Introduction
Bartholinitis is a very painful inflammation of the Bartholin gland (also called “large vaginal atrium gland” in Latin), which is perceived as unpleasant by the women affected. Usually only the ducts of the gland located in the area of the labia minora are affected. These can then be recognised as smaller reddish spots in the vaginal vestibule.
Nevertheless, bartholinitis requires treatment in any case. Depending on the progression of the inflammation, different treatment steps are recommended. and Bartholinitis symptoms
Early stage
In early-stage bartholinitis, only the excretory ducts of the gland are initially affected. In this case it would be advisable to start an anti-inflammatory treatment early. This can reduce the cell response to the respective pathogens, i.e. all signs of inflammation such as swelling, redness, overheating are reduced and it is prevented that the bartholinitis spreads even further to the glands themselves.
Thus, the affected tissue has the opportunity to recover by swelling and the Bartholinitis with all its discomfort is reduced. Another important point in the treatment of Bartholinitis is the relief of pain through medication. As the inflammation affects a very pain-sensitive area of the female sex, it is therefore perceived as extremely unpleasant.
Cooling the affected areas can also have a pleasant effect against the pain. If the bartholinitis is already more advanced, i.e. if an “abscess” (= an encapsulated accumulation of pus) has already formed at the site of the glandular exits, it would be advisable to relieve the pustule. In any case, this should be done by a doctor by making an incision in the encapsulation in the course of the glandular duct.
The pus should be completely removed. Afterwards, i.e. when the outlet has been opened, the walls of this artificial body cavity can be sutured to the surrounding tissue so that it is kept open in the future. Further accumulations of pus as a result of Bartholinitis can thus drain off and do not immediately form a new so-called “Bartholin cyst” (Bartholinitis cyst).
This treatment process is also called “marsupialisation”. In the following, it is helpful to keep the open cyst clean with sitz baths to minimize the number of pathogens in this area. Furthermore, this is to counteract the relocation of the opening or its reclosure.
Closure can also be prevented by means of a tamponade. In the further course of the procedure, the opened cyst contracts and forms a new excretory duct. However, this is only recommended for “mature” abscesses.
If they are not yet mature enough, the whole process can be conservatively remedied by the application of red light and traction ointment (e.g. Ilon® ointment). A pain-relieving treatment, as described above, is recommended during this time. If, however, a recurrence of bartholinitis with renewed formation of a boil occurs, which, by the way, happens very often, the entire gland should be surgically removed.
If the “Bartholin cyst” is not addressed with one of the above mentioned treatments, it can burst spontaneously, i.e. without external influence. Even then, surgical treatment is recommended. In this case, the burst Bartholin’s cyst should be further cut open, completely freed of pus and kept open by suturing the cyst walls.
Without treatment, serious complications can occur. The pathogens could spread further, beyond the gland, and affect the whole body. In the worst case, this can lead to life-threatening blood poisoning, which requires urgent medical attention.
It is also important to take a smear of the opened cyst, which should then be examined microbiologically. This provides information about which pathogen was responsible for the bartholinitis. Typical are staphylococci, Escherichia coli, streptococci, anaerobes.
Gonococci, which are sexually transmitted for example (also known as gonorrhea), can also be causative. If these can be detected, a targeted antibiotic treatment against the corresponding pathogen must be started. This procedure is also recommended if the condition does not improve despite appropriate treatment, but there is also a general deterioration in the body’s condition.
Of course there are alternative methods for the treatment of Bartholinitis. Homeopathy, for example, also offers the possibilities for treatment. Certain homeopathic remedies are recommended, such as Mercurius solubilis, Hepar sulfurius, Acidum silicicum and Thuja.
These are used depending on the stage of bartholinitis and are dosed accordingly. Alternatively, bartholinitis can also be treated with herbal medicine. A remedy of choice are warm sitz baths with special additives such as oak bark, camomile blossoms, witch hazel or witch hazel.
These work against the inflammation. Furthermore, a so-called re-tuning therapy can be applied. This can be done either with medication or with stimulation therapy.
This is intended to stimulate and strengthen the body’s own defence system so that it can independently fight the inflammation and in future defend itself earlier against the colonisation of germs. Although these alternatives seem to be more gentle, they should be used with care and professional support. If the desired effect does not occur, a medical clarification would be advisable.
In the early phase or even later as a supplement to surgical and antibiotic therapy, sitz baths can have a positive influence on the course of bartholinitis. For this purpose, a bathtub or a special sitz bath attachment for the toilet is filled with water and disinfectant additives. Afterwards one should stay in the water for 15-30 minutes.
Various substances are suitable as additives to warm water. A popular and long known additive is camomile. When taking a sitz bath, chamomile penetrates into deep layers of the skin and develops anti-inflammatory effects there.
This is why a sitz bath with chamomile is also suitable for early symptoms of bartholinitis. In addition, chamomile promotes wound healing, which is why it is wonderfully suited as an accompanying measure after surgical therapy. The effect of chamomile has been proven by scientific studies.
Another possibility is the addition of potassium permanganate. This has a disinfecting and astringent effect. This means that it leads to a “drying out” of the inflammation.
When using it, one should pay particular attention to diluting it in the right proportion, as in extreme cases it can lead to burns on the skin. It should also not be used for too long a period of time, as it can lead to undesired drying of the skin. Furthermore, Polyvidon Iodine, which also has a disinfecting effect, can be used.
