Generality
Bartolini's glands are two small oval structures, belonging to the external female genital apparatus .
These glands are located in the posterolateral portion of the vaginal opening, at the level of the lower end of the skin folds (or lips) of the vulva.
Bartolini's glands may be affected by inflammatory processes ( bartolinite ), during which they increase in volume and become painful. When the channels from which the lubricating liquid flows are obstructed, cyst formation may result. The latter can remain for a long time asymptomatic, but, if they become infected, they evolve into abscesses (saccular formations containing pus).
The pathological conditions affecting the Bartolini glands require the evaluation of the gynecologist, who can carry out the correct diagnostic classification and indicate the most appropriate treatment for the case.
What are
Bartolini's glands are two ovaloid or roundish structures, located deeply and symmetrically arranged (one on each side) near the lateral and posterior wall of the vaginal orifice. These formations are very small (rarely exceeding 1 cm in diameter) and not palpable (except in the presence of diseases or infections).
Through a narrow excretory canal, about 1.5-2 cm long, the glands flow to the sides of the vestibule of the vagina, on the surface of the vulva. More precisely, Bartolini's ducts open at the level of the furrow formed by the small lips laterally and by the hymen (or its residues) medially.
Functions
Bartholin's glands secrete a mucous substance that helps maintain lubrication of the vaginal canal when a woman is sexually aroused.
During intercourse, a small amount of this thick, viscous and transparent liquid can help to moisten the opening of the vagina, making sexual intercourse more comfortable.
Bartolini's glands change their structure with age: in young girls, they have small dimensions (since they are not yet functioning in this period), while in sexually active adult women they reach their maximum volume. These structures then undergo a progressive involution and, after menopause, are atrophic.
Bartolini's glands are also called major vestibular glands, to distinguish them from other glandular structures, of smaller dimensions, which are scattered in the lower part of the female genital tract. Among these are the Skene glands, located near the distal urethra, in the upper zone with respect to the vaginal introit.
Like Bartholin's glands, in a state of sexual arousal, Skene's glands begin to secrete a fluid that appears to contribute to vaginal lubrication during copulation.
Diseases and Disorders
Bartholin's glands may be involved above all in inflammation and cyst formation; these problems are common in women of reproductive age, particularly between the ages of 20 and 30. In some cases, however, these structures may be affected by serious infections and neoplastic processes.
Generally speaking, it is important to maintain proper intimate hygiene, have protected sexual intercourse and consult your doctor when you notice lumps and inflammations in the genital area. The goal of any treatment is to preserve the gland and its function whenever possible.
Bartholinitis
Bartholiness is an inflammation that can affect only one or both of Bartolini's glands. Usually, the process involves a swelling of the lower third of the labia majora, associated with acute pain, redness and tension of the overlying skin. Other often related symptoms are weight loss in the lower abdomen and local itching.
Bartholiness is usually caused by a vaginal infection ( vaginitis ). The factors predisposing to inflammation of Bartolini's glands include poor hygienic conditions, sexual relations, the inability to wash for a long time and the excessive use of synthetic underwear or tight-fitting clothes that cause rubbing.
The simple inflammation of Bartolini's glands can be transient and resolves within 3-5 days. In several cases, however, the pathological process can give rise to the formation of a cyst.
Once it is ascertained that it is bartholinite, therefore, the doctor can prescribe a pharmacological-type treatment based on anti-inflammatories (to counteract the acute inflammatory process in progress) and, possibly, antibiotics, both orally and through the use of ointments to be used locally. If the inflammation returns two or three times over the course of a year, surgical removal of the involved Bartholin's glands may be indicated.
cysts
Bartholin's gland cysts are the most common vulvar cystic formations : this condition affects about 2% of women, usually between 20 and 30 years of age. With time (menopause), on the other hand, the condition is less likely to manifest.
The disorder occurs following an obstruction of the ductus of Bartolini, which causes the enlargement of the gland due to the stagnation of mucus, from which follows the formation of a cyst. The reason why the fluid produced by the glands cannot flow normally is not always known; rarely, cysts result from an ongoing infection, a sexually transmitted disease (such as gonorrhea and chlamydia) or from the congenitally abnormal development of genital tract tissues.
Frequently, cystic formations are asymptomatic; however, larger cysts can cause an annoying sensation, especially during walking and sexual intercourse. In addition, larger lesions can be associated with tenderness, vulvar irritation and dyspareunia.
Most of Bartolini's cysts are unilateral and palpable near the vaginal orifice; when they are large, these formations extend the large lips of the affected side and cause a vulvar asymmetry. Furthermore, if cysts are affected by an infectious process, very intense pain and fever may occur.
The evaluation of the condition includes a specialist medical examination. The differential diagnosis is made with other cystic and solid lesions of the vulva, such as the epidermal inclusion cyst (round and asymptomatic bulges located in the labia majora), the papillary hydroadenoma (benign neoplasm that derives from the sweat glands, located above all in the small lips), fibroma and lipoma.
Generally, Bartolini's gland cysts do not need treatment when they are of modest size, do not cause discomfort and are not subject to infection. On the other hand, if the lesion becomes symptomatic or abscess, instead, drainage (incision of the gland), with or without complete enucleation of the gland (bartolinectomy) may be necessary.
The prevention of complications affecting Bartolini's cysts involves bathing in warm water, to be performed several times a day, soaking up to the pelvis.
Abscesses
When the liquid contained within a Bartolini cyst becomes infected, an abscess may form (pus collection following the penetration of some germs). This becomes very voluminous (it can reach the size of a walnut), besides causing intense pain around the gland and secretions (usually yellowish). In some cases, there may also be some fever lines.
Abscesses affecting Bartholin's gland are often polymicrobial; the most frequently isolated pathogens are Escherichia coli, Neisseria gonorrhoeae and Chlamydia trachomatis .
This pathology makes it necessary to resort to antibiotics prescribed by the doctor and to drainage to favor the escape of the purulent material. This approach allows a sudden improvement of vulvar pain.
In case of relapses, marsupialization may be indicated, ie the gland is incised and left open to allow continuous drainage and prevent the liquid from stagnating inside; after surgery, the walls of the abscess cyst retract, leaving a new orifice for secretions. Alternatively, it is possible to proceed with surgical removal of the infected cyst by bartolinectomy .
tumors
Vulvar tumors rarely originate in Bartolini's glands.
In general, primitive carcinoma occurs in post-menopausal women, due to the transformation in the neoplastic sense of the epithelial components of the gland. However, the tumoral pathology of Bartolini's glands can occur in young women, being sometimes related to human papillomavirus infection.
Other risk factors include intraepithelial vulvar neoplasia (VIN), genital lichen sclerosus, squamous hyperplasia, vaginal carcinoma and chronic granulomatous disease.
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.
Considering that Bartolini's glands undergo an involution in menopausal or peri-menopausal women, the appearance of a vulvar mass requires an excisional biopsy to exclude the presence of a malignant process.
The therapy involves surgical excision of the local tumor and dissection of the inguinal and femoral lymph nodes. These approaches are sometimes associated with post-operative radiotherapy and chemotherapy.
General prevention
- The first and most important rule of prevention of inflammation and cysts of Bartolini's glands is the maintenance of a 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 whole day, if not necessary, since they do not allow the correct skin perspiration. For the same reason, the use of synthetic clothing and particularly narrow underwear is not recommended: the continuous rubbing of the fabric on the skin can cause local irritation.
- Practicing safe sex - using, in particular, a condom whenever you have intercourse - can help reduce the chances of developing a cyst infection and the formation of an abscess of Bartholin's glands.
