Bartholinitis: diagnosis, symptoms, causes and treatment

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Bartholinitis: definition

Bartholinitis refers to localized inflammation of the Bartholin gland. It is a fairly common vulvar pathology, which can manifest as cysts or abscesses.

This Bartholin gland takes its name from the Danish anatomist Gaspard Bartholin. They are in fact two hormone-dependent glands, responsible in particular for vaginal lubrication. Its shape is flattened and elongated and it measures approximately 10 to 15 mm.

The two Bartholin glands are located in depth, close to the vestibule, and surround the hymenal ring (vaginal opening) on ​​both sides. They are vascularized thanks to several arteries (bulbar and perineal) and a complex venous network.

Bartholin’s glands are retained by the constrictor muscle of the vulva; their excretory duct eventually ends up between the labia minora, near the hymen. The size of these glands quickly increase in size after puberty and tend to decrease in size with menopause.

The function of Bartholin’s glands is to lubricate the vagina continuously, thanks to their secretions, especially during sexual intercourse. When inflamed, Bartholin’s glands can be the site of infection.

In rare cases, their removal is sometimes necessary, especially in cases of recurrent Bartholinitis. This does not, however, prevent the vagina from being lubricated by other vaginal glands under the influence of estrogen.

What are the symptoms of Bartholinitis?

Bartholinitis is characterized by acute pain localized in the vagina. It can also be accompanied by redness or a feeling of heat in the same area.

The medical diagnosis will validate the presence of a firm lump (a cyst or an abscess) during a palpation. This diagnosis is confirmed by the clearly visible presence of swelling in the vulva and perineum.

This swelling is responsible for a throbbing pain and a red, hot deformity.

Which are the symptoms of Bartholinitis?

Bartholin’s gland infection comes from germs of vaginal origin (sexually transmitted): mycoplasmas, chlamydia or even gonococcus. The infection then goes up through the canal.

But Bartholinitis can also be of digestive origin and caused by Enterobacteriaceae. Moreover, Bartholin gland abscesses are mainly caused by bacteria of digestive origin and less often by STIs.

In reality, STIs such as chlamydia or gonorrhea are mainly responsible for Bartholinitis in co-infection with HIV. It can also be a complication of vulvovaginal surgery.

In other situations, a cyst forms near the excretory duct or the gland itself, resulting in superinfection. This cyst can be caused by an obstruction in the excretory duct and can also be caused by a congenital stenosis.

Some doctors also cite the trauma of childbirth or the episiotomy as possible causes of Bartholinitis.

Diagnosis and examination

Only a clinical examination ensures a reliable diagnosis. It will allow in particular, thanks to samples, to look for possible STIs (syphilis, chlamydia, gonorrhea or others) as causes of Bartholinitis.

These samples are particularly indicated for people at risk, including young women or who have several partners. The search for germs is sometimes necessary in the partner, depending on the nature of the germ found during the samples.

What are the treatments for Bartholinitis?

The first-line treatment is based on a surgical examination of the abscess. For this, an incision is necessary at the level of the vestibular mucosa, vertically, in the nympho-hymenal groove.

An incision at the level of the protruding dome of the Bartholin gland is also possible. When the abscess already has fistulas, the surgery will consist of enlarging the drainage hole sufficiently.

A bacteriological sample of pus (after incision of the vestibular mucosa) should also be taken. After widely opening the abscess, abundant cleaning of its cavity is carried out using an antiseptic solution.

Drainage will be in place for 24 to 48 hours using an iodoformed wick or a Delbet type blade.

In order to limit the risk of recurrence, marsupialization can be performed: this is a surgical technique aimed at draining the cyst or abscess. It consists of suturing the wall of the abscess to the surrounding vestibular mucosa.

However, marsupialization has the disadvantage of increasing the risk of pain during healing. Antibiotic prophylaxis is usually performed during surgery by intravenous injection.

After the operation, the prescription of analgesics is recommended. The patient can then be discharged after 24 to 48 hours following the operation. Convalescence is organized around nursing care, which ensures proper healing of the drainage opening.

The rate of recurrence of Bartholinitis is estimated at 10 to 15% after a first episode. When they recur too frequently, removal of the Bartholin gland may be considered.

Evolution and possible complications

Generally, Bartholinitis is a benign pathology, which progresses favorably, when it is correctly treated. The main complication is recurrence, in 5 to 15% of cases, despite drainage or marsupialization.

In the event of too frequent recurrence, an ablation of the Bartholin gland may be proposed.

In 5% of cases, hematomas can occur after surgery, but also sepsis, and in the long term dyspareunia (pain during intercourse) or chronic pain.

What to remember about Bartholinitis

Bartholinitis is most often benign but is a frequent reason for consultation. A clinical examination is necessary and the treatment is surgical, in order to drain the abscess of the Bartholin gland.

Antibiotics are often given in conjunction with surgery. When treatment is done correctly, complications from Bartholinitis are rare. The evolution is therefore most often favorable.

The main risk is recurrence.

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Bartholinitis: diagnosis, symptoms, causes and treatment

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