Bartholin's gland disease consequences. Bartholinitis and abscess of the Bartholin gland. Drug therapy of pathology

Bartholin's gland is a small paired formation located in the thickness of the labia majora. It got its name from the surname of the anatomist who discovered it, Caspor Bartolini, who published his works in the 17th century. The gland duct opens in the vestibule of the vagina, not far from the labia minora. She secretes a liquid secretion that lubricates the genitals and facilitates sliding during coitus. Bartholinitis is an inflammatory disease of the gland, often becoming chronic with the formation of a cyst. Most often, the disease is of an infectious nature and is associated with STD pathogens.

Mechanism of disease development

The Bartholin gland belongs to the exocrine glands, that is, it secretes its secretion out through the excretory duct. Functionally, it can be divided into:

• Producing part- has the shape of a pea, the inside is lined with secretory epithelium, which produces a liquid secretion. This is where fluid accumulates before it is released.
• Outflow tract- a thin tube 1.5-2 cm long, opening between the labia minora and the entrance to the vagina. Through it, the secretion is released onto the surface of the mucous membrane.

The duct of the Bartholin gland is relatively wide and various microorganisms easily penetrate through it. With a decrease in local immune defense or general resistance of the body, even opportunistic microflora that populate the skin and rectum can cause inflammation - bartholinitis.

The main causes of the disease are:

• Streptococci;
• Staphylococcus;
• Escherichia coli;
• Proteus;
• Klebsiella.

Nonspecific microflora can penetrate into the gland not only through the duct from the outside, but also through the blood or lymph flow from internal foci of chronic infection (tonsillitis, carious cavities, inflammatory diseases of the internal genital organs). In this case, bartholinitis is secondary and recurrent in nature if the underlying cause of the disease is not cured.

Among the causative agents of STDs, damage to the Bartholin gland is caused by:

Microorganisms attach to the surface of the epithelium, penetrate deep into it, where they multiply intensively and release toxic metabolic products. Under their influence, epithelial cells die, an inflammatory reaction develops: a rush of blood to the site of the lesion, swelling, and the release of leukocytes into the tissue. Due to swelling of the walls, the gland duct narrows or becomes completely impassable, its secretion accumulates inside, stretching the capsule - a cyst is formed. The purulent process inside it leads to the formation of an abscess - a limited cavity filled with pus. In the latter case, the gland is filled with dead leukocytes, microorganisms and remnants of epithelial cells. Partial breakdown products are absorbed into the blood with manifestations of a systemic reaction: body temperature rises, general health worsens.

Without treatment, the perineal tissue surrounding the gland sometimes undergoes purulent melting. As a result of this development of the disease, rough, disfiguring scars are formed at the site of inflammation, which interfere with sexual activity. In some cases, the abscess opens out, but complete emptying rarely occurs and the remaining pus causes new exacerbations of bartholinitis. The inflammatory process in the gland duct often leads to the formation of a cyst, which gradually increases in size and blocks the entrance to the vagina.

Clinical picture

Symptoms of bartholinitis are expressed to varying degrees, depending on the intensity of the inflammatory process. They appear acutely, often after hypothermia, menstruation, childbirth, abortion or unprotected sexual intercourse. First, a woman feels tingling, pain, heat, heaviness in the labia, which intensifies with movement and makes sexual intercourse painful or impossible. Along with this, general health worsens: body temperature rises to 38 degrees C, appetite disappears, headaches, and general weakness occur. Gradually, the pain in the perineum increases, becomes pulsating, the woman finds it difficult to walk and sit, and night sleep is disturbed.

Acute bartholinitis in most cases develops on one side. The labia majora at the site of the gland swells, increases in size, and its skin turns red. In the thickness of the lip, a painful lump ranging in size from one to several centimeters is felt - the gland itself. If the inflammatory process does not involve the surrounding tissues, then the skin above it is mobile and easily moves. When subcutaneous fat is involved, the epidermis becomes fused with it and loses its mobility. Often the inguinal lymph nodes react to inflammation; they increase in size and become visible in the form of round, dense formations under the skin. After some time from the formation of an abscess, it may burst outward with the flow of yellow-green pus.

After acute inflammation subsides, the disease enters the chronic stage. At first, the symptoms completely disappear and the woman feels healthy. This period of calm lasts from several months to several years, but any decrease in immune defense leads to an exacerbation of bartholinitis. Pain and swelling in the labia area, discomfort when walking, sitting, and sexual intercourse reappear. The temperature does not always rise and does not reach high values. As a rule, general health does not suffer.

Sometimes the inflammation is mild and occurs unnoticed by the woman or with minimal symptoms that are easy to miss. If, as a result of the disease, the patency of the gland duct is disrupted, then the gradual formation of a cyst begins. In the thickness of the labia majora, at its base, a subcutaneous volumetric formation of a round shape appears, painless to the touch, not fused with the surrounding tissues. It bulges outward, partially covering the entrance to the vagina. If both Bartholin glands are affected, the vestibule can be completely blocked, and sexual intercourse becomes painful due to the dryness of the external genitalia.

Diagnostics

The diagnosis of bartholinitis is made by a gynecologist after interviewing and examining the patient. Typically, diagnosis does not require additional research methods, but if another pathology with similar symptoms is suspected, the doctor prescribes:

• General blood analysis– an acute inflammatory process is manifested by an increase in the number of leukocytes, a shift in the leukocyte formula to the left, and an increase in ESR;
• General urine analysis– with bartholinitis, trace concentrations of protein may be detected;
• to pathogens of STIs – allows you to identify the possible causative agent of the disease;
• , separated from the Bartholin gland - the most accurate way to identify pathogenic microflora and its sensitivity to antibiotics.

Treatment

Treatment of bartholinitis is carried out on an outpatient basis or in a day hospital. Therapy must be combined with diet, protective regimen and sexual rest.

In the case of an STD, both partners must undergo antibiotic treatment to prevent recurrence of the disease.. During the period of acute inflammation, you should refrain from spicy, pickled foods, alcohol, and fatty foods. It is necessary to drink at least 2 liters of liquid per day - fruit drinks, compote, juice to quickly remove toxins from the blood and normalize well-being.

