Opening of abscess of Bartholin glands in Lyubertsy

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Bartholinitis (Bartholin gland abscess, Bartholin gland cyst) is a disease in which the Bartholin glands become inflamed. These glands are located on both sides of the vagina in the area of the labia minora (in the vestibule of the vagina). Their main function is to maintain moisture at the vaginal opening during sexual intercourse. The excretory ducts of the glands open onto the surface of the labia minora. When the ducts are infected (with sexually transmitted infections - gonorrhea, trichomoniasis and chlamydia, less often - gonococci, streptococci, staphylococci, E. coli and other microorganisms), inflammation occurs, which can subsequently spread to the entire gland and surrounding tissues. In most cases, only one gland becomes inflamed, i.e. the inflammatory process is one-sided.

The reasons for the development of bartholinitis are infection through the excretory ducts of the Bartholin glands. This is facilitated by:

Insufficient genital hygiene;
Unprotected sexual intercourse;
Sexual intercourse during menstruation;
The presence of diseases such as colpitis, urethritis, the presence of sexually transmitted diseases;
Decreased immunity.

Opening a Bartholin gland abscess in the clinic

Opening a Bartholin gland abscess is a surgical procedure that involves cutting the source of suppuration along anatomical lines. A similar operation is performed when a purulent accumulation with inflammation of surrounding tissues forms in the area of the paired gland of the vulva (Bartholin's gland) at the vestibule of the vagina. Paired glands are necessary for the production of vaginal secretion, which is able to maintain optimal moisture of the mucous membrane. Many different infections can cause inflammation of the gland itself or its duct. Pain in the vaginal area, local redness, an increase in the size of the pathological area and deterioration in general health indicate the need to seek advice from a gynecologist.

Preparatory stage

Before the operation it is necessary to prepare. A woman is examined by a gynecologist. Then the patient is prescribed a series of tests and examinations, including:

vaginal smear;
linked immunosorbent assay;
blood test for antibodies to viral hepatitis, HIV infection;
ECG;
fluorography.

Before surgery, it is necessary to shave the hair in the intimate area. It is necessary to empty the intestines and bladder, it is recommended to give a cleansing enema and douche the vagina with an antiseptic solution. Most often, local anesthesia is given, so there is no reason to refuse food and water.

Contraindications

Drainage of the cavity should also be carried out in case of independent breakthrough of the abscess. If this happens, you should immediately go to the hospital, as purulent contents remain in the cavity, which can cause a relapse. The doctor installs special tubes to drain the remaining fluid, after which they are treated with an antiseptic.

In addition, the contents of the abscess can enter the bloodstream and cause sepsis. For this reason, you should never open an abscess yourself or ignore the symptoms.

Catheter placement – Word

This is a modern method of surgical treatment for Bartholin’s gland cyst, especially in case of its recurrence.

Under local anesthesia, the cystic area is opened with a small incision of about 5 mm, the contents are removed and sent for bacteriological examination, the cyst cavity is washed and a Word catheter is installed in it (this is a silicone tube 55 mm long, 5 mm in diameter with a channel inside, blindly ending, with thinner walls at the end, due to which the tip can inflate into a ball, which has no analogues), inflating its rubber tip to 3 ml with a physiological solution of 0.9% sodium chloride, thereby fixing it in the cavity of the cyst. For better fixation and prevention of loss during the woman’s movements, it is recommended to apply 2-3 absorbable interrupted sutures along the contour of the catheter emerging from the cavity of the cyst. The second end of the catheter is inserted into the vagina. The catheter remains in the cyst cavity for 6 weeks. This is aimed at forming a channel for the passage of secretions, the walls of which do not grow together. The study shows that the Word catheter is an easy-to-use, low-cost outpatient procedure with acceptable short-term recurrences. Treatment costs are seven times lower than with marsupialization [7]. While the catheter is in the cyst cavity, the patient is advised to have sexual rest to avoid its loss. In a number of countries there is no such restriction, since studies have shown that the pain symptom caused by both the cyst itself and the procedure performed with the catheter in the cavity completely disappears over time (by day 6) [8]

As an alternative, a Voroda or a Jacobi ring (the catheter does not have a channel, it is harder, shaped like a ring) which is installed through 2 punctures in the mucous membrane and capsule of the cyst and the 2 ends are fastened to each other.

