Bartholin’s cyst: surgery, treatment withoutoperations

Update: October 2018 Bartholin cyst cyst sufficient
common pathology among young women 30 – 35 years. 
If education is small, it does not bother
woman and even remains not diagnosed. But in the case of
an increase in the size of the cyst appears characteristic complaints and arises
a lot of inconvenience – from discomfort during intercourse to impossibility
to live an active lifestyle. Therefore it is necessary to hold
timely and high-quality treatment of the Bartholin gland cyst.

From anatomy course

In anticipation of the vagina there are a large number
functioning glands, whose task is to protect the vulva from
infection and trauma, as well as moisture
sexual contact. The glands of the vulva constantly produce the secret
which not only moisturizes the external genitals, but also removes with
they are pathogens and various microparticles.

Among the glands of the vulva, the Bartholin glands play a huge role.
that are deep in the labia majora, mainly in
lower third of the vestibule of the vagina. Bartholin glands are paired
body, have a rounded shape and in the absence of pathology are not visible and
do not feel out In size, the Bartholin glands do not exceed 1.5 –
2 cm. The mouth of the excretory ducts of these glands are on the inside
the side of the labia minora.

What is it

With закупоривании выводного протока железы, вязкий и тягучий
the secret that it forms begins to accumulate in the gland,
stretching its walls, resulting in a cyst are formed –
cavity filled with secret.  Features of Bartholin cyst
glands:

  • can reach significant sizes (up to 7 – 8 cm);
  • are formed more often on the one hand (bilateral cysts is a phenomenon
    rare);
  • have a benign nature and do not degenerate into cancer;
  • do not affect the course of pregnancy and condition
    fetus;
  • do not violate the hormonal balance;
  • not inherited;
  • often recur.

Withчины и механизм образования

Withчинами формирования кисты служат либо ее инфицирование, либо
creating a mechanical obstacle in the excretory duct of the gland.

Infection of the gland can be caused by both specific
microorganisms and non-specific. To specific
pathogens include:

  • gonococci;
  • chlamydia;
  • Trichomonas;
  • ureaplasmas and other.

Representative nonspecific pathogens
conditionally pathogenic flora that are activated by
predisposing factors:

  • E. coli;
  • streptococci;
  • staphylococcus;
  • protei and others.

Predisposing factors

The following can provoke cyst formation
circumstances:

  • weakened immunity;
  • neglect of personal hygiene;
  • wearing close linen from synthetics;
  • the use of lubricants (clog gland ducts, and
    not only Bartholin);
  • wrong washing technique (procedure should be performed under
    water jet from front to back);
  • wearing tight clothes (tight jeans or pants);
  • bacterial vaginosis;
  • hypothermia of the lower half of the body;
  • promiscuous sex life (high risk of infection);
  • stress;
  • rough sex;
  • epilation in the bikini area (skin damage);
  • gynecological manipulations that damage the vaginal mucosa
    and vulva (abortion, hysteroscopy;
  • chronic gynecological (cervicitis, adnexitis, endometritis) and
    common diseases (tonsillitis, caries, pyelonephritis);
  • immunodeficiency states;
  • endocrine pathology (diabetes mellitus).

Education mechanism

With попадании инфекции в область наружных половых органов вульва
inflamed. Infectious process captures excretory canals
Bartholin glands, causing canaliculitis.  With этом выводное
the hole is clogged, and the secret produced by the gland begins
accumulate inside and form a cyst. If the contents of the cyst
abscess – gland abscess develops.

Perhaps the formation of cysts without the participation of pathogenic
microorganisms. In this case, the excretory closure occurs.
duct overgrown by surrounding tissues that is caused
mechanical damage to the mucosa and its subsequent healing
(hyperplasia or fibrosis).

Clinical picture

Bartholin gland cyst sizes can vary from
pea to chicken egg. Clinical picture развивается при
reaching an impressive size when a cyst begins to deliver
discomfort and breaks the habitual way of life. Small formations
asymptomatic and only in case of inflammation of the cyst
Bartholin gland complaints appear.

Large formations cause pain when moving (walking,
squats) and discomfort during sexual intercourse.