To treat bartholinitis use:

To speed up healing, physiotherapy methods are also used - exposure to ultra-high frequency current, magnetotherapy, and local electrophoresis. They become the main ones in the treatment of the chronic form of the disease, together with them they use general restorative procedures - ozone therapy, oxygen therapy, intravascular laser irradiation of the blood. Drugs are prescribed to activate the immune response - immunomodulators (Licopid, Thymalin). Sanitation of other foci of chronic infection is carried out and the intestinal microflora is normalized with the help of pre- and probiotics (Bifilac, Acipol, Linex).

Treatment at home is fraught with chronicity of the process, since there is no adequate antibacterial therapy. Bartholinitis often develops in conditions of immunodeficiency and the body is not able to cope with the causative agent of the disease. Do not squeeze pus out of an inflamed gland! The abscess capsule may break not outward, but into the tissues, in this case the purulent process spreads to the subcutaneous fatty tissue. Folk remedies are recommended to be used in addition to primary therapy: decoctions of chamomile, calendula, eucalyptus in the form of sitz baths relieve inflammation well and have an antibacterial effect.

Inflammation of the Bartholin glands during pregnancy, treat with topical medications whenever possible to minimize the risk to the fetus. Self-medication in this case is unacceptable, especially the independent use of antibiotics and antipyretics - this can lead to congenital malformations in the child.

Removal of formed Bartholin gland cysts and opening of abscesses is carried out surgically. The woman is hospitalized in the gynecological department for 5-6 days, the operation is performed under general anesthesia or epidural anesthesia. Local anesthesia is used only when removing a non-inflamed cyst. The doctor either eliminates the formation along with the gland, or forms a new excretory duct to replace the overgrown one. If an abscess is opened, it is completely cleaned of pus, washed with an antiseptic and partially sutured.

The earlier and more fully the treatment of bartholinitis is carried out, the lower the risk of chronicity and further surgical intervention. To prevent the disease, you should carefully observe personal hygiene, especially during menstruation, and use condoms during sexual intercourse.

Video: doctor about Bartholin gland cyst and bartholinitis

Video: inflammation of the Bartholin glands, “Live healthy!”

Inflammatory diseases of the external female genitalia are very common. Bartholin's paired glands are the largest of all the glands in this sphere. In the presence of certain conditions and factors, they can become inflamed, resulting in a rather serious disease that is fraught with complications.

What is bartholinitis

Bartholinitis is an inflammation of the large (Bartholin's) gland located in the vestibule of the vagina. It has a very narrow excretory duct, which, if not treated in a timely manner, closes completely, which creates an obstacle to the release of its secretion and is a prerequisite for suppuration. The purulent process spreads to the tissue near the inflamed gland, which leads to the formation of a true abscess - a cavity filled with pus.

With bartholinitis, the gland increases in size, the mucous membrane above it turns red

Sometimes a false abscess of the Bartholin gland occurs, which develops secondarily in the area of ​​its cyst. Bartholin gland cysts are smooth-walled cavities filled with sterile glandular fluid. They occur when the gland duct is blocked. If the contents of such a cavity become infected, a false abscess forms.

Bartholinitis occurs only in women, since men do not have Bartholin glands.

Classification of the disease

Bartholinitis can be classified as follows:

• by prevalence of the process:
  • unilateral;
  • bilateral;
• according to the nature of the disease:
  • spicy;
  • subacute;
  • chronic, recurrent.

Bartholinitis most often has a unilateral localization and an acute course. But in the presence of a constant provoking factor, bartholinitis can acquire a chronic, recurrent course, that is, it constantly returns. Subacute disease is called when the symptoms of inflammation are mild (pain, redness, swelling, fever), which is often associated with the characteristics of the woman’s immune system.

Reasons for the development of pathology

The cause of inflammatory changes in the Bartholin gland is infection of its lumen with pyogenic microorganisms (Staphylococcus aureus, Escherichia coli, Proteus, enterococci, etc.).

Staphylococcus aureus is a spherical bacterium, the causative agent of a large number of dangerous diseases.

There are a number of predisposing factors for the development of inflammation in the gland:

• neglect of genital hygiene, especially after childbirth, abortion, during menstruation;
• tight underwear, causing friction of the skin of the external genitalia and mechanical compression of the ducts of the Bartholin glands;
• Irregular change of daily and sanitary pads.

Diabetes mellitus is a factor that provokes the development of pustular diseases, including bartholinitis, as well as vaginal disease (). Therefore, in diabetes mellitus, bartholinitis and thrush are often combined. If they recur, it is recommended to check your blood sugar levels.

Bartholinitis most often affects women of childbearing age, since the listed provoking factors are characteristic of this period.

Symptoms of bartholinitis

Inflammation of the Bartholin gland is accompanied by the following symptoms:

• pain in the perineum, increasing with movement, defecation, or while sitting;
• swelling in the labia area;
• redness;
• discharge of pus from the excretory duct of the gland when trying to squeeze it out;
• sometimes - an increase in the size of the inguinal lymph nodes and their soreness;
• low fever, chills, weakness, body aches.

When an abscess occurs, the condition worsens significantly:

• fever, weakness, sweating increase;
• pain in the perineal area intensifies and becomes throbbing;
• the area of ​​swelling and redness increases;
• in the area of ​​the vaginal vestibule, a small, round, extremely painful formation appears, soft to the touch.

If you notice the above symptoms, you should immediately consult a gynecologist.

Diagnostics

Diagnosis of bartholinitis includes a consultation with a gynecologist, who will suspect the pathology based on characteristic complaints, as well as upon examination of the external genitalia in a gynecological chair.

