Symptoms, causes and treatment of Bartholinitis

Update: October 2018

It hurts in such an “interesting” place, which is not that difficult to walk,
but it is impossible to say to anyone – it is inconvenient. General weakness
the temperature goes overboard and one thing remains – to go “give up”
gynecologist.

Those who are familiar with these symptoms are well aware that
we are talking about the most unpleasant disease – Bartholinitis. Bartholinite
women fortunately are not so common and are diagnosed in
mainly in childbearing age.

Little anatomy

The threshold of the vagina is reliably protected by small genital
lips that are nothing but skin folds, but so
tender, that look like a mucous membrane. Outside small genital
lips cover large labia connecting at the top and bottom
spikes (front and back).

In the large lips of the lips there is fatty tissue and many
sweat and sebaceous glands, lips themselves intensively covered with hair
(secondary sexual trait). But besides the listed in depth
Bartholin glands (localized
rounded shape and dimensions not more than 1 cm).

The duct of glands (they are also called the large glands of the vestibule
vagina) is displayed at the entrance to the vagina, in the place where
is the hymen. Since both large and small shame
lips there are 2, respectively, large glands vestibule
vagina too 2.

The main task of the Bartholin glands is to produce a secret
which keeps the vaginal mucosa moist and
produces lubricant in moments of sexual arousal for
facilitate the introduction of the penis.

Bartholinite – what is it?

Bartholinitis is a disease of the reproductive sphere,
which is characterized by the inflammatory process in bartholin
gland due to penetration of infectious agents into it. how
Bartholin gland is usually involved in the process with only one
parties. As a result of inflammation, the parenchyma of the gland and its surrounding
the fiber is melted, an inflammatory capsule is formed
character with purulent content.

Why does bartholinitis occur?

The development of bartholinitis is due to infectious causes, then
there is an immediate entry of pathogenic microorganisms in
Bartholin gland.

  • Often the causative agents of the disease are infections that
    spread sexually. Most often it is gonococci and
    Trichomonas, less chlamydia.
  • But often Bartholinitis causes nonspecific microorganisms.
    from the discharge of pyogenic flora (streptococci, staphylococci and intestinal
    wand).
  • The fungal nature of the inflammatory process is not excluded.
    (Candida mushrooms).

But when diagnosing a disease, often not one stands out, but
several infectious agents, that is, bartholinitis has arisen
the result of an attack by an association of microorganisms. However, not all women
gonorrhea sufferers, or, for example, trichomoniasis, fall ill
Bartholinitis. For this you need the effect of provoking
factors:

  • weakening the body’s defenses (antibiotic treatment,
    hypothermia, chronic stress, vitamin deficiency);
  • the presence of chronic foci of infection (chronic tonsillitis or
    caries can serve as a starting point in the development of the disease –
    pathogenic microorganisms reach the Bartholin gland
    hematogenous way);
  • menstruation or the end of the second phase of the cycle;
  • microtraumas in the area of ​​the vestibule of the vagina and / or the labia
    (for example, during depilation);
  • wearing tight and tight underwear (squeezes out
    duct of the gland, due to which the secret is concentrated in the cavity
    glands and infected);
  • neglect of intimate hygiene rules;
  • promiscuous sexual intercourse (the risk of infection increases
    sexually transmitted infections);
  • gynecological intrauterine procedures or surgeries
    urinary tract in violation of the rules of asepsis;
  • inflammation of the urethra or vagina (urethritis,
    vaginitis), when the infection easily penetrates the excretory duct
    glands.

Of личного опыта: By роду своей деятельности
I often have to deal with this unpleasant sore.
The diagnosis of “Bartholinitis” can easily be made only by the way
the woman entered the office. Feet “raspberry”, gait duck, on
face grimace of pain. It is clear that it is very painful, not that
move around and even lie down. Of course, all patients go straight
sent to the gynecology for the opening of the abscess. I want to ask
and at the same time warn all women: “Why endure the pain? For what
hope?”. Bartholinite does not resolve itself, but when trying
home self-treatment will only “mature” faster and in any case
will have to go to the doctor. Therefore, at the slightest discomfort in
such a gentle intimate place should immediately run to the reception. And further.
No woman applied for an ambulance with an acute
Bartholinitis, due to the ticklishness of the situation, although cause an emergency room
can and should, especially with symptoms of intoxication and
inability to move.

how уже сообщалось, предрасполагает к возникновению заболевания
tight underwear. Now there are more and more fans of strings,
especially among young women and young girls. Give up on
similar “beauty” because besides mechanical inconvenience, wearing
String provokes the development of the disease.

