painful upon palpation, the formation under the skin is elastic. With an abscess, the symptoms are much more pronounced, the area of inflammation is painful, and leakage of purulent contents may be detected. Laboratory tests include a vaginal smear, bacterial culture, PCR diagnostics to identify sexually transmitted infections that caused inflammation, if any.

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Treatment bartholin gland cysts

Treatment of a Bartholin gland cyst should be aimed at restoring the functions of the gland itself and depends on the accompanying symptoms. Small cystic formations that do not cause discomfort and do not become inflamed do not require treatment. Treatment is indicated for frequent relapses or for inflammation or abscesses. With a Bartholin gland cyst, there is no need to follow a special regimen or diet, except in cases where a true Bartholin gland abscess is observed, in which case bed rest is indicated.

Medication treatment may include taking the following medications:

• Antibiotics to get rid of a concomitant infection. So, if the Bartholin gland cyst is caused by gonorrhea or chlamydia, then preference is given to antibiotics of the penicillin or tetracycline group. Doxycycline may be prescribed. For gonorrheal or chlamydial infection, the drug is taken once at a dosage of 200 mg, followed by 100 or 200 mg per day. The dosage depends on the severity of the disease. The daily dose should be divided into 2 doses with an interval of 12 hours, the drug is washed down with a sufficient amount of water in order to reduce the effect on the gastrointestinal tract. The course of treatment is 10-14 days.
• Sulfanilamides. If antibiotics do not bring the expected result, or the patient is intolerant to this group of antibiotics, sulfanilamides are prescribed, such as Biseptol, etc.
• Local treatment - use ichthyol ointment or Vishnevsky ointment, but local treatment in no way excludes antibiotic therapy, since only with full treatment is complete recovery possible.
• Immunostimulants or drugs to increase the body's resistance to infections.

Bartholin's gland cyst removal

But most often, treatment of a Bartholin gland cyst involves surgical treatment - removal of the gland itself or a number of other surgical manipulations such as marsupialization, opening of the cyst, laser vaporization of the Bartholin gland cyst.

The most radical method is the removal of the Bartholin gland or extirpation. But it is worth resorting to in case of frequent relapses of the disease, ineffectiveness of other treatment methods, repeated relapses after marsupialization, because despite the simplicity of the operation, it is associated with risks, and, as is known, there are no "unnecessary" organs in the body.

Risks and disadvantages associated with Bartholin's gland removal surgery:

• performed under general anesthesia;
• several days of hospitalization;
• possibility of bleeding (the gland is located in close proximity to a venous node);
• formation of postoperative hematomas and fistulas;
• application of internal and external sutures;
• cost of the operation (in private clinics it reaches 8000 UAH).

Extirpation is the only method that gives a 100% guarantee of no relapses, but the consequences of removing a Bartholin gland cyst do not make it preferable. Since the main function of the gland is to produce a secretion that maintains constant moisture in the vagina, the main negative consequence is vaginal dryness, which can negatively affect the quality of sexual life. We can also add here that the perineum is injured, and the stitches can cause painful sensations even a long time after the operation.

Marsupialization of Bartholin's gland cyst

Marsupialization of the Bartholin gland cyst or creation of an artificial duct is an outpatient procedure and is performed under local anesthesia. The procedure is relatively simple and lasts about 20-30 minutes. The doctor anesthetizes the site of the largest cyst bulge and cuts out an oval flap of mucous approximately 1.5 cm in size. The cyst is dissected with exactly the same incision, symmetrical to the first one. Its contents are removed, the cavity is washed out and then the wall of the cystic formation is sutured to the edge of the mucous lip, thereby leaving an artificially formed duct. This manipulation preserves the gland and its functions. Sometimes, after the marsupialization procedure, relapses still occur, but their probability is about 10%, and the procedure itself can be rescheduled again, since it is simple and low-traumatic, which is incomparable with the complete removal of the gland.

Laser vaporization of Bartholin's gland cyst

Laser vaporization of the Bartholin gland cyst is also an outpatient procedure. The cystic formation is affected by a laser beam, which “evaporates” the pathological tissues. The procedure takes 10-30 minutes, its duration depends on the size of the cyst, is performed on an outpatient basis, does not require hospitalization and anesthesia, completely excises the altered tissues and only them, the laser power is strictly dosed, there is no risk of bleeding. Before laser vaporization, a minimum of tests and preparation is required, rehabilitation is quick and consists only of observing the rules of personal hygiene and abstaining from sexual activity.

Some private clinics also offer the procedure of installing a Word catheter. This procedure is probably the most modern approach to treating Bartholin's gland cysts and bartholinitis. Its essence is that the cavity of the cystic formation is opened, emptied and washed. Then a small catheter is inserted, at the end of which a balloon is inflated, which prevents it from falling out. The catheter is left for about a month, during which the artificially formed new duct is completely epithelialized, which prevents its walls from sticking together in the future. The procedure takes 5-10 minutes, is almost completely painless, the probability of relapse is less than 10% and only in the case of repeated infection of the patient.

Treatment of Bartholin's gland cysts with folk methods

Traditional and alternative medicine also offers several ways to treat Bartholin's gland cysts. Hirudotherapy or leech treatment of Bartholin's gland cysts is one of them. Its advantages include the possibility of recovery without the use of drugs or surgery, which is indicated, for example, for nursing mothers. The disadvantages include a decrease in hemoglobin levels, minor bleeding at the bite sites, and cost. The number of leeches and sessions is calculated for each patient individually, depending on the size of the cystic formation.

For home treatment and relief of discomfort, you can use the following recipes:

• hypertonic salt solution. Take two teaspoons of coarse salt per glass of hot water, dilute them in water. Soak a pad made of soft cotton fabric in the solution and apply to the inflamed area. It is recommended to change the pad twice a day.
• Grind 200 g of aloe leaves without thorns, add 400 g of honey and natural red wine. Boil the resulting mixture for about an hour on low heat in a water bath and then strain through cheesecloth. Take 1 tablespoon three times a day half an hour before meals.

Crumble black bread, add one grated clove of garlic, mix everything with liquid honey. Apply the compress to the affected area. Can be combined with sitz baths with chamomile and oak bark.

Prevention

Prevention of Bartholin's gland cysts consists of the following:

• compliance with personal hygiene rules;
• monogamous lifestyle, avoiding casual sex;
• timely treatment of urogenital infections;
• regular visits to a gynecologist;
• strengthening the immune system, leading a healthy lifestyle.

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