Abscess symptoms

False and true abscess of the Bartholin gland are distinguished. If only the excretory duct is infected, and the glandular tissues are healthy, we are talking about a false abscess. The inflamed duct is filled with purulent contents, stretches, and its opening is blocked, while in the surrounding tissues, as a rule, there is no suppuration. A true abscess is characterized by suppuration of the gland itself.

A false abscess has an acute, rapid onset. A painful sensation appears in the area of the labrum major, depending on the side of the affected gland, increased pain with active movement, sitting and walking, during intimacy. On the side of inflammation, there is pronounced swelling and redness of the skin, while the skin easily moves to the sides. In addition to local symptoms, high body temperature is often noted - up to 38.5-39 C, fatigue, chills and loss of strength.

A true abscess has an even higher temperature - up to 40 C, and pronounced symptoms of intoxication. The pain is constant even at rest; there is a feeling of “pulsation” of the affected area. In this case, it is advisable to perform laboratory tests - there is an increase in the level of leukocytes and ESR. Swelling of the labia can reach 5 cm in diameter, the skin over the abscess becomes bright red, motionless when palpated. In some cases, there is an increase in the inguinal lymph nodes from the causative side.

Bartholinitis

Bartholinitis is an inflammatory disease of the Bartholin glands, caused by the penetration of infectious agents into their tissues. They can be specific (gonococci, trichomonas, chlamydia, ureaplasma) or nonspecific (Escherichia coli, streptococci, staphylococci).

Bartholinitis can develop as a result of sexual contact with a partner suffering from a sexually transmitted disease. Sometimes bartholinitis is diagnosed with vaginosis, colpitis, cervicitis, cystitis, urethritis.

Women of reproductive age are susceptible to the disease. In girls who have not reached puberty and women during menopause, bartholinitis is diagnosed extremely rarely.

The first symptom of bartholinitis is redness of the labia in the area where the gland duct exits. Later the following symptoms appear:

formation of a compaction in the form of a knot or pea;
swelling of the lower third of the labia majora;
serous or purulent discharge;
itching;
pain when walking;
deterioration of general condition.

Bartholinitis occurs in acute or chronic form. In chronic bartholinitis, exacerbations can be triggered by menstruation, change of sexual partner, or hypothermia.

Diagnosis of the uterus

As a rule, correct diagnosis of a vaginal gland abscess is not difficult and makes it possible to determine subsequent treatment tactics. To detect suppuration of the large gland of the vestibule of the vagina, the following diagnostic tests and tests can be performed:

analysis of peripheral blood composition to determine the severity of pathological changes;
biopsy of the cyst to exclude oncological processes;
bacteriological culture from the patient’s genitals, which will help establish the presence of sexually transmitted pathologies.

The need for additional diagnostic examinations will be decided by the treating doctor on an individual basis. In this case, many factors will be taken into account: the presence and nature of pathological signs, the condition and age of the patient, the number of pregnancies and abortions, features of the menstrual cycle.

Preparation and execution

Before opening a Bartholin gland abscess, a woman must undergo a comprehensive examination. It includes tests for sexually transmitted infections, vaginal smear and culture. Bartholinitis often develops as a complication of gonorrhea and other STIs. Laboratory diagnostics will allow you to exclude dangerous diseases and select effective treatment.

The opening of a Bartholin gland abscess in gynecology in Biryulyovo is usually performed on an outpatient basis, under local anesthesia. The intervention takes 10-30 minutes. After treating the wound, the woman can go home. In case of extensive inflammation, the patient is hospitalized in a hospital, and the operation is performed under general anesthesia.

