Bartholinitis is a relatively painless enlargement of a gland in the vaginal area. Infections cause inflammatory abscesses, which are easy to remove in most cases.
What is bartholinitis?
Bartholinitis affects the Bartholin glands located on both sides of the entrance to the vagina. They produce fluid on the mucosa of the (inner) surface of the labia majora to secrete (i.e., moisten) the vagina. In the process, the openings of these glands sometimes become blocked, causing fluid to leak back into the gland. The resulting Bartholinitis is a swelling (cyst), up to the size of a chicken, in the lower part of the labia. In the case of infection, an inflammatory abscess forms, which must be treated. Bartholinitis is common, especially in younger women under 30.
Causes
Experts believe that the cause of bartholinitis is a buildup of fluid in the glands. Secretions can accumulate especially when the opening of the gland (duct) is obstructed by skin folds or due to infections. These are caused by various bacteria. Bartholinitis, for example, is caused by intestinal bacteria such as Escherichia coli, which can enter the vaginal area due to improper hygiene. Infection with Neisseria gonorrhoeae, bacteria that cause gonorrhea, or with Chlamydia trachomatis can also lead to bartholinitis. Chlamydial infections in particular often go undetected in women because there are hardly any symptoms. However, the bacteria nest intracellularly where, as energy parasites, they can cause chronic inflammation such as bartholinitis. Due to favorable climatic conditions or a weakened immune system, the bacterium Staphylococcus aureus, which is present in the body in up to 30% of people, can also spread and cause bartholinitis.
Symptoms, complaints and signs
In bartholinitis, painful inflammation occurs primarily in the lower third of the labia minora or labia majora. These swellings usually occur on one side only and are very (pressure) painful. Affected individuals experience pain especially when sitting or walking, which can increase in intensity as the disease progresses. Sometimes there is redness and itching in the affected area. A possible accompanying symptom is fever, which is manifested by sweating, fatigue and other characteristic symptoms. Bartholinitis can be recognized by its noticeable appearance. The enlargement of the gland reaches the size of a chicken egg and is usually very red, although this depends on the course and any concomitant diseases. If bartholinitis is treated promptly, the growth remains almost skin-colored and swells less. If an infection develops in the area of the enlarged gland, further complaints usually occur. Painful inflammation may then occur. Often the bartholinitis weeps or even bleeding occurs. Accompanying throbbing pain occurs, which can radiate to the entire intimate area and in severe cases to the abdomen. Based on these symptoms, the disease can be clearly diagnosed.
Diagnosis and course
If the cyst in bartholinitis remains small and no infection occurs, the disease is often not noticed. If it continues to grow, a small swelling is first noticed on one side of the vaginal entrance, which is painless. Within a few days, however, bartholinitis can develop into a full-blown infection with a painful lump, causing discomfort when walking or sitting. Pain during sexual intercourse may also indicate bartholinitis. If the lump does not resolve after two or three days of self-treatment (e.g., sitz baths) or if severe pain occurs, a physician should be consulted immediately for treatment of bartholinitis. In older women over 40, other possible diagnoses (e.g., cancer) should be reviewed in this context. To diagnose bartholinitis, a swab is taken from the vagina or cervix in addition to a pelvic exam to test for bartholinitis pathogens.
When should you go to the doctor?
As a rule, bartholinitis leads to relatively severe and unpleasant discomfort in the area of the vagina and especially on the labia. For this reason, a doctor should then be consulted if there is unexpected pain or swelling in this region.The labia may also be reddened or even affected by itching. It is not uncommon for patients to feel ashamed of bartholinitis. Treatment by a doctor is essential. Pain during sexual intercourse can also be a symptom of bartholinitis and should definitely be examined by a doctor. In most cases, however, bartholinitis can be treated well reactively. It also causes discomfort or leads to pain when sitting or walking. In this case, a doctor must also be consulted. As a rule, bartholinitis can be treated directly by a gynecologist. Special complications or other complaints do not occur and in most cases there is a completely positive course of the disease.
