Differentiation from a cyst

A cyst should not be confused with an abscess or an empyema caused by accumulation of pus during an acute inflammation. An abscess is an accumulation of pus in the Bartholin’s gland caused by backflow. A cyst, however, only describes a cavity that is filled with fluid; an inflammation is not present here.

The cyst is the result of repeated inflammation of the Bartholin’s glands, which is the link between the abscess and Bartholinitis. Due to the constant inflammation and adhesion, the architecture within the cyst changes. Cavities are formed in which, once the inflammation has subsided, normal glandular secretions accumulate, which are normally used to moisten the vagina.

It is not uncommon for the excretory duct to be altered after recurrent inflammation in such a way that no secretion at all can be released. Due to the accumulation of secretion, cysts can develop up to the size of a chicken egg. In contrast to the abscess, which is a sign of acute inflammation, the cyst lacks classic signs of inflammation, as it is not an expression of the inflammation.

The cyst can be palpated alone as a spherical, bulging accumulation of fluid in the labia. In most cases, redness and pain are absent in a Bartholin cyst. Another problem of a cyst, apart from the palpable accumulation of fluid, is that it can be a reservoir for bacteria, which feel very comfortable in the cysts.

Typical germs are the known pathogens of cystitis such as coli or rod bacteria. Normally, the outflow of secretion prevents bacteria from ascending into the gland or flushes them out. If this outflow is absent and the bacteria can multiply undisturbed in the cyst, a circulation with recurrent inflammation of the Bartholin gland can develop, which leads to new cysts in which bacteria cavort, which in turn leads to even more severe infections.

To interrupt this circulation, a Bartholin cyst is usually opened, drained or even completely removed in cases of recurrent inflammation. If possible, this minor operation is performed at a time when the cyst is not currently inflamed, because interventions in inflamed tissue have a greater risk of complications such as wound healing disorders or renewed inflammation. However, small cysts that do not restrict, disturb or hardly inflame affected women in any way can be left without therapy. Sitting baths and hygiene in toilets can also reduce the risk of bacteria entering the vaginal entrance and ascending to the gland.

How long before you need surgery?

If the household remedies no longer help and even the antibiotic therapy initiated by the doctor/gynaecologist does not bring sufficient improvement, the operation represents a further therapeutic option. An operation is always necessary if the inflammatory, usually purulent secretion has accumulated due to the obstruction of the excretory duct and a so-called empysema has developed, which does not open spontaneously (spontaneous rupture). In addition, it can happen that the inflammation also spreads to surrounding tissue and encapsulates itself.

This is then called an abscess. A cystic healing of the bartholinitis with the formation of a retention cyst also often requires surgical therapy. The abscess in the genital area can be a serious complication of bartholinitis.

An abscess is an encapsulated space filled with purulent secretion (mixture of bacteria, inflammatory cells and tissue fluid). Due to the surrounding capsule, antibiotics can no longer adequately reach the focus of the inflammation and act sufficiently. In addition, an abscess can gain access to the bloodstream and the inflammation can thus spread to other parts of the body.

An abscess almost always has to be surgically split so that the pus can drain away. The abscess in the genital area often shows itself by a prominent swelling with redness, overheating and severe pain. At the same time, fever and a general feeling of illness as well as swollen lymph nodes frequently occur. Risk factors that promote the formation of an abscess include smoking, poor personal hygiene, diabetes mellitus, circulatory disorders and a weak immune system.