The large vestibular glands, also called Bartholin’s glands, are a pair of organs, about 0.5 cm in size, located in the lower 1/3 of the vaginal vestibule, lateral to the bulbocavernous muscle. In the absence of an inflammatory process, the glands are not palpable. Bartholin’s glands have an excretory duct about 2-2.5 cm long that opens into the vagina. Characteristic of the large vestibular glands is that they produce mucus, which serves as a natural lubricant for the vagina. It has been found that in 2% of women of reproductive age, and more precisely in those between the ages of 20 and 30, obstruction of the drainage duct of the glands occurs. The result of this obstruction is a collection of mucus and the formation of a retention cyst. The reason for the formation of a Bartholin’s cyst is the contamination of the draining channels located in the vaginal vestibule. Non-spore-forming anaerobes of the Bacteroides fragilis species, representatives of the Peprostreptococcus genus, are isolated as the causative agents of the infection, but also bacteria of the Streptococcus genus, Staphylococcus, E.coli, etc. are found. Among the causative agents of acute bartholinitis are bacteria that cause sexually transmitted diseases – Neisseria gonorrhoeae. The formed Bartholin’s cyst can be asymptomatic or manifest with severe pain, chills, dyspareunia, inability to sit. The face has all the characteristics of inflammation – swelling, pain, redness, warmth and impaired function. As the infection progresses, an abscess may develop. Making a diagnosis is easy – during a gynecological examination, a painful, swollen and reddened mass is clearly visualized. In asymptomatic patients, the cyst may be small, painless and not cause unpleasant sensations. In severe infection, regional lymphadenitis develops. In postmenopausal women, examination of cyst material is mandatory because of the risk of vulvar carcinoma. Treatment of Bartholin’s cyst or abscess is a combination of medical and surgical treatment. It is necessary to prescribe antibiotic therapy – broad-spectrum antibiotics that cover both Gram (+) and Gram (-) bacteria are used. In the case of purulent discharge, material is sent for microbiological examination, after which the therapy is adjusted according to the antibiogram obtained. Symptomatically, antipyretics and analgesics are prescribed, which control the febrile-intoxication syndrome and pain. Asymptomatic patients do not need conservative therapy. Large, painful and recurrent Bartholin’s cysts or abscesses require surgical treatment. Bartholin’s gland extirpation is used for frequently recurring cysts. In this intervention, an incision is made through which the capsule of the cyst is removed, as well as the Bartholin’s gland itself. In the case of purulent content of the cyst, a drain is placed. A method with a fairly good result and a low risk of recurrence is the so-called marsupialization – a surgical intervention that is performed under short-term intravenous or local anesthesia and consists in opening the cyst,evacuation of the contents and suturing the edges of the cyst to those of the vagina. Inflammation of Bartholin’s glands is a very painful and unpleasant condition that disrupts the performance of normal daily activities and needs timely treatment.
Leave a Reply