To diagnose bartholinitis, an examination by a gynecologist is necessary, during which you need to take the correct position on the chair

Additionally, for bartholinitis, the following studies are prescribed:

• general blood test - it is expected to increase the number of leukocytes and, which is a sign of an inflammatory process;
• examination of a vaginal smear under a microscope is a method that allows you to quickly determine the causative agent of the disease, but it is not always accurate, therefore it is used only for preliminary diagnosis;
• sowing the contents of the gland on a nutrient medium to determine the sensitivity of bacteria to antibiotics is a labor-intensive, but the most accurate method for determining the causative agent of the disease and its sensitivity to antibiotics, which is very important due to the increasing number of cases of bacterial infections that are resistant to the most commonly used antibacterial drugs (Amoxiclav , Ceftriaxone, etc.).

The result of sowing is usually known no earlier than 3 days after collecting the material.

When an abscess forms, the gynecologist, when examining the external genitalia, will see a rounded formation and pronounced swelling, spreading to the labia majora and minora.

Unlike an abscess, a Bartholin gland cyst has an elastic consistency to the touch and is absolutely painless. The skin in the projection of the cyst is not changed in any way, the general well-being of the patient is not disturbed.

Sometimes Bartholin gland cysts reach large sizes, which leads to unpleasant sensations in the genital area and worsens the quality of intimate life.

Treatment methods

Treatment methods depend on the severity of the inflammatory process:

• In the absence of an abscess, therapy is carried out on an outpatient basis with the help of medications.
• When an abscess forms, urgent hospitalization and autopsy are indicated.
• A vaginal gland cyst that causes discomfort must be surgically removed as planned.
• If the cyst is asymptomatic, there is no need for surgical correction.

For bartholinitis, local and general methods of therapy are used. During treatment it is necessary to abstain from intimate life.

Local therapy

Locally prescribed:

With early treatment at the very beginning of the disease, local physiotherapy can be prescribed:

• UHF is a physiotherapeutic treatment method that uses ultra-high frequency electromagnetic fields, a kind of heat treatment that, with the help of special equipment, penetrates human tissues and organs;
• ultraphonophoresis on the area of ​​projection of the inflamed gland is a method based on the combined action of ultrasound in combination with medicinal substances.

Physiotherapy has the following effects:

• improves blood circulation in the area of ​​inflammation;
• increases the number of immune system cells that destroy pathogens;
• relieves swelling;
• stimulates rapid resorption of infiltrate;
• prevents suppuration.

Recipes for preparing antiseptic decoctions, infusions, solutions for compresses and baths

Instead of pharmaceutical antiseptics, you can use herbal preparations (decoctions of chamomile, sage, etc.) for lotions and baths, and saline solution for applying compresses.

Preparation of sage decoction:

1. Take 2 tablespoons of dry sage leaves and place them in an enamel bowl.
2. Pour in 200 ml of hot water.
3. Place in a water bath and keep for 15 minutes.
4. Strain the resulting broth and squeeze the leaves through cheesecloth.
5. Bring the volume of the decoction to 200 ml by adding clean boiled water.
6. Cool to room temperature and use 2 times a day as a lotion.

Chamomile decoction is prepared in the same way. The ingredients are taken in the same proportions.

Chamomile decoction for bartholinitis relieves inflammation

Preparation of infusion from nettle leaves, blackberries and yarrow flowers:

1. Take 1 tablespoon of the listed plants.
2. Pour 700 ml of boiling water over the leaf mixture.
3. Leave for 1.5 hours, then strain the cooled infusion.
4. The prepared infusion is used as a lotion on the external genitalia twice a day.

In addition to lotions, baths based on medicinal herbs are used. To prepare a bath that has a pronounced anti-inflammatory effect, you will need:

1. Take 1 tablespoon each of eucalyptus leaves, chamomile flowers and dried oak bark.
2. Pour 1 liter of water over the leaves.
3. Boil the mixture for 10 minutes.
4. The resulting broth must cool to room temperature, after which it must be strained.
5. Immerse the external genitalia in the resulting decoction for 15–20 minutes 1–2 times a day.

Instead of decoctions and infusions, you can use baths with potassium permanganate. To do this, you need to fill a basin with water (preferably boiled) and add a few crystals of potassium permanganate (the solution is prepared by eye). It is necessary to immerse the external genitalia in a basin with the solution for 10–15 minutes. Potassium permanganate is a strong antiseptic and effectively fights the causative agent of the disease. The resulting solution should have a pale pink tint. The bright pink solution is too concentrated. Its use can lead to a chemical burn to the mucous membrane.

Saline compress:

1. Take 3 heaped tablespoons of table salt (90 grams).
2. Pour them into 1 liter of warm boiled water.
3. Stir until completely dissolved (a solution with a salt concentration of 10% is obtained).
4. Apply multi-layer gauze dressings with saline solution to the swollen labia, changing them as they dry.
5. Before changing the dressings, rinse the genitals with clean boiled water.
6. Under no circumstances should the compress be covered with airtight materials (oilcloth, cellophane).

A hypertonic salt solution attracts water from soft tissues, thereby reducing their swelling and severity of pain. In addition, a high salt concentration contributes to the death of harmful microorganisms in the area of ​​inflammation.

Self-applying warm compresses to the area of ​​the inflamed gland can lead to the spread of infection.

In case of recurrent inflammation, immunomodulatory therapy (Genferon, Viferon suppositories for insertion into the vagina) can be prescribed. These drugs are intended to increase local immunity of the external genitalia and to improve the body's overall resistance to infections. Immunomodulators should be used during the period of remission (after the elimination of inflammation).

Doctors argue about the effectiveness of immunomodulators

There have been no serious medical studies confirming the effectiveness of immunomodulators, so many doctors do not recommend the use of these drugs, considering them useless.

Methods of systemic influence

Common treatments include:

• antibiotic therapy;
• taking non-steroidal anti-inflammatory drugs (NSAIDs).

Bartholinitis is a bacterial disease, the causative agent of which is fought with antibiotics. Their appointment is necessary when the pathology is accompanied by an increase in body temperature. Antibiotics of various groups (for example, Amoxiclav, Ceftriaxone, Levofloxacin, Metronidazole, Clarithromycin, etc.) can be prescribed orally or by injection (intramuscular or intravenous). After the analysis is ready to determine the sensitivity of bacteria, the drugs are replaced if necessary.