As household remedies against bartholinitis, plants or remedies that have an anti-inflammatory, antibiotic or softening effect are usually mentioned. The chamomile sitz bath is at the very front. It has been scientifically proven that chamomile has a local anti-inflammatory effect and promotes wound healing, which is why a sitz bath with chamomile is suitable both in the early stages of the inflammation and later as an accompanying measure in addition to the medically initiated therapy.
Ginger is also one of the frequently recommended household remedies. Although there is no scientific analysis of bartholinitis in particular, it is known that ginger generally has anti-inflammatory properties, which is why it can be taken as a supporting measure. Ginger can, for example, be sliced and infused with hot water and then enjoyed as tea.
Other household remedies, such as aloe vera, vermouth, lemon grass, gentian, dandelion or garlic have not yet been specifically tested for their effectiveness against bartholinitis. However, scientific studies have proven their anti-inflammatory, partly antibacterial, partly pain-reducing effect. If the symptoms do not go back with the home remedies, a doctor should definitely be consulted.
The homeopathic therapy of Bartholinitis consists of two pillars. On the one hand it consists of acute therapy, on the other hand of constitutional therapy. The acute treatment depends on the character of the symptoms.
If the pain is pulsating and the abscess is red and hot, the use of belladonna is recommended. If the pain is sharp to the touch and the abscess is shiny and the skin all around is swollen, Apis is particularly suitable. If you suffer from splinter-like pain and also have a craving for acidic foods, Hepar Sulfuris is suitable.
This is called a “homeopathic scalpel”, as it is said to open the abscess. If the splintery pain comes and goes quickly, the sweat smells bad and if genital condylomas are present at the same time, Nitricum Acidum can be used. Jealous young women who cannot tolerate tightness of the neck and suffer from a bluish-red abscess are recommended to use Lachesis.
Since, according to homeopathic doctrine, it is a disease from the field of “sycosis” (a non-self-limiting miasma that can lead to chronic diseases), simply suppressing the abscess would possibly shift the problem to the internal organs. Therefore, in addition to the acute therapy, a constitutional therapy is recommended. There is no scientific basis for the homeopathic therapy of Bartholinitis according to the criteria of modern medicine.
Ointments are of varying importance in the treatment of Bartholinitis. Firstly, in the case of a simple inflammation of bartholinitis, antibiotic-containing ointments can help to contain the inflammation. Ointments containing active ingredients such as fusidic acid, nebacetin or bacitracin are best suited for this purpose.
If an abscess has already formed but is not yet fully developed, an ichtholan ointment can help. The ointment has the effect that the abscess matures faster and can be treated surgically more quickly. Other ointments that promote the maturation of abscesses can also be used for this purpose.
If the Bartholinitis does not improve with general measures such as sitz baths or one or the other home remedy, or if the symptoms increase, one should consult a doctor in time, who will then decide on the further procedure depending on the extent of the inflammation. The first warning signs are fever and exhaustion as well as unbearable pain when sitting and walking. In mild cases, antibiotic ointments are suitable for treatment with antibiotics.
In most cases, however, antibiotics are prescribed in the form of tablets. If the inflammation is not yet so far advanced, therapy with antibiotics alone may be sufficient. Usually, preparations such as Ceftriaxone are prescribed, which cover the spectrum of the most common pathogens.
If an abscess has already formed, the usual procedure is a surgical opening. In addition to rapid relief, this offers the possibility of searching for the triggering pathogen. As a result, an antibiotic can be specifically selected which is optimally effective against the pathogen found.
If the antibiotic and/or surgical therapy is not carried out in time, there is a rare risk that the germs will enter the bloodstream. As a result, life-threatening blood poisoning can occur. If the outlet of the inflamed Bartholin’s gland sticks together, an abscess, i.e. an accumulation of pus within the inflamed gland, can develop.
Once this development has taken place, it is usually necessary to surgically drain the abscess. Many women shy away from surgical therapy at the beginning. Since the development of an abscess is usually associated with very severe discomfort when sitting and walking, most women find the surgical opening of the abscess a great relief in the end.
The procedure is usually performed on an outpatient basis. A local anaesthetic is usually sufficient. The most commonly used surgical technique is called marsipulation.
Here the abscess is opened with a scalpel. The walls of the abscess cavity are then sutured to the skin so that the cavity remains open to the outside. This is necessary because otherwise the Bartholin abscess tends to recur.
The secretion obtained in this way is used to determine which germ is responsible for the inflammation so that antibiotic therapy can be started. If the inflammation recurs frequently, it may be considered to remove the affected Bartholin’s gland as a whole. Other surgical procedures, such as the sole aspiration of the secretion from the abscess with a needle, the creation of an artificial fistula by means of a catheter or the irrigation of the wound with alcohol or silver nitrate, no longer correspond to today’s medical standards.
Surgical therapy of bartholinitis is an outpatient procedure that only takes a few minutes. The duration of the antibiotic therapy depends on the germ, the extent of the inflammation and the antibiotic chosen. As a rule, however, it does not last longer than a few days. It is important to note, however, that the antibiotic should not be discontinued earlier than discussed with the doctor, as incorrectly administered antibiotic therapy can lead to the development of antibiotic-resistant germs. In rare cases, chronic inflammation of the Bartholin glands can develop, which can lead to a longer treatment period.