Opening the Bartholin gland abscess is only the first stage of therapy. An autopsy is performed to remove pus and stagnant secretions from the ducts. After the procedure, the doctor sanitizes the gland. Sometimes additional drainage is installed, lavage or physiotherapy is prescribed. Treatment necessarily includes antibiotics and anti-inflammatory drugs that will help cope with the infection and avoid relapse of the disease.

Performing an operation to open a Bartholin gland abscess

Surgery is considered the optimal method of combating suppuration of the Bartholin gland. In most cases, surgery to open an abscess is performed in a clinic; there is no need to place the patient in a hospital setting. Operation technique:

the woman is located in the gynecological chair;
the doctor treats the external genitalia and vaginal walls with an antiseptic solution;
to prevent pus from entering, a tampon made of several layers of sterilized gauze is inserted;
the area of the future incision is treated with a 5% iodine solution;
the doctor determines the area of the clearest fluctuation, where the skin is thinnest;
an incision is made using a sharp instrument on the inside of the labia majora, bringing it to the lower border of the abscess cavity (this is necessary to prevent the formation of a fistula, which is possible if during the operation all “pockets” where pus can accumulate are not eliminated);
after the purulent contents have drained, the abscess cavity is treated with an antiseptic (sprinkled with streptocide or wiped with a sterile swab soaked in an alcohol solution of iodine);
so that the hole does not close until the pus is completely freed (it will still form for some time), a drainage tube or turunda is placed in it;
A cotton-gauze bandage is placed in front of the vulva, which will absorb the remaining pus.

The tampon from the cavity of the opened abscess is removed one day after the operation. No postoperative dressing is required. Until the granulation fills the cavity, measures must be taken to prevent the hole from sticking together. To do this, a drainage tube is left at the intervention site, which is replaced with a gauze strip after a day or two. It is recommended to treat with Vishnevsky ointment or Levomekol.

If the patient experiences frequent relapses of the Bartholin gland abscess or a non-healing festering fistula is formed, doctors advise resorting to radical surgery - excision of the gland and excretory duct.

Conditions that increase the risk of developing bartholinitis

Experts identify background conditions that can increase the risk of developing bartholinitis, and, consequently, its complications such as abscess of the Bartholin gland.

Various local microtraumas, which include scratching, scratching, most often occurring during sexual intercourse (when insufficient lubrication is produced). These places of violation of the integrity of the mucous membrane are the entrance gates through which the infection enters.
Violation of general rules of personal hygiene. It is especially important to maintain good hygiene during menstruation.
Tight underwear, which can interfere with the physiological outflow of secretions produced by the Bartholin gland. This secretion, which stagnates, provides ideal conditions for the growth and reproduction of pathogens.
Unprotected promiscuous sex life. Sexually transmitted infections themselves can cause bartholinitis and abscess of the Bartholin gland.
Chronic infection in the body. Foci of chronic infection such as pyelonephritis, caries, and so on, increase the risk of bartholinitis. In this case, the spread of infection will occur through the flow of lymph and blood.
A general decrease in immunity or local hypothermia. This leads to the body becoming more vulnerable.
Hypovitaminosis.
Previously undergone surgical interventions on the external genital or internal genital organs, during which the rules of antiseptics were violated, or if all recommendations were not followed after the surgical interventions.

Recommendations after surgery

After opening the abscess, it is important to carefully follow the doctor’s recommendations:

Avoid sexual intercourse during the recovery period;
Do not visit baths, saunas, swimming pools, ponds;
Washing in the shower instead of lying in baths;
Avoid overheating and hypothermia;
Give preference to loose cotton underwear.

As a rule, recovery occurs quite quickly. At first, it is preferable to remain in bed to prevent stress on the perineal tissue.