You should not neglect antibiotics for bartholinitis and try to cure it yourself only with folk remedies (baths, lotions, saline solution). This can lead to the formation of an abscess.

In case of high fever (temperature more than 38.5 °C), as well as to relieve pain, NSAIDs (Nurofen, Ketonal, etc.) are prescribed.

Nurofen is a non-steroidal anti-inflammatory drug, it relieves pain, relieves inflammation and reduces temperature during fever

Treatment of vaginal gland abscess

When an abscess forms, hospitalization in a gynecological hospital and opening of the abscess is required:

After surgery, antibiotic therapy is indicated. Inpatient therapy lasts about 7 days. The woman is then discharged for home treatment. You cannot sit for 4–5 weeks and you must abstain from sexual activity. Recovery after surgery is usually uneventful.

If the incision is made correctly, the skin and mucous membrane around the vagina heal without pronounced scars and discomfort does not occur in the future during sexual intercourse.

Sometimes, if not addressed in a timely manner, the opening of the abscess occurs spontaneously. Usually after this the severity of the pain syndrome decreases and overall well-being improves. In case of spontaneous opening of an abscess, in order to avoid possible complications, hospitalization is required, which includes professional wound care and antibiotic therapy. Therefore, it is necessary to consult a doctor immediately.

Video: how to treat inflammation of the Bartholin glands

Forecast

If you consult a doctor in a timely manner, the prognosis is favorable. A decrease in the severity of symptoms of the disease occurs 1–3 days after the start of treatment. If the rules of intimate hygiene are violated or wearing tight underwear, bartholinitis often returns.

Possible complications

If help was not provided to the woman at the onset of the disease, an abscess forms. There is a possibility that the formed abscess of the Bartholin gland will open on its own. But a less favorable development of events is also possible. Purulent inflammation can spread to neighboring tissues, spread deep into the pelvis, and cause sepsis.

Opening an abscess, even in a medical facility, is sometimes accompanied by the development of complications. Possible consequences of surgery:

• the formation of a fistula - a non-healing passage leading deep into the gland, from which pus is often released;
• dehiscence of sutures, which is possible due to poor-quality technique for applying them or poor treatment of the wound;
• formation of a gonadal cyst, possible with complete closure of the lumen of the gland;
• recurrence of an abscess, spread of infection to surrounding tissues, development of sepsis due to ineffectiveness of antibiotics, poor wound care or a pronounced decrease in immunity.

All these complications often develop with delayed seeking of medical help and inadequate treatment. It is especially dangerous to delay the treatment of bartholinitis during pregnancy, as this can lead to the development of an ascending infection, infection of the membranes and the fetus.

Prevention

The basis for preventing inflammation of the vaginal gland is proper genital hygiene. To prevent relapse of the disease it is necessary:

• change underwear daily;
• wear underwear made from natural fabrics;
• avoid wearing tight underwear;
• change tampons and pads regularly;
• wash regularly, using the correct technique.

Many women make mistakes when carrying out hygiene measures in the area of ​​the external genitalia:

• Rinse the external genitalia from back to front (thereby introducing microbes from the rectum to the genital mucosa). The stream of water should wash the genitals strictly from front to back.
• Rinse not only the external genitalia with soap and water, but also the mucous membrane of the vaginal opening. The mucous membrane inside the vagina is very sensitive to any products, even special ones intended for intimate hygiene. With regular washing, the vaginal mucosa becomes dry, and its beneficial microflora, which protects the genitals from infections, dies.

Bartholinitis is a gynecological pathology that affects the vestibule of the vagina. Infectious causative agents of the disease are pathogenic microorganisms that cause an inflammatory process in the Bartholin gland, with septic damage to its tissues and excretory duct. If the doctor has diagnosed bartholinitis, treatment is carried out with the mandatory use of antibiotics and local procedures. In the advanced stage of the disease, the formed abscess contains pus, which requires urgent surgical intervention with washing the cavity of the affected gland.

Treatment of bartholinitis should begin as early as possible, immediately after the pathology has been diagnosed. To cope with the inflammatory process and prevent further spread of infection to nearby tissues and organs, a woman must follow all doctor’s orders. Bartholinitis has several stages of development, each of which has different characteristics, and therefore treatment will be prescribed to the patient on an individual basis.

Treatment of bartholinitis at the initial stage - the stage of canaliculitis - in most cases is carried out on an outpatient basis. The gynecologist prescribes medications to the patient and advises on all medical procedures that will have to be performed independently at home.

Treatment of the disease at the initial stage includes:

• compliance with bed rest;
• restriction of physical activity;
• applying cold compresses to the affected gland;
• anti-inflammatory treatment using baths with extracts of medicinal plants, salt and potassium permanganate;
• taking extended-spectrum antibiotics;
• vitamin therapy.

Treatment of bartholinitis at the second stage - the stage of false abscess - is also often practiced on an outpatient basis . Only in the case of a serious inflammatory process, complicated by severe intoxication, can the patient be sent to the hospital. An ambulance should be called if the body temperature during bartholinitis exceeds 38.5°C.

Treatment of the disease at the second stage consists of antibiotic therapy, local treatment with Levomekol and Vishnevsky ointment; if necessary, the affected gland is opened on an outpatient basis with the contents removed and the abscess cavity washed.

The third stage of bartholinitis - purulent cyst of the gland - requires treatment in a hospital . The formed purulent abscess is opened surgically. After treating the cavity, the doctor forms an excretory duct from the Bartholin gland, leaving a catheter or drainage tube in it to drain the secretions.

Also, treatment of the third stage of the disease includes mandatory antibiotic therapy and local treatment. In some cases, the Bartholin gland is removed completely if periodic relapses of the disease occur.

Treatment of acute bartholinitis

Treatment of the acute form of bartholinitis is mainly carried out in a hospital. Only the initial stage of the disease can be carried out under the supervision of a doctor on an outpatient basis. The condition for a speedy recovery is strict adherence to all the doctor’s prescriptions.

