Bartholin gland abscess
The content of the article:
- The reasons
- Classification
- Symptoms
- Complications
- Diagnostics
- Treatment
- Prevention
- Video
An abscess of the Bartholin gland (an abscess of a large vestibular or large vestibular gland) is an infectious and inflammatory disease in which a delimited cavity filled with purulent contents is formed in the tissue of the gland.
Bartholin's glands are small paired glands of the vestibule of the vagina, which are located at the base of the labia, their excretory ducts open on the inner surface of the labia minora. On palpation, sexual arousal and during intercourse, a secret is secreted through the ducts, which ensures sufficient lubrication of the female genital tract, preventing irritation of the mucous membranes.
According to statistics, an abscess of the Bartholin gland is recorded in about 2% of women, more often 20-40 years old. In children, the disease does not develop, occasionally occurs in older women and adolescents.
A Bartholin gland abscess is manifested by severe pain and swelling in the labia
Timely started treatment avoids the development of complications, the prognosis is usually favorable.
The reasons
An abscess is a complication of bartholinitis - inflammation of the vestibule gland, the inflammatory process can develop against the background of an existing cyst in the gland tissue. Infectious agents usually spread from primary foci located in the urethra, vagina, and rectum. Most often, the causative agent of the infection comes from adjacent organs. In rare cases, hematogenous infection is observed from separated foci. The reason may be sexual contact with an infected partner, you can also bring the infection through dirty hands, medical instruments, and sharing towels.
Risk factors include:
- decreased immunity;
- hypothermia of the body;
- endocrine system pathology;
- infectious diseases;
- frequent stress;
- the presence of bad habits;
- excessive physical activity;
- the use of certain drugs (for example, long-term use of immunosuppressive drugs);
- injury (including when carrying out any medical procedures).
A pathological condition can occur with congenital narrowness of the excretory canal, in which the secretion is difficult or completely blocked, a cyst is formed, against which an abscess can develop when an infection joins.
Classification
An abscess of the Bartholin gland can be true and false (the latter is most often noted), unilateral and bilateral, specific and nonspecific. Specific is spoken of when a pathogen is isolated that causes the development of specific infections (including sexually transmitted infections), non-specific infectious agents can be staphylococci, streptococci, E. coli.
Allocate true and false abscesses of the Bartholin gland:
- true - represents a formed abscess, the parenchyma of the organ is affected;
- false - blockage of the gland duct with inflammation, but without purulent fusion, without the spread of the pathological process to the gland parenchyma.
Symptoms
The pathology is accompanied by pronounced local symptoms, as well as signs of intoxication of the body.
An abscess forms in the lower or middle third of the labia. On palpation, it has an elastic consistency, not welded to adjacent anatomical structures. On palpation, a small amount of pus may be released.
There is a sharp soreness in the labia area, the pain can radiate to other parts of the body, increases with physical activity, during bowel movements, with palpation of the inguinal lymph nodes. In the affected area, pronounced edema is noted, which can partially or completely block the entrance to the vagina, hyperemia. There may be a foreign body sensation in the perineum.
The patient has weakness and fatigue, increased sweating, headache, chills, tachycardia, an increase in body temperature to subfebrile values. With a false abscess, the general condition does not suffer (one of the diagnostic signs).
With the progression of the pathological process, a neoplasm usually breaks through with the release of pus to the outside. After this, the symptoms usually subside.
Complications
In the absence of timely, correctly selected treatment for the acute form of the disease and with reduced immunity, the pathology can become chronic. In the chronic course of the disease, periodic maturation and dissection of the neoplasm is noted, during the period of remission, a dense painless formation forms in the thickness of the labia, a feeling of discomfort during sexual arousal and intercourse may be observed. The affected area is gradually deformed due to cicatricial changes after the opening of abscesses, secondary lymphadenitis develops.
Non-healing rectovaginal fistulas can be a complication of the chronic variant of the pathology. If they are large enough, feces can be thrown into the lumen of the vagina.
In the absence of adequate treatment, there is a risk of inflammation spreading to adipose tissue, the formation of phlegmon, the ingress of infectious agents into the bloodstream with the development of sepsis.
Diagnostics
To make a diagnosis, first of all, collection of complaints and anamnesis and a gynecological examination are required. Laboratory tests are prescribed (general blood count, bacteriological examination of secretions from the gland duct, tests for sexually transmitted infections). Ultrasound may be required to clarify the diagnosis.
Differential diagnostics is carried out with boils of the labia, drip abscess, malignant neoplasms. To exclude cancer, as well as in case of relapses of the pathology, a biopsy may be needed.
Treatment
Conservative treatment (drug therapy, physiotherapy techniques) can be effective only in the early stages of the pathological process. In other cases, the treatment is combined - surgical intervention with drug support.
Non-surgical therapy is recommended to be carried out in a hospital; the patient can carry out postoperative treatment at home under the supervision of a doctor. Antibacterial and / or antifungal drugs (if the abscess is of fungal etiology), anti-inflammatory, pain relievers are prescribed.
An abscess is treated primarily with surgery
The choice of the type of surgical intervention is selected depending on the available signs, the general condition of the patient and a number of other factors, based on the opening of the abscess of the barthrolin gland and removal of pus with subsequent anti-infective treatment. Surgical treatments are presented in the table.
| Method | Description |
| Wide incision | Excision and emptying of the abscess |
| Incision with the installation of a word catheter | Excision, installation of a catheter for 1.5-2 months in order to form an excretory canal for the outflow of secretions |
| Marsupialization | The abscess is opened, the cavity is washed, after which the walls of the capsule are sutured to the mucous membrane of the labia to form a duct |
| Bartholynectomy | Removal of the gland along with the abscess |
The operation can be performed both under local anesthesia (more often) and under general anesthesia. Within 2-3 days after opening the abscess of the Bartholin gland, it is necessary to wash the postoperative wound with antiseptic solutions. In the postoperative period, you need to wear loose underwear made from natural fabrics; it is recommended to use panty liners. The patient should not use tampons during her period.
When using non-radical surgical methods to remove a neoplasm, relapses of pathology are possible.
Prevention
To prevent the development of the pathological process, it is recommended:
- avoid promiscuous sex;
- use quality contraception;
- timely treat diseases, against which an abscess may develop;
- improve immunity;
- avoid physical overload;
- avoid stressful situations;
- to refuse from bad habits;
- avoid hypothermia of the body;
- carefully observe the rules of personal hygiene.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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