  • First, they are too narrow and externally sexual.
    organs
  • D secondly, they are made of synthetic materials that do not give
    skin to “breathe.”

Bartholinite: classification

Depending on how the disease progresses, share
acute and chronic bartholinitis, which often recurs,
therefore, it is called recurrent. Acute process in turn
может быть в виде ложного и истинного абсцесса бартолиновой glands.
False abscess or canaliculitis is said to be inflamed.
the external duct of the gland, it becomes blocked, and inflammatory
exudate accumulates in the gland. With a true abscess in
the inflammatory process involves not only iron itself, but also
tissues that surround it.

Chronic bartholinitis develops due to untreated
acute process, after the spontaneous opening of the abscess. Sharp
the phenomena subside, but periodically the disease is exacerbated. When
хронического бартолинита формируется киста бартолиновой glands.

how проявляется бартолинит?

With Bartholinitis, symptoms are so characteristic that it is difficult
confuse the disease with anything else.

Canaliculitis

Inflammation of the Bartholin gland always begins with canaliculitis,
то есть с нагноения выводного протока glands. Celebrated
reddening of the skin over the nidus of inflammation and its swelling. In this
stages, many patients take bartholinitis for pimple and try
squeeze it out. At the same time from the excretory duct of the gland is allocated
one or two drops of pus, which are necessary for the tank. research. By
after some time the duct is blocked (pus is
a substance that tends to thicken and form a crust),
as a result, pus accumulates inside the Bartholin gland, it
stretched and formed the so-called “bump”, located
between the lower and middle third of the big lip. On
tumor formation is marked by hyperemia, and the skin is easily
is shifting. Since a false abscess forms a bulging big
shameless lips, then the entrance to the vagina is closed. Female patients
experiencing pain while walking, running or coitus, burning in the area
crotch The general condition suffers slightly, the temperature is not
rises above subfebrile numbers.

True abscess

With the introduction of pathogens into the gland tissue, as well as
pyogenic (purulent) occurs in the fiber that surrounds it
melting of the parenchyma of the gland to form a capsule, in which
pus is localized. Both small and labia swell up, and with
the unaffected side too, blush and sharply painful when walking, in
alone and when touched. The pain is so intense that the patient does not
can walk. Celebrated значительное повышение температуры тела
(above 38.5 degrees), signs of intoxication appear (weakness,
chills, dyspeptic disorders). Pain is consistent and
pulsating character. On examination determined by hyperemia of the genital
lips and puffiness, the skin above the abscess is hot to the touch, does not move,
and with palpation, fluctuation is detected (free movement
liquid contents in the outbreak of inflammation). In some cases
enlarged lymph nodes.

Chronic Bartholinitis

If you do not treat the acute process in a timely manner, it is transformed
in chronic form. In this case, the disease often recurs, and
recurrences are characterized by minor inflammation and pain.
Palpation of iron is somewhat compacted and sensitive.
Chronic Bartholinitis доставляет дискомфорт во время интимной
proximity. The longer the disease, the greater the chance
the formation of a Bartholin gland cyst as a result of accumulation in it
liquid content.

Diagnostics

Diagnostics заболевания достаточно проста. Bartholinitis diagnosis
can be delivered already at the first treatment of the patient to the doctor. AT
clinical minimum examinations include: OAK, OAM, smear on
vaginal microflora (see increased white blood cells in a smear), blood from
вены на ATИЧ-инфекцию и сифилис. AT обязательном порядке назначается
bacteriological seeding of either purulent discharge from the duct
glands or vaginal discharge for determination
infectious agent and its sensitivity to antibiotics. Of
Additional research methods prescribe a PCR smear for
detection of genital infections (chlamydia, genital herpes,
trichomoniasis, human papillomavirus).

Bartholinite: what to do?

When detecting Bartholinitis, treatment should begin immediately.
The earlier treatment is started, the better the prognosis of the disease. Simpler
just treat bartholinitis in the canaliculitis stage, whose therapy
can be carried out at home.