Treatment of symptoms of bartholinitis in women has the following goals:

• elimination of pain in the source of inflammation and intoxication of the body;
• prevention of the formation of a true abscess - the third stage of the disease;
• prevention of the formation of cystic complications of the Bartholin gland.

The course of treatment consists of antibacterial, anti-inflammatory and antipyretic drugs, and physiotherapy.

Local treatment

For bartholinitis, the following remedies may be effective:

1. Cold . Wrap an ice pack in clean gauze and apply to the affected gland for about 30 minutes. After this, take a break for the same amount of time and reapply the bubble, filling it with a new portion of ice. The total duration of topical ice treatment is 2 hours daily.
2. Salt compresses . An 8-10% salt solution helps to resolve inflammation and draw out infectious contents from the wound cavity without destroying the tissue structure. A salt solution of the required concentration is prepared as follows: for 1 liter of water, take 3 tbsp. l. salt. The water should be warm so that the salt dissolves better. Moisten gauze, folded several times, in the resulting solution and place on the affected gland for 40 minutes. Perform the procedure at least 6 times a day.
3. Dressings with Vishnevsky ointment or Levomekol . Both of these drugs are used to treat bartholinitis at home. The drug is applied to a gauze swab, which should be secured at the site of inflammation of the gland with a bandage. In this case, dressings with drugs should be alternated, for example, during the day, treat bartholinitis with Vishnevsky ointment, and at night with Levomekol.
4. Antiseptic solutions . Treatment of bartonylitis should be carried out with solutions with a disinfecting effect that do not lead to locally irritating results and burns on the skin. For example, drugs and Chlorhexidine are used, which should be used to wash the inflammation and treat the wound.

Physiotherapeutic treatment

Physiotherapy treatment can be prescribed provided that local treatment has helped improve the woman’s condition. With adequate therapy, this occurs on the 4th day. Physiotherapeutic treatment includes magnetic therapy and UHF, phonophoresis.

Treatment with antibiotics

Treatment of bartholinitis with antibiotics is mandatory, since the pathology is caused by infectious agents. The course of antibiotic therapy is 7-10 days. To increase the effectiveness of treatment, it is important to identify the causative agent of the disease and its sensitivity to antibacterial agents.

But in practice, there is not enough time for this, since the disease develops rapidly, and antibiotic therapy, in most cases, must be started immediately. For this reason, bartholinitis is often treated with extended-spectrum antibiotics without additional research.

What antibiotics are used to treat bartholinitis? These drugs are Azithromycin, Cefazolin, Amoxiclav. Trichopolum and Tinidazole are prescribed less frequently. Along with antibiotic therapy, symptomatic treatment is prescribed, aimed at eliminating pain and relieving fever. It is carried out with non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen) and analgesics (Analgin, Baralgin).

Surgery

Treatment of acute bartholinitis by surgery is carried out when a purulent abscess forms. During the operation, the doctor opens the inflammatory lesion and removes the pus present in it. Then the wound surface is treated with 3% hydrogen peroxide, and a drainage tube is inserted into the cavity of the gland; it is necessary to remove the remaining pus.

After a few days, if the dynamics of recovery are positive, the tube is removed. To speed up the healing process, a course of antibiotics and local treatment is prescribed.

Treatment of chronic bartholinitis

Treatment of chronic bartholinitis requires an individual approach. The fact is that the formed dense capsule in the Bartholin gland can create a barrier to the penetration of medications. Treatment of the chronic form of the disease is carried out in two ways - medication and surgery.

Conservative treatment

The goal of drug therapy is to eliminate the clinical picture of the pathology and relieve the inflammatory process. Treatment in this case may be similar to the treatment of the acute phase of bartholinitis, that is, antibiotics, local and symptomatic therapy are used.

After the condition improves, physiotherapeutic methods are prescribed: UHF, infrared laser, magnetic therapy and ozokerite. Vitamin therapy is used to strengthen immune defense. Anti-inflammatory sitz baths can be prescribed locally using antiseptic solutions of chamomile, oak bark, and potassium permanganate.

Surgery

Surgery for chronic bartholinitis is carried out in two ways:

• marsupialization - the formation of an artificial duct of the Bartholin gland;
• extirpation - complete resection of the gland.

Marsupialization is the preferred surgical treatment option for bartholinitis in gynecology. Indications for its implementation are frequent relapses of the disease, the formation of a large-diameter cystic formation, and inconveniences that arise during sexual intercourse and in everyday life.

The purpose of marsupialization is the formation of an artificial channel, thanks to which the accumulated secretion in the gland can be freely removed to the outside.

How is the operation performed?:

1. The patient is given anesthesia.
2. In the abscess or cyst of the Bartholin gland, the doctor makes an incision no more than 0.5 cm long.
3. The opened cavity is thoroughly cleaned of contents and washed with 3% hydrogen peroxide or other antiseptic solution.
4. A catheter is inserted into the organ cavity and secured with a special ball.
5. After a few weeks, the catheter is removed, and in its place an artificially created duct of the Bartholin gland should be formed, ready to function in the desired direction.

Rehabilitation after marsupialization is easy and quick, complications are rare. Relapses of bartholinitis occur in 2-10% of all patients who have undergone this surgical intervention.

Estirpation is performed less frequently, since this operation is often accompanied by serious blood loss. This is due to the fact that the Bartholin gland has a connection with a large vein. Also, a serious disadvantage of the operation is the disruption of the subsequent natural process of moisturizing the vaginal walls.

But sometimes extirpation is a real salvation for a woman if she has constant relapses of the pathology or has had unsuccessful marsupialization in the past.

How the operation is performed:

1. The patient receives anesthesia.
2. The doctor makes an incision on the inner surface of the labia minora.
3. Through the resulting hole, the iron is completely removed to the surface.
4. Catgut suture material is applied to the incision site.

Rehabilitation after extirpation lasts at least 10 days. At this time, the woman is prescribed physiotherapeutic procedures - UHF, magnetic therapy, phonophoresis and applications using anti-inflammatory drugs.

