Generality
Bartholiness is the inflammation of Bartolini's glands. This disorder is typical of fertile age .
Bartolini's glands are located in the vulvar region, between the labia majora, near the vaginal orifice, where they contribute to the normal lubrication of the vagina, especially during sexual intercourse.
Bartholiness is generally caused by an infection or traumatisms of the genital area. The factors predisposing to inflammation of Bartolini's glands include poor hygienic conditions, sexual intercourse and the excessive use of synthetic underwear or tight-fitting clothes that cause rubbing.
The main symptoms of bartholinitis are pain, tension and swelling of the affected area, which is covered with edematous and reddened skin . The patient complains of difficulty in walking and taking a sitting position. These manifestations may also be associated with a rise in body temperature .
In most cases, the simple inflammation of Bartolini's glands is transient and resolves within 3-5 days. In other cases, however, the pathological process can give rise to the formation of a cyst or an abscess .
The diagnostic setting of bartholinitis involves a gynecological examination .
The therapeutic intervention consists in the use of anti-inflammatories to counteract the acute inflammatory process in progress, possibly associated with hot-damp packs or sitz baths to favor the spontaneous drainage of the gland. The doctor can prescribe antibiotics, to be taken either by mouth, or through the use of ointments to be used locally.
The abscess formations that derive from the bartolinite are incise and drained. If the inflammation returns two or three times over the course of a year, surgical removal of the involved Bartholin's glands (bartolinectomy) may be indicated.
What's this
Bartolini's glands (in short)
- What they are - Bartolini's glands (or major vestibular glands) are two small ovaloid or roundish glands.
- Where they are - Bartholin's glands are located deeply and arranged symmetrically (one on each side) near the lateral and posterior wall of the vaginal orifice.
- What they are for - The function of Bartolini's glands is to secrete a viscous and transparent liquid during sexual intercourse. This fluid is normally produced to help lubricate the vaginal canal when a woman is sexually aroused. Sometimes, the excretory ducts from which this liquid normally emerges become obstructed, favoring the proliferation of germs.
- How they change with age - In young girls, Bartolini's glands are small (since they are not yet functioning in this period), while in adult sexually active women they reach their maximum volume. As we age, these structures undergo involution and, after menopause, are atrophic.
Bartolinite: what is it?
Bartholiness is an inflammation that affects only one or both of Bartolini's glands. The inflammatory process develops in the lower extremity of the skin folds of the vulva (small and large lips), on the sides of the vestibule of the vagina.
Bartholiness appears as swelling, pain, redness and tension in the skin above the involved Bartolini's gland.
Causes and Risk Factors
Bartolinitis: what does inflammation depend on?
Bartholiness is usually caused by an infection . The most common pathogens are bacteria of vaginal or intestinal origin, such as Streptococcus or Escherichia coli, but Chlamydia trachomatis and Mycoplasma hominis may also be implicated.
Bartholiness can also be caused by traumatic injuries, such as those caused by the repeated compression or rubbing of the private parts during prolonged sexual intercourse, the use of a bicycle or too-tight underwear (loincloths, briefs, etc.). Less often, bartholinitis results from the abnormal development of genital tract tissues (congenital malformation) or from a sexually transmitted disease such as gonorrhea.
Bartholiness can occur in the absence of pre-existing lesions or in the context of a glandular cyst . Inside the inflamed Bartholin's gland, a collection of pus can develop that comes out of the excretory duct or, if obstructed, towards the inner face of the labia majora.
Bartolinitis: predisposing and / or aggravating factors
Factors that can predispose to inflammation of Bartolini's glands include:
- Poor general hygiene conditions;
- Sexual relations (especially if frequent and vigorous);
- Inability to wash the private parts for a long time;
- Habit to dress with synthetic and colored underwear, and / or with tight-fitting clothes that cause rubbing (like leggings and tight jeans);
- Excessive use of the bicycle.