Treatment and therapy
Treatment of bartholinitis depends on the size of the cyst, the pain, and the degree of infection of the cyst. Sometimes treatment can be done at home. This should involve bathing in a tub with a little warm water (sitz bath) several times a day for three or four days to burst a smaller infected cyst. In more severe cases of bartholinitis, surgical drainage using local anesthesia or sedation is necessary. For the treatment, the doctor makes a small incision on the cyst for drainage and then places a small rubber tube (catheter) in the incision. This remains in place for up to six weeks to keep the glands open and allow complete drainage until the bartholinitis is completely healed. This treatment of bartholinitis is often accompanied by medication with antibiotics, especially if the bartholinitis was caused due to a sexually transmitted infection. In case of more frequent cyst formation, a so-called marsupialization is performed. For this, small drainage incisions are made on each side of the vaginal entrance to create a permanent opening of about 6 mm each. If these procedures do not help, surgical removal of the Bartholin’s gland may be advised.
Outlook and prognosis
Bartholinitis has a very favorable prognosis if the cyst is small and occurs without an inflammatory process. In these cases, medical treatment is usually not needed. Often, the patient does not even notice the painless cyst. The larger the cyst is, the more likely it is that medical intervention will be necessary. The cyst is usually removed completely within a few minutes in a routine operation. Following wound healing, the patient is free of symptoms and is considered cured. The process takes a few days or weeks. Despite recovery, bartholinitis can develop again over a lifetime. Younger women under the age of 30 are particularly affected. In case of a repeated occurrence, the prognosis does not change. It again depends on the individual circumstances. However, the patient is often sensitized to the first symptoms due to her previous experience and seeks treatment more quickly. This has a positive influence on the prospect of cure. The prognosis is particularly unfavorable if the patient also suffers an infection. This must also be treated with medication. Removal of the cyst is then not sufficient. The healing path is delayed and complications may occur if the immune system is weakened.
Prevention
To prevent bartholinitis, it is recommended to practice safe sex using a condom and to maintain thorough hygiene of the female intimate area to prevent the entry of intestinal bacteria that cause bartholinitis.
Follow-up
After bartholinitis, the intimate area must first be protected from further irritation. Avoiding perfumed and aggressive skin care products can help the sore area heal well without causing redness with itching and other discomfort again. After severe bartholinitis, it is recommended to use sitz baths or compresses with antiseptic or soothing solutions. Wound-cleansing rinses for use in the intimate area have also proven effective. Affected women should initially visit their gynecologist every one to two weeks for the necessary check-ups. After a month, they can return to the usual schedule, provided the physician does not detect any further abscesses or redness.Further follow-up focuses on identifying the triggers of bartholinitis. Affected women should first change bed linen and check shampoos and shower gels for allergens. In addition, strict intimate hygiene should be observed in the weeks and months following acute bartholinits. Possible triggers such as chlamydia or streptococci can be found in public toilets in particular, which are best avoided. If, despite all measures, inflammation occurs again, a visit to the gynecologist is recommended.
What you can do yourself
In the case of bartholinitis, self-healing rarely occurs; the disease must definitely be treated by a doctor, especially at an advanced stage. If the disease was caused by gonococci, the pathogens of the sexually transmitted disease gonorrhea (gonorrhea), treatment with antibiotics is indicated. Self-help options are not available in this case. However, sexually active persons can prevent infection. Since gonococci are very easily transmitted during sexual intercourse, infection can only be prevented one hundred percent by abstinence. However, the risk of infection can be significantly reduced by preventive measures. These include, above all, the consistent use of condoms, which should be used not only during vaginal intercourse, but also during anal and oral sex, as well as during foreplay. Early-stage bartholinitis that is not caused by gonococci can also be treated by those affected themselves. Anti-inflammatory and pain-relieving ointments from the pharmacy are particularly helpful here. In addition, the symptoms can be alleviated by sitz baths. Baths with highly concentrated salt water have a strong antibacterial effect and are usually very effective, but if the intimate area is already irritated, such baths can be very painful. The salt dose should therefore be increased slowly. Sitz baths with chamomile tea or chamomile tea concentrate are also helpful. Irradiation with red light can help to encapsulate the focus of inflammation from the healthy tissue.