With гинекологическом осмотре выявляется асимметрия половой щели
– on the one hand, the large sexual lip is enlarged (a consequence
inflammatory edema). If the cyst is large, it is determined
a rounded body that rises above unchanged color
skin With пальпации образование безболезненно или чувствительно,
elastic consistency and agile (not soldered to the skin).

If an infection process prevails in a cyst, the clinical
picture is changing. Infectious agents penetrate the excretory duct
glands, causing inflammation in it – canaliculitis. Contraction occurs
duct, but it is not completely blocked, so when you compress
a few drops of pus are secreted in the inflamed area. At the patient
there are complaints of minor pain in the affected area,
a dense roller is felt in the labia minora and appears
redness of the orifice of the gland duct.

In the absence of a medical duct fully stenoses
(closes) and pus outflow becomes impossible. is he
begins to accumulate inside the duct, pushing the gland aside, which
called a false abscess. Characteristic clinical development
picture: sharp pain when moving and touching the labia, their bright
hyperemia and edema, symptoms of intoxication. False abscesses are often
spontaneously opened and emptied, as a result, patients do not
See a doctor. But in process of healing of the opened abscess
the inflammatory process goes into the category of chronic and
sluggish, which leads to the final clogging of the excretory
duct and secondary cyst formation.

If the infection affects the Bartholin gland tissue, then
ее гнойное расплавление – формирование истинного абсцесса  с
pronounced symptomatology (sharp and throbbing pain, enormous
sizes up to 10 – 15 cm, hyperemia, intoxication).

Diagnostics

Diagnose: “Bartholin gland cyst” for a doctor not
presents difficulties. Primary gynecological examination
confirms suspicion (characteristic round and elastic
education, mobile and slightly painful on palpation).

Assigned laboratory tests:

  • vaginal smear;
  • general blood and urine tests;
  • blood biochemistry;
  • PCR diagnostics (detection of hidden genital infections);
  • bacterial seeding of educational contents to determine
    pathogen and determine its sensitivity to antibiotics.

Treatment

Tactics of treatment is determined by the size of education, the presence
complaints and possible complications. If the cyst is small, no more than 2
cm, the preference is given to dynamic observation. Often
small cysts resolve themselves. Bartholin’s cyst
glands can be eliminated without surgery in two cases:

  • the initial stage of inflammation – canaliculitis, when the process
    captured only the duct of the gland, and the gland itself is not inflamed;
  • small size (up to 3-4 cm) cysts in the “cold” period (no
    inflammatory signs).

Conservative therapy includes:

  • Exercise limit

In the case of canaliculitis, the patient is advised to move less.
(walk, run), because the movements are even more traumatic
sore lip and aggravate inflammation.

  • Cold on the crotch

Ice warmer wrapped with a cotton towel
apply to the inflamed labia for 20-30 minutes, making
breaks of 20 minutes. Cold constricts the blood vessels that
prevents further spread of infection and reduces
swelling at the site of inflammation. In addition, exposure to cold
eliminates pain during inflammation.

  • Local procedures

They have an anti-inflammatory effect. Recommended
take sessile warm baths with disinfectants
(solution of potassium permanganate, chlorhexidine or miramistin). Baths
take 10 – 15 minutes 4 to 6 times a day. You can also
Inflamed area impose lotion with a solution of cooking
salt (3 tablespoons of salt dissolved in a liter of warm water).
Lotions are applied for 20 to 30 minutes every 6 hours. Allowed
use of ointment applications with levomecol
(anti-inflammatory effect). But applications with ichthyol or
Vishnevsky ointment absolutely can not be applied. Ichthyolum and ointment
Vishnevskogo have a warming effect and only strengthen
inflammation (the transition of canaliculitis to abscess), so they are prescribed
before planned surgery for accelerated
ripening abscess.

  • Antibiotics

In the tissues of the vulva the blood network is well developed, therefore
the infection spreads very quickly. The earlier assigned
antibiotic therapy, the lower the risk of canaliculitis transfer to
suppuration of the gland. Until the results of the tank. seeding cyst contents
broad-spectrum antibiotics are prescribed (fluoroquinolones,
cephalosporins, macrolides, penicillins). If necessary, by
analysis results, a change of antibiotics. A course of treatment
standard and is 7 days.