Bartolinitis: those most at risk
The pathologies that involve Bartolini's glands are mainly inflammations (such as bartholinitis) and the formation of cysts . These problems are more common in women of reproductive age, particularly between the ages of 20 and 30.
With time, however, bartholinitis is less likely to occur. In fact, in peri-menopausal women, Bartolini's glands undergo a physiological involution . For this reason, the possible appearance of a lump or a vulvar mass requires an excisional biopsy, in order to exclude the presence of a malignant tumor.
Symptoms and Complications
Bartholiness typically occurs with swelling of the affected area, redness, intense pain and fever . The inflamed Bartholin's glands are a source of discomfort during sexual intercourse and make activities such as sitting or walking annoying. In the presence of a bartholinitis, the external genitals modify their normal appearance: when the swelling becomes very voluminous, the large lips of the affected side (one or both) are stretched and covered with edematous and reddened skin.
Bartolinite: how to recognize it
Bartholiness appears as one-sided bulge (if the inflammation involves only one Bartolini's gland) or bilateral, at the lower third of the labia, next to the vaginal opening. This swelling can increase: from small like almonds, the inflamed Bartholin's glands can reach the size of a walnut or even an apricot.
Other typical Bartholinitis symptoms include:
- Acute pain ;
- Redness ;
- Local itching ;
- Discomfort during intimacy .
If the inflammation of Bartolini's glands depends on an infectious process, moreover, fever, a sense of weight in the lower abdomen and production of vaginal secretions (usually yellowish) can also occur.
If the swelling of the external genitalia is very voluminous, the bartholinitis can cause tension in the skin overlying Bartolini's glands with vulvar irritation and pain during sexual intercourse (dyspareunia) and walking. Urination can also become difficult.
Concurrent complications and pathologies
Bartholiness can promote the obstruction of an excretory duct; this event determines the enlargement of the gland due to stagnation or stasis of its viscous secretion within the same canal, from which follows the formation of a Bartolini cyst .
When the fluid contained within a Bartolini cyst becomes infected, an abscess can form (collection of pus due to the penetration of some germs, more frequently E. coli, Neisseria gonorrhoeae and Chlamydia trachomatis ). In this case, the appearance of some fever, pus and very intense pain is possible.
The abscesses of Bartolini's gland are sensitive to the touch, they become very bulky and cause a reddening of the skin above them.
Diagnosis
Bartolinite: how is the diagnosis made?
The diagnosis of bartholinitis is established with a specialist medical examination. With the physical examination, the gynecologist can carry out the correct classification of the pathology.
Gynecological examination
The evaluation of bartholinitis involves the examination of the external genitals, during which the gynecologist can observe the swelling and determine if an infection is present. Furthermore, with palpation of the affected part, the doctor can define whether the inflammation has given rise to complications, such as cysts or abscesses.
If there are secretions, it is possible to take a sample to send to the laboratory or make a swab to ascertain the presence of infections, including sexually transmitted diseases.
Biopsy
In some cases, signs of vulvar cancer can mimic bartholinitis and Bartolini's cyst. Therefore, the doctor can collect a sample of the lesion to analyze it under a microscope and recognize any neoplastic features.
The biopsy is especially indicated for women over the age of 40 and when the swelling appears to be irregular in shape or has strange bumps, to exclude any vulvar cancer.
Bartolinitis: differential diagnosis
The differential diagnosis is made with other disorders or lesions of the vulva that produce symptoms similar to those of bartholinitis.
Rarely, tumors of the vulva originate from the neoplastic transformation of the epithelial components of the Bartholin's gland. It should be noted that this pathology can be correlated with human papilloma virus (HPV) infection.
The tumor of Bartolini's glands usually presents itself as an irregular, nodular and persistently hardened palpable vulvar neoformation. Belatedly, clinical signs such as excoriation, pain and itching appear. The lesion may become necrotic or ulcerated, sometimes causing bleeding or watery vaginal secretions.
