Bartholinitis

Synonyms in a broader sense

Inflammation of the Bartholin's glands
English: bartholinitis

definition

Bartholinitis is a unilateral inflammation of the Bartholin glands (Glandula vestibularis major) of the labia majora.
Bartholin's glands are responsible for the secretion of secretions into the vagina, for moistening the vaginal entrance and for moistening during sexual intercourse. If the secretion of the Bartholin gland is prevented by a blockage of the gland outlet, the secretion builds up and a Bartholinitis cyst develops. The cyst can be the size of a tennis ball.

introduction

Bartholinitis is a mostly very painful bacterial inflammation of the Bartholin glands (Glandulae vestibularis majores) or their execution courses.
These denote small glands in the back third of the large labia, the ducts of which open into the vaginal vestibule on the inside of the labia minora.
Their job is to create a secretion that moistens the vagina during sexual intercourse. Bartholinitis usually leads to obstruction of one of its ducts, which means that the secretion can no longer flow off efficiently. The result is a backlog of secretions and an inflammation of the gland.

Intestinal bacteria (E. coli) responsible, in rare cases also gonococci (Gonorrhea, gonorrhea) or staphylococci. If the inflammation spreads to surrounding tissue, abscess formation occurs (also Called Bartholin empyema) and in the absence of therapy to chronic cysts. Therapeutically, the abscess can be split and sutured open. Alternatively, hip baths, compresses and antibiotics have a supportive effect.

Epidemiology

Are only affected Womenwho are at sexual maturity, but mostly between the ages 20 and 30 years of age.

Is Bartholinitis Contagious?

Bartholinitis is rarely contagious, as it is mostly harmless bacteria that cause the inflammation.
As long as the abscess is closed, no pathogens can be transmitted to the partner. Nevertheless, it is advisable to avoid intercourse for a few days in order to improve intimate hygiene and the healing process.

If, however, gonococci or a chlamydial infection are the cause of bartholinitis, drug therapy should be started as a matter of urgency and intercourse should be avoided during this time. Since both gonococci and chlamydia are highly contagious and are transmitted through sexual intercourse, the partner should be treated with medication in these cases. This can lead to disease complications and repeated mutual infection ("Ping pong effect") between partners.

root cause

The most common causes of bartholinitis are bacteria. They enter the Bartholin's gland via the vaginal entrance and can cause inflammation there. This inflammation can lead to the entrance of the Bartholin gland being blocked and the secretion to build up in the Bartholin gland and the formation of cysts.
All types of bacteria that can enter the body can cause bartholinitis. The human body is colonized with bacteria in some areas of the body, which are present there but do not make you sick. For example, if these bacteria get to places - in this case in the Bartholin's gland - where they don't belong due to poor hygiene, they can possibly trigger a disease there. Such pathogens would be Escherichia coli (E. coli - in the intestines) and Staphylococcus areus (on the skin and respiratory tract). Likewise, a pathogen can be transmitted through traffic, reach the Bartholin glands and trigger Bartholinitis. One such bacterium is, for example, the Neisseria gonorrhoeae (Synonym: gonococci; Causes of gonorrhea).
Excessive hygiene can also lead to bartholinitis.Continuous use of non-pH-neutral care materials in the intimate area can disturb or even destroy the acidic environment of the vagina. And if bacteria get into the Bartholin gland at the same time, it could also cause Bartholinitis.

Symptoms

Typical signs of inflammation are always the following: swelling, redness, overheating and pain. These properties are decisive for every inflammation in the body and they are used to characterize inflammation to this day. These symptoms also occur with inflammation of the Bartholin's gland, known as bartholinitis. Even if these signs are usually clear, their extent is very different.

Also read on this topic: Swelling in the vaginal entrance

Bartholinitis initially begins with a slight inflammation, which is accompanied by minor pain in the vaginal area. The stronger the inflammation, the more intense the pain becomes, in parallel with the growth of the Bartholin's cyst complaining about. If the inflammation is very pronounced (Bartholinitis cyst), sitting or walking can cause pain.

