Bartholin’s Gland Inflammation – Symptoms and Treatment

Disease Definition. Causes of the Disease

Bartholinā€™s gland inflammation is an inflammation of the vaginal gland that produces lubrication, also known as the Bartholin gland. These glands are paired and located within the thickness of the labia majora, about 1 cm in size, with their ducts opening into the vaginal area (vaginal entrance) at 5 and 7 oā€™clock positions. The diameter of these ducts is very small, about 1 mm.
Device Features: The main function of the Bartholin gland is to secrete a small amount of viscous lubricating substance in response to sexual arousal. The secretion of this gland is necessary only to lubricate the small labia and the vagina at the beginning of sexual intercourse. The main source of lubrication during intercourse is vaginal secretions.

Bartholinā€™s gland inflammation mainly occurs in women of childbearing age, averaging 2%, between the ages of 20-30, and less so around menopause. The disease rarely occurs in girls before puberty. For example, there have been reported cases, including that of a seven-year-old girl suffering from an abscess in the Bartholin gland. Based on the results of a study involving 430 women without clear symptoms of the disease, a cyst was found in the Bartholin gland of one in every 30 participants, exceeding the previously published figure of 2% prevalence of the disease among visits to gynecologists.

Causes of Bartholinā€™s Gland Inflammation

Bartholin gland inflammation is often caused by conditional pathogenic microorganisms living in the pit area: staphylococci, streptococci, and coliforms. The latter is the main cause of the disease, being detected in 18% of cases. Sexually transmitted diseases can sometimes cause Bartholinā€™s gland inflammation, such as syphilis and chlamydia. In addition, cases have been recorded where Streptococcus pneumoniae and Neisseria sicca were the cause of Bartholinā€™s gland inflammation, which also cause meningitis, nerve inflammation, pneumonia, and spine inflammation. The exact reasons for the development of Bartholinā€™s gland inflammation are still unknown.
Risk Factors: General immune system suppression in addition to the unclear anatomical characteristics of the gland and its duct.

Symptoms of Bartholinā€™s Gland Inflammation:
When Bartholinā€™s gland inflammation develops in women, there is swelling at the bottom of the labia majora, and a circular formation appears in this area that can reach a size of 6-8 cm, but most often it is 3-4 cm. The formation is extremely painful, hard, and tense. It may be warm to the touch. The patient suffers from severe pain when moving. In some individual cases, there may be a rise in body temperature to 39 degrees.
Cysts in the Bartholin gland are painless and not tense, and they can reach very large sizes, extending along the labia majora to the pelvis. Most often, cysts only cause cosmetic discomfort and may interfere with sexual activity.
Bartholinā€™s Gland Inflammation During Pregnancy:
Bartholinā€™s gland inflammation can occur during pregnancy. Inflammation develops in the same way as in other cases.

Classification and Stages of Bartholinā€™s Gland Inflammation:

Diseases of the Bartholinā€™s Gland can be classified as follows:

  1. Primary Stage (Canaliculitis) ā€“ Appearance of bloody secretions from the Bartholinā€™s gland duct, with localized pain at the vaginal entrance. This stage is often overlooked.
  2. Bartholinā€™s Gland Inflammation ā€“ Acute inflammation of the Bartholinā€™s gland without swelling of surrounding tissues.
  3. Bartholinā€™s Gland Abscess ā€“ Acute inflammation of the Bartholinā€™s gland with swelling of surrounding tissues and abscess formation.
  4. Bartholinā€™s Gland Cyst ā€“ A stretched duct of the Bartholinā€™s gland containing varied content (pus, fluid, blood).

According to the nature of disease progression:

  • Acute Bartholinā€™s Gland Inflammation.
  • Chronic Bartholinā€™s Gland Inflammation with recurrent episodes.

Complications of Bartholinā€™s Gland Inflammation:

  • The spread of the inflammatory process to surrounding fatty tissues surrounding the Bartholinā€™s gland can be a serious complication of Bartholinā€™s Gland Inflammation. Blood poisoning can rarely develop in cases of weakened immune system individuals.
  • Recurrent episodes of Bartholinā€™s Gland Inflammation can also be considered a complication, as inflammation of this gland can occur up to 10 times a year in some cases.
  • The main complication of Bartholinā€™s Gland Cyst is the occurrence of inflammation within it, leading to Bartholinā€™s Gland Inflammation with appropriate ramifications. In itself, the cyst may only cause cosmetic discomfort and may interfere with sexual and sports activities.