Treatment with traditional methods

Treatment of bartholinitis with folk remedies is justified if the woman does not self-medicate. If you suspect the development of inflammation of the Bartholin gland, then first of all you need to seek help from a gynecologist, who, in addition to the main treatment, can prescribe herbal medicine methods. It is important to remember that treatment with herbal remedies should be long-term and regular; resorting to it from time to time is pointless.

Let's look at folk recipes that successfully treat bartholinitis.

Sitz baths with herbal extracts:

1. Chamomile based. 2 tbsp. l. pour 2 cups of boiling water over the herbs and leave for about an hour. Add the finished broth to a bowl of boiled water and take a bath for at least 15 minutes.
2. Based on eucalyptus. 2 tbsp. l. Pour 2 cups of boiling water over the plants and leave for 30 minutes. Then pour the eucalyptus decoction into a bowl of water and take a bath as in the previous case.
3. Based on calendula. 2 tbsp. l. plants, brew 0.5 liters of water in an enamel bowl, place it in a water bath for 15 minutes. Cool the finished broth, strain and add to the water for a sitz bath.

Every woman wants to be healthy and happy. Knowledge about possible female diseases and their manifestations, and most importantly, timely contact with a gynecologist play a decisive role in this. When working properly, the Bartholin gland has a great influence on the sexual life and health of not only a woman, but also her partner. Let's figure out what Bartholinitis is, how it forms, consider its symptoms, causes and methods of therapy to combat inflammation of the Bartholin gland in the vestibule of the vagina.

Definition and purpose of the Bartholin gland

The discoverer of the gland was the Danish professor and anatomist Caspar Bartholin. It was described as a large paired gland located near the entrance to the female genital organs, in the thickness of the labia majora and at their base. The size of this gland can reach two centimeters. The glands produce a gray, protein-rich fluid that maintains normal moisture in the vaginal lining. The secreted secretion promotes free penetration of the male genital organ, reduces friction during reciprocating movements, thereby improving the quality of sexual life.

The amount of secretions produced depends on the period of a woman’s cycle. During menopause, after surgical interventions on the genitals, as well as in the middle of the cycle, less secretion is secreted than usual. Its greatest amount is produced at the end of the cycle, especially at a young, childbearing age.

Bartholinitis: what it is and its causes

According to statistics, bartholinitis affects approximately five percent of women of reproductive age. The disease occurs as a result of inflammation of the excretory ducts of the Bartholin glands, located at the beginning of the vagina. Infection occurs due to the penetration of various disease-causing microorganisms, such as gonococci, staphylococci, E. coli, and Trichomonas vaginalis. The disease-causing flora penetrates the excretory duct of the gland with inflammatory fluid from the vagina and urethra. In some cases, for the occurrence of bartholinitis, it is enough to have hemorrhoids, anal fissures, or intestinal fistulas. With gonorrhea, the risk of inflammation of the Bartholin glands increases by 30 percent.

Bartholinitis contributes to blockage of the gland ducts, resulting in significant swelling at the entrance to the vagina. This leads to painful sensations in the perineum, increased body temperature, and prolonged inflammation.

Reasons contributing to the appearance of bartholinitis:

• Violation of the rules for preventing diseases of the genital organs and maintaining health.
• Incompletely cured, advanced sexually transmitted diseases and sexually transmitted infections.
• Promiscuous sex life.
• Weakened immunity. Avitaminosis.
• Chronic stress condition.
• Hypothermia or overheating of the body.
• Complications after abortion or gynecological surgery.
• Disease of the urinary tract.

Symptoms of inflammation of the Bartholin gland

Bartholinitis entails lethargy, apathy, the temperature rises to 40 ° C, obvious pain appears in the area of ​​the external genitalia, increasing with movement or in a sitting position. The labia majora, located above the Bartholin gland, becomes red and swollen. After the purulent inflammation is removed, a state of relief comes almost immediately, the pain subsides, and the temperature returns to normal.

Bartholinitis in its chronic form lasts for quite a long time, periodically exacerbating during the menstrual period, after hypothermia or due to concomitant chronic diseases. If there are no exacerbations, chronic bartholinitis can be asymptomatic, sometimes causing discomfort in the area of ​​the inflamed gland and pain during genital contact with a sexual partner. Often, in the chronic form, a large gland cyst forms at the entrance to the vagina.

Bartholinitis is divided into several types:

1. False suppuration of Bartholin gland tissue. The patient's general well-being remains unchanged; walking is hindered by severe pain. When you press on the inflamed area, a small amount of liquid is released, which must undergo bacteriological examination. This type of inflammation leads to protrusion of the inner surface of the labia majora, thereby covering the entrance to the female genital organs. When the excretory duct is completely blocked, a pseudoabscess of the Bartholin gland occurs.
2. True suppuration of the Bartholin gland. It is observed when microorganisms penetrate into the main tissue of the gland and surrounding tissue. Swelling of the genitals and enlargement of the inguinal lymph nodes are observed. Even in a lying position, patients complain of sharp pain in the perineum and difficulty moving. All this is accompanied by elevated temperature, increased leukocytosis and ESR.
3. Pathological formation on the Bartholin gland. The cyst appears as a painless, round swelling and is located in the lower part of the labia majora. The size of the cyst can reach the size of a goose egg. With the formation of an abscess comes sharp throbbing pain, deterioration of the general condition, high temperature, and poisoning of the body.

Therapy for inflammation of the Bartholin glands

After examining the patient by a gynecologist, additional tests will be required to identify the source of the pathogenic flora that provoked the inflammation. To do this, using a colposcope, samples of the mucous membrane from the diseased gland, cervix and urethra are taken from a sick woman for study. For a more detailed diagnosis, a bacteriological research method or PCR diagnostics may be required. Anti-inflammatory, pain-relieving medications and antibiotics will also be prescribed. The course of treatment lasts ten days.

If the patient has a purulent formation, then it is opened and the inflamed tissue is disinfected with appropriate means. Cysts are removed surgically, restoring the patency of the ducts.