It is not uncommon for women to only notice the inflammation during sexual intercourse before it either heals on its own or can progress further and further within a short time and the symptoms become increasingly severe. Depending on whether only one or both glands are affected, the pain on both sides or only on the back of the affected labia and around the vaginal entrance can be felt. If both labia are affected by the inflammation, the pain also occurs on both sides of the labia and around the vaginal entrance.

As mentioned for the typical signs of inflammation, the inflamed and reddened gland and the surrounding, swollen tissue are classic. The swelling occurs to a greater extent when the duct is blocked by adhesions, the pus inside the gland cannot drain, backs up and pressures the surrounding tissue. The constriction puts additional stress on the surrounding tissue and every minor touch leads to pain. Physiologically, the Bartholin's gland is only the size of a bean, but can grow to the size of a table tennis ball due to the inflammation and the backwater.

If the pus does not flow in any direction, a coarse, elastic abscess can develop, which can be as large as a hen's egg and usually has to be split open by a doctor with a scalpel. This accumulation of pus in the end piece of the gland is called empyema in technical terms.

Bartholinitis should not be confused with a urinary tract infection that causes discomfort in the anterior vaginal area. If, in very rare cases, bacteria or their metabolic products get into the bloodstream in bacterial bartholinitis, fever and flu-like symptoms can also occur. With these symptoms, other diagnoses must always be considered and excluded, such as the above-mentioned urinary tract infection with an inflammation of the renal pelvis or an inflammation of a hair follicle of the pubic hair (= boils), as these clinical pictures can all cause similar complaints.

Read more on the topic:

• Bartholinitis symptoms
• Pain in the labia / clitoris

diagnosis

There one Bartholin's cyst a particular Size and redness usually just look at the cyst. Palpation can be used but is not done because of the pain.
The secretionthat flows out of the Bartholin's cyst is transferred to the Pathogen in the laboratory (Creation of a bacterial culture) examined. Because only in this way can the therapy be aligned accordingly.

treatment

In the early phase of Bartholinitis, local treatment with vaginal creams, vaginal tablets and hip baths with certain additives (Disinfectant) the cyst can subside.
Another treatment method would be antibiotics. Which antibiotic treatment is used depends on the bacterium and should also cause the cyst to subside. The administration of antibiotics should also prevent the inflammation from spreading. If the creams and antibiotics are no longer sufficient, the surgical method (Marsupialization) be applied. Under anesthesia, incision (Incision) the Bartholin's cyst caused the pus to flow out and then the cyst wall was sewn to the outside with the surrounding area. This will keep it open and allow the cyst to dry out. After a certain time, the sutures are pulled and the opening closes again through the healing of the wound.
If the acidic vaginal environment is out of balance, lactic acid ovules (Lactobacilli; Vagiflor) balance to be restored.

Read more on the topic: Bartholinitis treatment

Can you or should you treat Bartholinitis yourself?

There is a tendency to treat mild forms of Bartholinitis yourself without antibiotics or a visit to a doctor / gynecologist. However, if the inflammation is already advanced and complications of a Bartholinitis such as empyema or an abscess develop, then a doctor or gynecologist must be consulted immediately, because the abscess can gain access to the bloodstream. This paves the way for the infection to spread throughout the body and can have serious consequences.

In the early stages, you can try "home remedies" to treat the inflammation yourself in order to prevent the inflammation from spreading to the entire gland. This is the case if the symptoms are limited to slight pain in the back third of the vagina, a slight reddening with / without overheating in this area, and a small swelling in the area of ​​the reddening. It is important that there is no fever, general fatigue or swollen lymph nodes in the groin area. If the symptoms do not get better within 1-2 days with self-treatment, or if they even worsen, a doctor / gynecologist should be consulted. In these cases, the inflammation has already spread and treatment with antibiotics or other measures may be required.