  • Nonsteroidal anti-inflammatory drugs

Recommended прием ибупрофена, индометацина и других НПВС.
These drugs not only reduce inflammation, but also have
analgesic effect. Other types are assigned as required.
analgesics and antispasmodics.

  • Immunomodulators and desensitizing drugs.

To strengthen the immune system appointed Viferon, tincture
eleutherococcus, echinacea tincture, thymalin and others
immunomodulators. Antihistamine (antiallergic) drugs
reduce swelling and itching (suprastin, claritin).

  • Physiotherapy

Conducted with the relief of acute inflammatory process (UV
and UHF, magnetic therapy and infrared laser irradiation).

Folk methods medicine

Folk remedies are used simultaneously with the therapeutic
treatment. is heи помогают снять отек и уменьшить воспаление, а также
stimulate immunity.

Recipes for immunity:

  • 1 recipe

Grind 100 – 150 gr. walnuts, a teaspoon of dill
seeds and 3 – 4 cloves of garlic in a blender. Mix with half a liter
liquid honey and insist 2 – 3 days. Mixture take 2 tea
spoons three times a day before meals.

  • 2 recipe

Grind 200 gr. aloe leaves (about 20 pieces) and mix with
half a liter of honey and half a liter of red dessert wine. Received
Mix the mixture and cook in a water bath for about an hour. Then
strain the mixture and take 2 teaspoons three times a day before meals.
Mixture stored in the refrigerator.

  • 3 recipe

Prepare a decoction of valerian root, pine buds, nut
leaves and herbs of grass (1 tablespoon of each plant per liter
boiling water, boil for 10 minutes, then insist 4 hours). Decoction
strain and drink 1/3 cup twice a day.

For local treatment:

  • warm baths of healing herbs (chamomile, calendula,
    eucalyptus);
  • infusion of nettle, yarrow and elderberry (in a tablespoon
    each herb pour 3 cups of boiling water, insist 2 hours) –
    use for sedentary baths;
  • flowers of camomile and marigold pour boiling water, insist
    2 – 3 hours, strain and hold warm sit-down trays.

Surgery

Surgical treatment of this pathology is carried out in the case of:

  • significant cyst sizes that cause discomfort and
    breaks a habitual way of life;
  • the occurrence of an abscess (the operation is carried out on emergency
    indications);
  • periodic cyst inflammation that requires carrying
    conservative therapy;
  • at the request of the patient (education causes psychological
    the discomfort).

In the presence of a Bartholin gland cyst developed and actively
several surgical techniques are used.

Marsupialization cyst

The most popular operational technique is
marsupialization cyst. It is performed under local anesthesia. Cavity
cysts is opened and its contents are evacuated. Then the cavity
treated with antiseptics, and the walls of the formation are hemmed to the edges
wounds so that the mouth of the newly formed
excretory duct. Such an operation makes it possible to save
functioning bartholin gland. The operation is carried out
outpatient and lasts about half an hour.

Peeling a cyst

Peeling a cyst достаточно сложная и травматичная операция,
which requires hospitalization and is performed under general anesthesia.
Capturing and lifting the skin with tweezers of the labia minora is produced
neat cut, not touching the capsule formation. Cyst neatly
expelled from adjacent tissues entirely. But its gap is possible,
which complicates the healing of postoperative wounds. Also great
risk of large blood loss. Then the bed of education in layers
sutured. The recovery period is long, up to 3-4 weeks.
Postoperative scar can cause skin pain and pain.
disrupt the appearance of the vulva. The advantage of this operation is
impossibility of re-formation of a cyst.

Laser vaporization

Unfortunately, the vaporization of a cyst with a laser is not carried out in each
clinic – the method requires special equipment. The essence
operation is to convert the laser light energy at
contact with damaged tissues in heat. Due to
what evaporates (vaporizes) cystic contents and
release of the blocked duct. And under the influence of laser
cystic cavity collapses and sclerosed.