The rehabilitation period lasts up to two months. To prevent relapse of the disease, treatment for colpitis and urethritis is prescribed. In the chronic form, the patient is recommended to sit in a filled bath with a diluted solution of potassium permanganate or medicinal chamomile infusion with hot water. At the same time, a course of treatment with ultrasound or high-frequency radiation is prescribed, as well as strict adherence to the rules for caring for the genitals. Elderly women are prescribed a biopsy for timely detection of cancer.

Inflammation of the vulvo-vaginal Bartholin glands can be avoided by regularly visiting a gynecologist and following simple rules of personal hygiene:

1. Wash the genitals only from the outside, do not use douching.
2. You need to wash from front to back under running water. This way you will protect yourself from getting E. coli from the anus into the vagina or bladder.
3. Change underwear and pads in a timely manner. You need to take a new pad after every trip to the toilet.

Bartholinitis – inflammation of the Bartholin gland.

These glands are located in the thickness of the lower third of the labia majora; their ducts open on the inner surface of the labia minora. The glands produce mucus necessary to moisturize the vestibule of the vagina. Stimulation of mucus production occurs under the influence of estrogens (steroid female hormones produced by the follicular apparatus of the ovaries). With age, the production of estrogen decreases significantly, as a result of which the secretion of the Bartholin glands decreases, which significantly increases the susceptibility of the gland to the development of the inflammatory process. When an infectious agent enters the mouth of the excretory duct, canalicular bartholinitis develops. However, over time, the infection spreads, which leads to the involvement of the gland parenchyma in the process. In the absence of timely administration of therapy at this stage, progression of bartholinitis occurs, which can lead to purulent complications. In this case, a false abscess or empyema of the gland is formed.

The incidence of bartholinitis among the female population is 15%, most of them are between the ages of 20 and 30 years. This disease does not occur in children and elderly women, since in children the gland is not sufficiently developed, and in postmenopausal women changes in the structure of the gland are observed.

The following factors contribute to the development of bartholinitis:

• sexually transmitted infectious diseases of the genital organs, for example, gonorrhea, trichomoniasis, chlamydia and others;
• inflammatory diseases of the reproductive system (vulvovaginitis, endometritis, etc.);
• vaginal bacteriosis, changes in vaginal microflora;
• immune disorders;
• hypo- or vitamin deficiency;
• failure to comply with personal hygiene rules;
• wearing tight underwear.

Depending on the course of the pathological process, bartholinitis is divided into acute and chronic forms. The acute form of the disease is characterized by severe symptoms, a rapid response to treatment, and complete elimination of the disease can be achieved within 3 to 4 weeks. The chronic form of bartholinitis is characterized by alternating asymptomatic periods, during which nothing bothers the woman, with periods of exacerbation, during which symptoms characteristic of the acute form of the disease develop.

As a rule, the prognosis for bartholinitis is favorable. In most cases, complete recovery occurs; only a quarter of patients develop a chronic form of the disease, which is often accompanied by the formation of cysts. To prevent the development of complications of the disease, when the first symptoms appear, you should immediately seek help from a specialist who will not only carry out all the necessary diagnostic measures, but also prescribe appropriate treatment. In addition, timely consultation with a doctor will significantly reduce the risk of developing a chronic form of the disease. The most common complications of bartholinitis include abscesses, which can subsequently lead to deformation of the labia and the formation of vaginal fistulas. Long-term chronic bartholinitis leads to the formation of a Bartholin gland cyst, which often suppurates.

Symptoms

Initially, the disease manifests itself as redness of the labia minora, which a woman may not pay attention to. Then swelling of the mucous membrane appears, and a small nodule (the size of a grain to a pea) is formed in the area where the duct of the Bartholin gland exits. As the nodule forms, a painful sensation appears, usually of a pulling nature. As swelling and pain increase, some discomfort appears when walking. There are also minor serous or purulent discharges and low-grade body temperature. In some cases, a woman notices local itching.

The purulent form of bartholinitis is characterized by a pronounced clinical picture. There is a rapid growth of nodes in the thickness of the labia, a throbbing pain appears, which bothers the woman not only while walking, but also at rest. It is also worth noting that it is not uncommon for pain to radiate to the groin area or thigh. Episodes of fever may occur, alternating with normal body temperature. In addition, a woman may complain of decreased performance, general weakness, and decreased appetite.

Chronic bartholinitis is most often asymptomatic. In some cases, there is some discomfort in the vulva, dyspareunia (a feeling of discomfort or pain during sexual intercourse). With exacerbation of chronic bartholinitis, symptoms characteristic of the acute form of the disease appear. The following factors can provoke an exacerbation:

• menstruation;
• maintaining an active sex life;
• hypothermia;
• insufficient intake of essential vitamins and microelements into the woman’s body.

Diagnostics

Diagnosis begins with the collection of characteristic complaints indicating the possibility of bartholinitis. Next, the doctor proceeds with a gynecological examination, during which hyperemia (redness) of the labia minora is detected. Upon palpation, a node is detected, upon pressing on which exudate of a serous or purulent nature is released. Also, these actions may be accompanied by the appearance or intensification of pain.

To identify the causative agent of the disease, microscopy and bacterial culture of the resulting exudate are performed. Bacterial culture allows not only to identify the microorganism that caused the development of bartholinitis, but also to establish its resistance to antibacterial agents. As a rule, the culture results become known after 5–7 days from the start of the study of the material. Therefore, if necessary, PCR is performed - diagnostics, which allows one to quickly identify the causative agent of the disease. The action of PCR (polymerase chain reaction) is to identify the genetic material of an infectious pathogen. This diagnostic method is highly specific, since it is it that allows one to determine the unique sequence of nucleotides characteristic of a particular pathogen. In addition, PCR allows you to simultaneously detect several pathogens without casting doubt on the results of the study.

When making a diagnosis, it is important to first make a differential diagnosis with the following diseases:

• boil of the labia;
• inflammation of the peri-vaginal tissue;
• atypical form of syphilitic chancre;
• Bartholin gland cancer.