Important signs that the inflammation is spreading are greater pain in the labia area than it did at the beginning. These can cause problems when sitting in particular. In addition, there is a swelling of the labia up to the size of a hen's egg, which can be red and overheated. Fever, fatigue and swollen lymph nodes can also occur at an advanced stage and are signs to be taken seriously.

Read more about this under Symptoms of Bartholinitis

Home remedies

On the one hand, disinfecting hip baths, for example with chamomile or sea salt (10-50g / liter of water) can be recommended. Chamomile and also sea salt have anti-inflammatory effects and at the same time can inhibit the spread of bacteria. It is recommended to put approx. 40-50g of chamomile flowers in a pot filled with half a liter of water and then to boil this mixture. After the water has boiled, remove the saucepan from the stove and let it steep for 10 minutes. Then filter the water through a sieve and pour the brew obtained into a seat tub with pleasantly warm water.

Then take a hip bath for about 10 minutes. It is important to ensure that the inflamed areas are adequately surrounded by water. If necessary, you can carefully dab the affected areas with the solution with a soft cloth. The baths can be carried out several times a day. Particular attention should also be paid to vaginal hygiene during the acute phase. This includes, for example, the use of a pH-neutral washing lotion for intimate hygiene instead of conventional soap. Care should also be taken not to wear too tight and synthetic underwear. In addition, it can help to forego sexual intercourse, as on the one hand it additionally irritates the already irritated tissue and on the other hand it can transport further germs into the inflammation area. Local cooling of the overheated area in the area of ​​the inflammation is another option to treat the inflammation.

Hip bath

Prophylactic measures can be taken in the event of painless lumps or swellings on the labia. Precursors of Bartholinitis) Hip baths with chamomile or Salt water apply.
Ten minutes a day is enough for this. Salt water (approx. 200g / session) and chamomile have an anti-inflammatory and disinfectant effect. For mild forms of Bartholinitis, good intimate hygiene, anti-inflammatory ointments and hip baths with disinfecting substances such as Betaisadona solution (Polyvidon iodine); Chinosol (quinolinol solution) or Serasept (polihexanide solution).
These, if used regularly, can avoid surgery. However, if the symptoms worsen or the fever rises, a doctor should be consulted as a matter of urgency and the bartholinitis treated surgically.

Treatment with an ointment

In the early stages of bartholinitis in which only the ducts are blocked and no pus has yet collected, antibiotic or anti-inflammatory ointments help in addition to good intimate hygiene and hip baths.
A gynecologist should be consulted for this.

Tea tree oil

Tea tree oil has an antimicrobial effect against bacteria / fungi and can have an anti-inflammatory effect. Tea tree oil is now used in alternative medicine, among other things. Used to treat skin infections, warts, acne and pimples. It is also used to treat wounds. It is used in the cosmetics industry. Despite its antimicrobial and anti-inflammatory effects, contact eczema is often discovered on the skin after using tea tree oil. Especially undiluted, tea tree oil seems to have a harmful effect on health due to the side effect profile. In particular, the use on the mucous membranes in the genital area is to be assessed as counterproductive. As a result, the oil is not recommended for the treatment of bartholinitis.

Read more about this under Tea tree oil

Homeopathy for Bartholinitis

Who on Antibiotics or if you want to avoid other anti-inflammatory ointments and solutions, you can also use homeopathic anti-inflammatory agents.
Typical active ingredients that are used in homeopathy are for acute bartholinitis Hepar Sulfur C15 and Pyrogenicum C9. With chronic bartholinitis you can Conium 15 and Staphisagria 15C use.
For acute Bartholinitis, take 5 globules twice a day over a period of 5 months. In chronic bartholinitis, i.e. if the infection recurs; take 5 globules daily for a period of 2 months. If there is no improvement despite homeopathic treatment, the inflammation must be surgically repaired.

