Diagnosis

Since a Bartholin cyst has a certain size and redness, it is usually sufficient to look at the cyst. Palpation can be used, but is not performed because of the pain. The secretion that flows out of the Bartholin cyst is examined for the pathogen in the laboratory (application of a bacterial culture). Only then can the therapy be adjusted accordingly.

Treatment

In the early phase of a bartholinitis, local treatment with vaginal creams, vaginal tablets and sitz baths with certain additives (disinfectant) can help the cyst to subside. Another treatment method would be antibiotics. Which antibiotic treatment is used depends on the bacterium and should also cause the cyst to subside.

The antibiotics should also be administered to prevent the inflammation from spreading. If the creams and antibiotics are no longer sufficient, the surgical method (marsupialisation) must be used. Under anaesthesia, an incision of the Bartholin cyst causes the pus to flow out and the cyst wall is then sutured to the outside of the body.

This leaves it open and the cyst can dry out. After a certain time, the stitches are removed and the opening closes again due to wound healing. If the acidic vaginal environment is out of balance, the balance can also be restored with the help of lactic acid ovules (lactobacilli; vagiflor).

Can or should one treat Bartholinitis oneself?

There is a tendency to treat mild forms of bartholinitis without antibiotics or by going to a doctor/gynaecologist yourself. However, if the inflammation is already advanced and complications of bartholinitis such as empyema or abscess develop, then a doctor or gynaecologist must be consulted immediately, because – the abscess can gain access to the bloodstream. This paves the way for the infection to spread throughout the body and can have serious consequences.

In the early stages, “home remedies” can be used to try to treat the inflammation itself in order to prevent the infection from spreading to the entire gland. This is the case when the symptoms are limited to slight pain in the posterior third of the vagina, a slight redness with/without overheating in this area, and a small swelling in the area of the redness. It is important that no fever, general fatigue or swollen lymph nodes in the groin area have occurred.

If the symptoms do not improve or even worsen within 1-2 days as a result of self-treatment, a doctor/gynaecologist should be consulted. In these cases the inflammation has already spread and treatment with antibiotics or other measures may be necessary. Important signs for a spreading of the inflammation are stronger pain in the area of the labia than at the beginning.

These can be particularly painful when sitting. In addition, there is a swelling of the labia up to the size of a hen’s egg, which can be red and overheated. Fever, fatigue and swollen lymph nodes can also occur in an advanced stage and are signs to be taken seriously.

On the one hand, disinfectant sitz baths, e.g. with chamomile or sea salt (10-50g/litre of water) may be recommended. Camomile and also sea salt have an anti-inflammatory effect and can also inhibit the spread of bacteria. It is recommended to put about 40-50g of chamomile flowers into a pot filled with half a litre of water and then bring this mixture to the boil.

When the water comes to the boil, remove the pot from the heat and leave to stand for 10 minutes. Then filter the water through a sieve and pour the resulting brew into a seat pan with pleasantly warm water. Then take a sitting bath for about 10 minutes.

Make sure that the inflamed areas are sufficiently surrounded by water. If necessary, you can also carefully dab the affected areas with the solution using a soft cloth. The baths can be taken several times a day.

Special attention should also be paid to vaginal hygiene during the acute phase. This includes, for example, the use of a pH-neutral washing lotion for intimate hygiene instead of conventional soap. Care should also be taken not to wear too tight and synthetic underwear.

In addition, it can help to avoid sexual intercourse, as on the one hand it additionally irritates the already irritated tissue and on the other hand it can transport further germs into the inflammation area. A local cooling of the overheated area in the area of the inflammation is another option to treat the inflammation. As a prophylactic measure, sitz baths with chamomile or salt water can be used for painless nodules or swellings on the labia (possibly precursors of bartholinitis).

Ten minutes a day is sufficient for this. Salt water (approx. 200g/session) and chamomile have an anti-inflammatory and disinfecting effect.

For mild forms of bartholinitis, good intimate hygiene, anti-inflammatory ointments and sitz baths with disinfecting substances such as Betaisadona solution (Polyvidon. Iodine); Chinosol (quinolinol solution) or Serasept (polihexanide solution) are helpful in addition to good intimate hygiene. If used regularly, these can avoid surgery.

However, if the symptoms worsen or the fever rises, a doctor should be consulted urgently and Bartholinitis should be surgically repaired. In the early stages of bartholinitis, where only the excretory ducts are blocked and no pus has collected, antibiotic or anti-inflammatory ointments can help in addition to good intimate hygiene and sitz baths. A gynaecologist should be consulted for this.

Tea tree oil has an antimicrobial effect against bacteria/fungi and can have an anti-inflammatory effect. Tea tree oil is nowadays used in alternative medicine to treat skin infections, warts, acne and pimples, among other things. It is also used to treat wounds.

It is also used in the cosmetics industry. Despite its antimicrobial and anti-inflammatory effects, contact eczema on the skin is often discovered after the application of tea tree oil. Especially undiluted tea tree oil rather seems to have a harmful effect on health due to its side effect profile.

Especially the application on the mucous membranes in the genital area has to be considered as counterproductive. Therefore the oil is not recommended for the treatment of bartholinitis. Those who want to avoid antibiotics or other anti-inflammatory ointments and solutions can also use homeopathic anti-inflammatory agents.

Typical homeopathic agents used in homeopathy for acute bartholinitis are Hepar Sulfur C15 and Pyrogenicum C9. In chronic bartholinitis, Conium 15 and Staphisagria C15 can be used. In acute bartholinitis, 5 globules are taken twice daily for 5 months. For chronic bartholinitis, i.e. recurrent infection, take 5 globules daily for 2 months. If there is no improvement in spite of homeopathic treatment, the inflammation must be treated surgically.