Diagnosis of Bartholinā€™s Gland Inflammation:

Diagnosing Bartholinā€™s Gland Cyst is not complicated. A non-painful and non-tense circular formation can be palpated within the thickness of the labia majora. Externally, the labia majora may be swollen, and the cyst piece may partially block the vaginal entrance. Compared to the cyst, the formation in Bartholinā€™s Gland Inflammation is painful and tense, and when an abscess forms, the skin above the formation becomes immobile, and the formation itself becomes hard and warm to the touch, intensely painful to the point of being impossible to touch. Enlargement of the inguinal lymph nodes may occur.

However, a detailed diagnosis should be performed to rule out diseases similar in appearance to Bartholinā€™s Gland Inflammation, such as lipomas, folliculitis, and some other conditions.

Recommended Examination:
To assess the formation, an ultrasound examination of this area is recommended, which can be performed using a regular vaginal probe. On ultrasound, the Bartholinā€™s Gland Cyst appears as a thin-walled cavity, there may be compartments, but the content is homogeneous, ā€œtransparent,ā€ and the inner boundary is straight. In the case of Bartholinā€™s Gland Inflammation, the cyst walls are thick, the inner boundary is not straight, and the content is not homogeneous.

Treatment of Bartholinā€™s Gland Inflammation:

Bartholinā€™s Gland Inflammation usually progresses rapidly. The disease is rarely diagnosed at the stage of canaliculitis ā€“ the primary inflammation of the gland duct. Patients often notice the disease when Bartholinā€™s Gland Inflammation has already occurred, meaning the stage where pus accumulation in the duct leads to swelling of the labia majora.

Is treatment of Bartholinā€™s Gland Inflammation necessary?

Treatment is necessary to avoid complications ā€“ the spread of the inflammatory process to surrounding fatty tissues surrounding the Bartholinā€™s gland.

Conservative treatment of Bartholinā€™s Gland Inflammation:
Surgery is not necessary in every case of Bartholinā€™s Gland Inflammation. In the primary stage, antibiotic therapy is recommended using broad-spectrum antibiotics. Topical application of Vishnevsky ointment or Levomycetin is applied locally. The outcome of this treatment may either result in improvement of the inflammatory process with cyst formation, or conversely, exacerbation of the process sharply, and in some cases, the wall bursts and part of the pus is expelled naturally.

In which cases should you consult a doctor urgently?

If an abscess is present in the gland, surgical treatment of Bartholinā€™s Gland Inflammation is necessary ā€“ immediate incision, preferably under intravenous anesthesia because local anesthesia in the presence of inflammation does not provide adequate anesthesia.

After incising the abscess, the abscess cavity is washed with antiseptic solution and a rubber drain with antibiotic ointment is placed. The pus content is sent for culture, and a polymerase chain reaction (PCR) analysis is performed to detect gonococci and/or chlamydia, which may also be a cause of inflammation. Daily changes in the dressing are made with drain replacement.

The result of this treatment is to stop this temporary inflammatory condition, but ultimately the gap will heal. As a result, a cyst may form or a new case of Bartholinā€™s Gland Inflammation may occur. This depends partly on the effectiveness of antibiotic therapy.

The main goal of treating Bartholinā€™s Gland Cyst is to create a permanent opening to facilitate the outflow of gland fluid, i.e., forming a new duct in the place of obstruction.

The following methods for creating the new duct are included:
Marsupialization for bartholinitis:

In cases of recurrent episodes and inability to insert a Word catheter, complete excision of the gland can be performed. This is a complex and lengthy operation, performed under general anesthesia, with a significant risk of blood loss. The main difficulty in this operation lies in the fact that the gland is closely associated with the cavity of the labia majora, which can cause severe bleeding if damaged. Recovery after this operation takes a long time, up to 10-14 days.