Differentiation from a cyst

A cyst is not to be confused with an abscess or empyema due to accumulation of pus during acute inflammation.

The abscess is an accumulation of pus in the Bartholin's gland caused by backwater. However, a cyst simply describes a cavity that is filled with fluid; there is no inflammation here. The cyst is the result of repeated inflammation of the Bartholin glands, which is the link to the abscess and Bartholinitis. Due to the constant inflammation and adhesion, the architecture within the cyst changes. Cavities form in which, after the inflammation subsides, the normal gland secretion, which is normally used to moisten the vagina, collects. It is not uncommon for the duct to be changed to such an extent after recurring inflammation that no secretion can be given off at all. Due to the backlog of the secretion, cysts can develop up to the size of a chicken egg.

In contrast to the abscess, which is a sign of acute inflammation, the cyst lacks classic signs of inflammation, as it is not an expression of the inflammation. The cyst can be felt as a spherical, plump accumulation of fluid in the labia. In the vast majority of cases, there is no reddening or pain in a Bartholin's cyst. In addition to the palpable accumulation of fluid, the problem of a cyst is that it can represent a reservoir for bacteria that feel very comfortable in the cyst. Typical germs are the known pathogens of cystitis such as coli or rod bacteria. Normally, the outflow of secretion prevents bacteria from rising into the gland or washes it out. If this drainage is missing and the bacteria can multiply undisturbed in the cyst, a cycle with recurrent inflammation of the Bartholin gland can arise, creating new cysts in which bacteria cavort, which in turn lead to even stronger infections.

In order to interrupt this cycle, a Bartholin's cyst is usually opened, emptied or even completely removed in cases of repeated inflammation. If possible, this small operation is performed at a time when the cyst is not inflamed, because interventions in inflamed tissue have a greater risk of complications such as wound healing disorders or renewed inflammation. Small cysts that do not restrict or bother affected women in any way or hardly become inflamed can, however, be left without therapy. Sitz baths and hygiene in toilets can also reduce the risk of bacteria getting into the vaginal entrance and rising up into the gland.

Read more on this topic: Bartholin's cyst

When do you need an operation?

If the home remedies no longer help and the antibiotic therapy initiated by the doctor / gynecologist does not bring about sufficient improvement, the operation is a further therapeutic option. An operation is always necessary if the inflammatory, mostly purulent secretion builds up due to the closure of the outlet duct and a so-called empysema has developed which does not spontaneously open up (Spontaneous rupture). It can also happen that the inflammation spreads to the surrounding tissue and becomes encapsulated. Then one speaks of an abscess. Cystic healing of Bartholinitis with the formation of a retention cyst often requires surgical therapy.

Read more about this under Retention cyst

Abscess in the genital area

The abscess in the genital area can be a serious complication of bartholinitis. An abscess is an encapsulated space filled with purulent secretion (a mixture of bacteria, inflammatory cells and tissue fluid). Due to the surrounding capsule, antibiotics can no longer adequately reach the focus of the inflammation and work sufficiently.
Additionally, an abscess can gain access to the bloodstream and the inflammation can spread to other areas of the body.

An abscess almost always has to be surgically split so that the pus can drain away. The abscess in the genital area often shows itself as a prominent swelling with reddening, overheating and severe pain. At the same time, fever and a general feeling of illness as well as swollen lymph nodes often occur.

Risk factors that favor the formation of an abscess include Smoking, negligent personal hygiene, diabetes mellitus, circulatory disorders and a weak immune system.

Read more about this under Abcess in the genital area - what helps?

During pregnancy

During pregnancy you should always consult a doctor if you suspect Bartholinitis. Most of the time, antibiotics are used primarily directly. An abscess must also be split during pregnancy and, above all, prevent pregnancy complications. Effects on the child are sometimes rather unlikely and are rarely or never observed.