Advantages of the method:

  • high accuracy: the laser effect only affects
    damaged tissues, without touching or injuring healthy ones;
  • bloodlessness: laser radiation immediately burns blood vessels,
    preventing bleeding;
  • painless: laser burns nerve endings;
  • regulation of the depth of penetration of the beam and its power;
  • speed: the procedure lasts from 5 to 20 minutes (depending on
    cyst size);
  • hospitalization is not carried out;
  • lack of cosmetic defects after treatment;
  • preservation of the Bartholin gland;
  • the risk of relapse is practically nil.

Installing a Word Catheter

Word catheter is an American novelty. The catheter looks like
a thin silicone tube that has a small balloon at one end.
The balloon can swell to several centimeters .. Above the pole
кисты производится маленький разрез примерно  3 – 5 мм,
the contents of the formation are removed, and the cavity of the cyst is washed
disinfectant solutions. A catheter is inserted through the incision into the cyst.
and inflate his balloon, which prevents the catheter from falling out of
cystic cavity. Wearing a vord catheter for a long time, up to 5 – 6
weeks, during this period, a new excretory
duct. The catheter is then removed. After removing the silicone tube
the walls of the resulting outflow channel can no longer grow together (they
covered with new layers of epithelium).

Manipulation is performed in 10 – 12 minutes. Similar treatment
carried out only in the “cold” period and requires compliance
sexual rest during the whole time of wearing catheter. Risk
relapse is minimal, not more than 10%.

Cyst puncture

Puncture of a cyst has only a temporary effect. Skin over
the formation is anesthetized with local anesthetics, and then fine and
long needle pierce the cyst. Content drained. Similar
The technique is used during pregnancy, when it is impossible
perform another surgery. After puncture
after a while the cyst forms again (ductal patency
not restored).

Piercing cysts

It is also a relatively new treatment method. Principle
методики совпадает с установкой ворд-catheter. Only instead
A silicone tube is inserted into the incisions above the cyst ring. With
piercing of education is created immediately 2 channels, which reduces
the probability of relapse is 2 times. The procedure is not painful and not
brings inconvenience when wearing a ring.

Gland extirpation

The operation “extirpation of the gland” means its complete
deletion. This is a radical method and is performed with inefficiency.
other operational techniques.

Disadvantages and risks of extirpation of the gland:

  • requires hospitalization;
  • performed under general anesthesia;
  • increases the risk of bleeding during surgery;
  • the formation of postoperative fistula or
    hematoma;
  • requires the imposition of internal and external seams;
  • expensive operation.

The positive point of this operation is 100% – guarantee
recurrence (no gland – the possibility of formation
cysts). But the removal of the gland significantly reduces the quality of intimate
life, especially in young women (dry vagina, lack of
lubrication, trauma to the perineum and pain during sexual
act).

Postoperative period

After prompt removal of a cyst, it is necessary to undergo
postoperative treatment, which includes:

  • antibiotics;
  • anti-inflammatory drugs;
  • applying cold to the wound in the first hours and days after surgery
    (relieves pain, reduces swelling);
  • treatment of seams 2 – 4 times a day with antiseptics;
  • dressings with levomecol (wound healing and anti-inflammatory
    act);
  • physiotherapeutic procedures (in 1 – 2 weeks after
    operations).

Further (the next 4 weeks) it is necessary to observe a number
recommendations:

  • sexual rest;
  • refusal of bathing and visiting baths and saunas;
  • wearing non-cotton underwear;
  • intimate hygiene.

Question answer

Вопрос: У меня киста бартолиновой железы около 3-х
see no worries. Do I have to delete it?

If there are no complaints and there are no signs of inflammation, then you can
observe education, but with the passage of the course
antibiotics and anti-inflammatory therapy.

Вопрос: Я планирую беременность, сдала все
analyzes. The gynecologist discovered in me a Bartholin gland cyst about
5 cm in diameter. What to do?

Before conception, it is necessary to get rid of a cyst, and operational
by. During pregnancy, it may fester (decrease
immunity), which will require emergency surgery and appointment
antibiotics are not always safe for the fetus.

Вопрос: Когда снимают швы после operations по поводу
Bartholin gland cysts?

Stitches are removed for 6 – 7 days.

Вопрос: Какие существуют противопоказания для
surgical treatment of vulvar cysts?

The operation is not performed in case of acute or exacerbation of chronic
process of the urogenital system and skin diseases in the field
crotch

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