Antibiotics

For this purpose, antibiotics are prescribed for a duration of 7,
maximum 10 days. Onзначается лечение антибиотиками совместно с
imidazole group drugs that are effective against
anaerobes (metronidazole, tinidazole). Parallel and held
local therapy. Cold therapy offered by many sites
I consider it inappropriate. As applied to the inflammation site
ice will undoubtedly reduce pain due to deterioration
blood supply inflammatory site, but by doing so will reduce and
admission to the center of antibiotics.

Topical ointment treatment

Local therapy includes medicinal applications.
ointments:

  • levomekol;
  • мазь ATишневского;
  • Ichthyol

Ointments with Bartholinite have a warming property, that is,
improve microcirculation and lead to one of two options:
either the inflammation center resolves, or “comes to a condition”, then
there is before maturation (the appearance of fluctuations).

ATажно проводить и аппликации с растворами

  • Chlorhexidine;
  • Miramistin;
  • Hypertensive.

Solutions not only differ in antiseptic characteristics, but also,
improving the blood supply, draw out fluid from the site of inflammation,
thereby reducing swelling (swelling).

Onродные средства

Also in the local conservative treatment of bartholinitis can
use folk remedies. Of народных методов назначаются
warm sessile baths with decoctions of medicinal plants:

  • chamomile;
  • calendula;
  • coltsfoot;
  • St. John’s Wort and others.

You can instead use infusions of herbs weak solution
potassium permanganate or furatsillina.

Физиотерапия — после стихания острой фазы
терапию продолжают физиотерапевтическими методами (УФО, УATЧ).

Surgical treatment

When формирования абсцесса бартолиновой железы неизбежно
surgical intervention. The operation is also carried out at
chronic bartholinitis (Bartholin gland cyst). If a
a Bartholin gland abscess has formed, it is urgently opened
(the golden rule of surgeons: “where pus is cut there”) under a local or
general anesthesia. The wound is washed intensively with peroxide first.
hydrogen, then an aqueous solution of chlorhexidine or furatsillina. AT
the postoperative opening is entered a gauze turunda for a period of 5 –
6 days, that is, until the discharge from the wound becomes “clean” (without
impurities of pus).

Dressings are carried out daily, with the treatment of wounds with antiseptics.
In parallel, after opening Bartholinitis are assigned
antibacterial drugs of various groups:

  • macrolides (azithromycin);
  • cephalosporins (ceftriaxone, cefuroxime);
  • fluoroquinolones (ziprolet);
  • penicillins (amoxiclav).

Together with antibiotics appointed trichopol for a period of 7
days

In chronic bartholinitis and cyst formation, it is removed in
planned order in the “cold”, that is, without signs of inflammation,
period. To do this, use 2 methods. Either produce
марсупализацию кисты, либо удаление (экстирпацию) glands.

ATо время марсупализации киста вскрывается линейным разрезом, а
its edges are stitched to the wound edges of the skin, thus forming
false opening of the excretory duct. AT рану вводится катетер, чтобы
cyst contents flowed out, and by the end of the second month it
tapers and the tube is removed.

When extirpation reveal the inner surface of small shameless
the lips, the gland is husked by an acute way (scalpel) and removed, the wound
sewed up.

When диагностирования острого бартолинита (ложный или
true abscess) during pregnancy produce it immediately
autopsy. And when a Bartholin gland brush is detected, its removal
откладывают на послеродовый period. Acute Bartholinitis during
gestation is dangerous spontaneous abortion,
intrauterine infection of the fetus and preterm labor.

Пример из практики: У меня была пациентка лет
30, which with enviable regularity, 2 times a year came from
recurrence of the disease. And in a quiet time she did not have
cysts, no bartholin gland seals, but bartholinitis
relapsed steadily, every 6 months. Byсле первого вскрытия
ulcer and successful antibacterial treatment of a woman with
recovery was discharged home. But she did it again through
half a year Byсле второго раза вскрытия абсцесса пациентка по
recovery was sent to be examined for genital infections.
No infections were detected. Byсле третьего поступления в
gynecology department me this woman that is her
recurrent bartholinite made me wonder. Byсле очередного
successful anti-inflammatory treatment I sent her to
an immunologist. Immunologist, prescribing tests, revealed serious violations
immunity and prescribed appropriate treatment. Completed therapy
benefited the patient and the more she with relapses of the disease is not
addressed

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