Before we discuss Bartholinitis, let’s first understand what the Bartholin’s glands are. They are located deep within the lower third of the labia majora on both sides. Their ducts open between the hymen and labia minora. Although they are part of the vulva, they are generally not visible to the naked eye.
Unprotected sexual intercourse, improper childbirth, and other conditions can lead to vulvar contamination, which can easily lead to inflammation of the Bartholin’s glands. The main pathogens causing inflammation include Staphylococcus aureus , Escherichia coli, Streptococcus aureus, Enterococcus aureus, Neisseria gonorrhoeae, and Chlamydia trachomatis. During an acute attack of Bartholin’s glands, the pathogens first invade the glandular ducts, causing inflammation of the Bartholin’s gland ducts. The duct openings become blocked by swelling or accumulation of exudate, preventing pus from escaping and causing it to accumulate and form an abscess, leading to a Bartholin’s gland abscess
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What are the symptoms of Bartholinitis?
- Local symptoms: Bartholinitis is mostly unilateral. In the early stage, local swelling, pain, and burning sensation of the vulva often occur, making it difficult to walk and sometimes causing difficulty in urination and defecation. During examination, local skin redness, swelling, fever, and tenderness can be seen, and small white spots can sometimes be seen at the opening of the Bartholin’s gland on the affected side. When a Bartholin’s gland abscess forms, the pain intensifies, and the diameter of the abscess can sometimes reach 3 to 6 cm, with palpable fluctuation. When the pressure inside the abscess increases, the surface skin becomes thinner, and the abscess can rupture on its own. If the rupture is large, the pus can drain on its own, and the inflammation subsides and the patient recovers. If the rupture is small and the drainage is poor, the inflammation will persist and repeated acute attacks may occur.
- Systemic symptoms: Some patients may experience fever, varying degrees of enlargement of inguinal lymph nodes, etc.
What is the difference between a Bartholin’s gland abscess and a cyst?
If only the opening of the Bartholin’s gland is blocked and the cystic fluid secreted by the gland is retained, but there is no infection, a cyst will form without the symptoms of an inflammatory abscess such as “redness, swelling, heat, and pain.”
How is Bartholinitis diagnosed?
Clinically, doctors can diagnose the condition based on the patient’s symptoms, physical signs, and a gynecological examination. Vaginal discharge should also be examined to determine if there is concurrent vaginitis. A routine blood test may be necessary. If a localized abscess ruptures, a culture and drug sensitivity test of the discharge are performed to identify the pathogen and the antibiotic to which it is susceptible, guiding the doctor in the proper medication and treatment.
What are the treatments for Bartholinitis?
- Medical Treatment: During acute attacks, adequate rest and maintaining local vulvar hygiene are recommended. Cephalosporin or quinolone antibiotics may be administered if necessary. If the abscess has not ruptured, symptoms such as local redness, swelling, and pain will generally be significantly alleviated after three days of antibiotic treatment. If there is no significant improvement, it suggests antibiotic insensitivity or that medical treatment is no longer effective. Depending on your condition, a change in antibiotics or surgical drainage may be necessary. If the abscess ruptures and drainage is unimpeded, recovery is generally achieved with rest and anti-infective treatment. The course of conservative antibiotic treatment is seven days, which may be adjusted based on the severity of the infection. Furthermore, any concurrent vaginitis should also be treated promptly.
- Surgical treatment: If a Bartholin’s gland abscess is enlarged, has a thin surface, is noticeably fluctuant, or has poor drainage after rupture, or if antibiotic treatment has failed, surgical treatment under local anesthesia is required in an outpatient clinic or day hospital. Some hospitals without day hospitals may require conventional hospitalization.
Surgical procedure
This surgical procedure is simple, technically challenging, and carries minimal risk. It primarily involves creating a stomy for the Bartholin’s gland abscess, creating a stomy at the lowest point of the abscess to allow for adequate drainage and cleansing of the abscess cavity. Postoperatively, local redness and swelling are immediately relieved, and pain generally subsides significantly within 24 hours. While surgical treatment is rapid and effective, regular outpatient follow-up visits and dressing changes are required until no significant new pus is present and the abscess cavity is closed. The entire treatment process typically takes 7 to 14 days.
It’s important to note that regular dressing changes and local care after surgery are crucial. Failure to promptly change the dressing and drain strip can impair healing of the abscess cavity. If the drain strip accidentally falls off, seek medical attention immediately to prevent the incision from closing before the abscess cavity heals, potentially compromising treatment effectiveness.
What is the prognosis for Bartholinitis?
Bartholin’s gland inflammation is a common, mild gynecological condition in women. With prompt and effective treatment, most cases resolve without scarring. However, in rare cases, localized inflammation may cause the labia minora to become larger than the contralateral labia, affecting appearance. When the body’s immune system weakens and pathogens invade again, inflammation can recur.
How to prevent Bartholinitis?
- Pay attention to vulvar cleanliness and sexual hygiene. It is recommended to wash the vulva with warm water once a day;
- If there is a possibility of sexually transmitted disease infection, condoms should be used throughout sexual intercourse, and the vulva should be cleaned promptly and medical attention should be sought after unprotected intercourse.
- Choose underwear with good breathability to avoid prolonged moisture in the vulva, which can cause local inflammation. Change your underwear frequently and dry it in a well-ventilated environment after washing. Try to expose it to sunlight for sterilization.
- Avoid wearing tight jeans or non-breathable pants for long periods of time.