Treatment

Treatment consists of prescribing broad-spectrum antibacterial agents that affect both gram-positive and gram-negative microflora. In case of mild inflammatory process, the use of local antibiotics is allowed, but in most cases the prescription of systemic antibacterial agents is required. In addition, local treatment with an antiseptic is carried out. Non-steroidal anti-inflammatory drugs are also used, which have antipyretic, anti-inflammatory and analgesic effects. If there is an itching disease in the clinic, antihistamines are prescribed.

After the acute period of the disease has stopped, physiotherapeutic treatment is prescribed, the effect of which is aimed at preventing the development of relapse. The following types of physiotherapy are used:

• UHF (ultra-high frequency therapy) is a method of physiotherapeutic treatment based on the use of an ultra-high frequency electromagnetic field. This procedure eliminates pain, reduces tissue swelling, stimulates blood circulation, and fights inflammation;
• Amplipulse therapy is a method of physiotherapeutic treatment based on the use of sinusoidal modulated currents. It has an analgesic effect, the maximum development of which is achieved after the full course. In addition, it helps improve tissue trophism and also reduces swelling;
• Ozokerite therapy is a type of heat therapy, which consists of performing thermal applications using ozokerite. Ozokerite is a petroleum compound and contains paraffin, methane, ceresin, ethane, propylene, hydrogen sulfide, carbon dioxide, resins and mineral oils. Ozocerite therapy is used in the treatment of chronic bartholinitis without exacerbation.

Surgical intervention is required when an abscess forms, as well as in the presence of a cyst, the formation of which is often observed in recurrent forms of bartholinitis. In this case, either removal or marsupialization of the Bartholin gland cyst is performed. Marsupialization is a surgical procedure during which the pathological cavity is opened with the further formation of a new duct with an opening. This operation allows you to restore the patency of the excretory duct of the gland, eliminate strictures (narrowings) that have arisen against the background of a long-term inflammatory process, as a result of which the function of the Bartholin gland is restored.

Medicines

Initially, antibacterial agents are prescribed empirically, that is, until culture results are obtained, which provide information not only about the causative agent of the infectious process, but also about its sensitivity to antibacterial agents. In this case, preference is given to broad-spectrum antibiotics, which have a detrimental effect on both gram-positive and gram-negative microflora. The culture results make it possible to use etiotropic antibacterial therapy, which consists of targeted administration of antibiotics that are active against the identified pathogen. Etiotropic prescription of antibacterial agents is considered the most rational, since this tactic allows you to choose the most effective drug with a narrow spectrum of action. When using antibacterial agents, it is important to carefully follow all doctor’s recommendations. In no case should you independently adjust the dosage and frequency of taking the drug, since these actions can cause the development of microorganism resistance to the antibiotic used. While taking antibiotics, various side effects can develop. The most common side effects are from the gastrointestinal tract: nausea, vomiting, heartburn, diarrhea.

When choosing an antiseptic for topical use, you should be guided by the following principles:

• the product must have an active effect against pathogenic microorganisms;
• the product must be harmless to those tissues that are being treated, that is, it must not have toxic or destructive effects.

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the COX enzyme, resulting in disruption of the synthesis of prostaglandins from arachidonic acid. Thanks to this mechanism of action, the following effects are achieved: antipyretic, anti-inflammatory, analgesic. As a rule, with bartholinitis, the body temperature rises slightly, therefore, when choosing a drug from the NSAID group, preference is given to drugs that have pronounced anti-inflammatory and, to a lesser extent, antipyretic and analgesic effects.

If there is an itching disease in the clinic, antihistamines are prescribed, the action of which is aimed at eliminating this symptom.

Folk remedies

To prevent the development of bartholinitis, you should follow the rules of personal hygiene, carefully choose underwear (it is recommended to give preference to natural materials), and exclude accidental unprotected sexual contacts. In addition, it is important to promptly diagnose and treat diseases of the genitourinary system.

At home, you can prepare a bath based on chamomile or oak bark. These plants have an anti-inflammatory effect, which plays a huge role in the treatment of bartholinitis. To prepare the bath, you must first prepare the plant material, from which you take 1 tablespoon and pour 1 glass of boiling water. The resulting solution is infused for 30 minutes. After this, the infusion is poured into a bath filled with water at a comfortable temperature. It is recommended to take a bath 1 – 2 times a day for no more than 20 minutes. In addition, baths with the addition of antiseptic solutions are used, for example, with a weak solution of potassium permanganate (potassium permanganate). Potassium permanganate is available in the form of crystals, which are intended to be dissolved in water, since crystals are not used in their original form. To prepare the bath, several crystals of potassium permanganate should be dissolved in water so that the liquid turns pale pink. As a rule, it is recommended to use 10 crystals per 1 liter of water. The bright crimson color of the water should be alarming, since a high concentration of potassium permanganate can lead to burns. In addition, in order to prevent the development of burns on the skin, the crystals should be thoroughly dissolved in water to prevent direct contact of the potassium permanganate crystals with the skin.

Applications with ichthyol ointment or Vishnevsky ointment also have a therapeutic effect. Balsamic liniment according to Vishnevsky contains birch tar, castor oil and xeroform. It has antiseptic, anti-inflammatory effects, and also promotes the process of tissue regeneration. When treating bartholinitis, the ointment is applied to a gauze swab and applied to the sore spot. It is enough to perform this procedure once a day. In addition, it is recommended to apply a gauze swab moistened with a hypertonic solution to the inflamed area. To prepare this solution you will need 3 tablespoons of salt, which dissolve in 1 liter of water at room temperature. Apply a tampon soaked in the prepared solution to the inflamed area for 30 minutes. This procedure is performed 5–6 times throughout the day.

It is important to understand that all folk recipes do not exclude the use of medications, but only complement them. That is why it is extremely important not to self-medicate, including not to use traditional medicine without first consulting a doctor. When the first signs of the disease appear, you should immediately seek help from a doctor.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.