Bartholinitis • Treatment according to severity

Bartholinitis is an inflammation of the Bartholin glands, which are located at the vaginal entrance. The main symptoms of Bartholinitis are swelling, redness, and pain. When bartholinitis requires surgery and how you can prevent it.

Symptoms of bartholinitis include pain, redness, and swelling.
© Getty Images / Doucefleur

In Bartholinitis, the so-called Bartholin’s glands (glandulae vestibulares majores) are inflamed. These roughly bean-sized glands are located in the back third of the labia majora. The ducts run towards the inner surface of the labia minora. Sexual arousal causes the glands to produce a secretion, thus keeping the vagina and vulva moist.

At a glance:

Wellness tips for the vagina

Wellness tips for the vagina

What is Bartholinitis?

Bartholinitis is inflammation of the Bartholin glands and their ducts. In Bartholinitis, only the duct of the Bartholin’s glands is actually inflamed, but this can spread to the glandular body. Inflamed Bartholin’s glands lead to swelling of the excretory duct, which consequently sticks together. The accumulated secretion is then a good breeding ground for bacteria. If pus collects and causes swelling, this is also known as Bartholin’s empyema or Bartholin’s empyema. If this spreads further, it is called a Bartholin’s abscess. The Bartholin cyst must be distinguished from this. It can occur when the ducts to the gland are blocked and fluid, usually mucus, builds up. Cysts are usually not painful.

Around three out of a hundred women will suffer from a Bartholin cyst, a Bartholin abscess or a Bartholin empyema at some point in their life.

bartholinitis anatomy

© onmeda

Recognizing bartholinitis: symptoms

Redness, pain, and swelling of a large labia are the first signs of bartholonitis. The swelling can be the size of a chicken egg. However, the pain is often so severe that the affected woman can no longer sit, and problems can also arise when walking. A general feeling of illness is also possible. Headache and body aches, loss of appetite and fatigue can occur.

The Bartholin’s cyst, on the other hand, is hardly tender on pressure. It feels plump and spherical and can take on the size of a chicken egg. In contrast to acute inflammation, reddening and overheating are in the background.

Bacteria cause bartholinitis

Bacteria that colonize the vaginal vestibule can invade the ducts of the Bartholin gland and cause bartholinitis.

The posterior area of ​​the vaginal vestibule, into which the excretory ducts of the Bartholin glands open, is naturally colonized by many different bacteria. Germs that penetrate such a duct can trigger Bartholinitis and lead to Bartholin’s abscess. The respective pathogen can only be precisely determined from the inflammatory secretion.

Bacteria that can cause bartholinitis:

  • E. coli bacteria: They are natural inhabitants of the intestine. They almost only make you sick when they are carried off to parts of the body where they normally do not occur. They are often found in urinary tract infections and wound infections.

  • Staphylococci: They are found on the skin and mucous membranes of many people. Most germ carriers do not get sick. If the pathogens penetrate, for example, on hair or in the case of injuries through the skin, they cause inflammation that forms a lot of pus.

  • Streptococci: Most streptococci are part of the natural colonization of the human skin. Group A streptococci can cause, among other things, purulent tissue inflammation.

  • Chlamydia: They also cause inflammation of the cervix, urethra or fallopian tubes. It is usually transmitted through sexual contact. In men, the urethra is mostly affected. Chlamydia can also cause inflammation of the eye through other routes of infection.

  • Gonococci: The infection almost always occurs through sexual intercourse. Gonorrhea, also called gonorrhea, is the result. In women, bartholinitis can be the only symptom of gonorrhea.

Myths and Facts About the Vagina

Myths and Facts About the Vagina

Bartholinitis is usually diagnosed quickly

In the case of acute bartholinitis, a visual diagnosis is usually sufficient. If inflammatory secretion escapes, it is examined in the laboratory for the exact pathogen.

Often the swelling is so painful that, in the woman’s favor, a palpation examination is dispensed with. In order to make a differentiated diagnosis, however, it is sometimes necessary to feel the swelling. A Bartholin’s cyst (accumulation of secretions without inflammation) is hardly tender on pressure, in contrast to an abscess. Therefore, a palpable finding is made before the operation.

Treatment of Bartholinitis

In the early stages, bartholinitis can be treated with pain reliever and anti-inflammatory agents. Topically applied ointments with diclofenac, hip baths with chamomile and compresses are initially the means of choice.

In the further course, antibiotics can subside a Bartholinitis from which an abscess has not yet developed. In the advanced stage, when pus is already forming and collecting, the drugs do not reliably penetrate the bacteria in the pus foci. Nevertheless, every person affected receives antibiotics. Because the focus of inflammation should remain as small as possible and no bacteria should spread into the body. If the exact pathogen is known from the wound secretion, the antibiotic can be used in a targeted manner.

Surgery for advanced bartholinitis

At an advanced stage, surgery is the method of choice.

During the procedure, the mouth of the Bartholin’s gland duct is cut open two to three centimeters. Then the pus cavity is opened and emptied. In the second step, the so-called marsupialization takes place. The edge of the wound cavity is carefully folded outwards and fixed with a suture so that an opening about two centimeters is retained. Marsupialization and drainage prevent the wound edges from sticking together. With this procedure, the function of the Bartholin gland is preserved. The stitches are removed after a few days and the wound is usually completely healed within four to six weeks.

As with all infected wounds, one strives for open wound healing after the operation of a Bartholin empyema. This means that the edges of the wound are not sewn together so that the wound secretion can drain away. The drainage leads the liquid to the outside through the opening obtained.

Daily hip baths clean and moisten the wound cavity. The body’s own wound cleaning and healing should be supported and the edges of the wound prevented from sticking together. Usually, after ten to 14 days, the wound will heal so far that the drain can be removed. The sutures are usually pulled about a week after the marsupialization – otherwise the treatment proceeds as described.

Prevent bartholinitis with proper hygiene

Condom use and good personal hygiene are likely to reduce the risk of bartholinitis. Because bacteria that have been carried into the ducts of the Bartholin glands are the cause of the disease. To prevent this, women should wipe from front to back when using the toilet.

Too frequent and intensive washing or the use of intimate sprays can damage the natural skin bacteria and thus promote pathogenic germs. It is sufficient to rinse the skin area thoroughly with water. This maintains a healthy vaginal environment.

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