When to consult a doctor promptly
To set the correct therapy and avoid the worsening of bartholinitis, it is advisable to go to the doctor at the onset of the first symptoms (swelling, redness and pain).
In general, the alarm bells to be considered are:
- Bartholinitis has persisted for over a week, interferes with walking or does not allow sitting;
- The swelling continues to increase in volume, produces very intense pain and is associated with the appearance of fever and purulent secretions (symptoms that indicate the probable evolution of inflammation in an abscess).
Treatment and Remedies
In most cases, bartholinitis is a transient disorder that tends to resolve within 3-5 days. On some occasions, however, inflammation can become complicated and result in the formation of a cyst or an abscess.
Different solutions can help alleviate discomfort and accelerate bartholinitis healing. Drugs are more effective in the early stages of inflammation.
Bartholinitis medications
To counter the acute inflammatory process in progress and limit its symptomatology, bartholinitis involves a pharmacological treatment based on anti - inflammatories and analgesics . At the same time, the doctor can advise cleansing the inflamed area, morning and evening, with a liquid germicidal soap, specific for the intimate parts, until the symptoms improve.
If an infection is confirmed, the doctor may prescribe antibiotics, either taken orally, or be applied locally for 7-10 days.
Surgery: when is it necessary?
If bartholinitis persists despite treatment or recurs 2-3 times over the course of a year, a surgical approach should be considered. In particular, if the recurrent inflammation causes a serious symptomatology or tends to easily give rise to complications, the superficial incision, marsupialization or removal of the Bartholin's glands ( bartolinectomy ) is indicated. These interventions are followed by a brief period of therapy with a local antibiotic and the possible reconstruction of the normal anatomy of the affected lip. The ideal is to carry out these procedures in the post-acute phase of inflammation, that is when the signs of inflammation are no longer present.
IN CASE OF RECIDIVES:
- Marsupialization consists of a small incision in the gland affected by the pathological process and in the externalization of its walls; in practice, the inner margins are sutured to the surface of the vulva to allow the emptying of the gland and a continuous drainage, so that the liquid can no longer stagnate inside. This procedure may require general anesthesia.
- Bartolinectomy is an extreme solution rarely adopted for persistent bartholinites with continuous production of pus, which cannot be treated differently. The intervention consists in the complete enucleation of Bartolini's glands. This procedure is performed under general anesthesia and involves a greater risk of bleeding or complications, such as scarring with vulvar deformity.
Remedies
When bartholinitis causes mild and bearable symptoms, it is possible to make hot-moist compresses or local sitz baths . The latter consist of local ablutions, with the immersion of the basin in hot water . The sitz baths have a calming effect and can be useful for reducing congestion in the inflamed area. The sitz baths are made in a container of a particular shape; alternatively, it is possible to dive in a bathtub, filled with water for a few centimeters.
In the case of bartolinite, the local sitz baths must be performed 2-3 times a day and, to be useful, they must last 10-15 minutes each. Sometimes, with this treatment, the inflammation disappears after 3-4 days. If the sitz baths are ineffective, instead, it is advisable to consult the doctor.
Prevention
Bartolinitis: can it be prevented?
- The most important bartholinitis prevention rule is the maintenance of good genital hygiene . Therefore, it is necessary to pay attention to an accurate and daily local cleaning and, especially in summer, to change underwear frequently.
- Another good habit to reduce the risk of incurring genital infections is to avoid the abuse of sanitary napkins and panty liners for the entire day, if not necessary. In fact, these hinder the correct skin transpiration. For the same reason, the use of tight clothes made with synthetic fibers is not recommended: the continuous rubbing of the fabric on the skin can predispose to local irritations.
- Another useful preventive measure for bartholinitis prevention is the use of a condom whenever there is a cohort relationship with the partner. In fact, practicing safe sex can help reduce the chances of developing a Bartolini's gland infection.
