A woman's Bartholin glands are located at the entrance to her vagina, one on each side. The glands are small, and may not be seen or felt when they are healthy. The function of the glands is to secrete fluid onto the mucosal, or inner, surface of the labia surrounding the vagina.
Issues with the Bartholin glands involve either abscesses, which are infections of the gland, or cysts, which are enlargements of the gland. Only one of the two glands is usually affected.
Women develop a Bartholin cyst when the duct exiting their Bartholin gland becomes blocked. Accumulation of the fluid produced by the gland develops, causing the gland to swell, forming a cyst. Should the cyst become infected, and abscess occurs. A Bartholin abscess may be caused by a number of different forms of bacteria, to include bacterial organisms which cause sexually transmitted diseases such as gonorrhea or chlamydia, or the bacteria that is commonly found in the intestinal tracts such as E. Coli. It is not unusual for a Bartholin abscess to involve more than one type of organism.
A Bartholin will cause swelling of the woman's labia on one side near to the entrance of her vagina. The cyst is usually not too painful. Significant pain is suggestive that an abscess has developed. Large cysts can be painful simply because they are large. A Bartholin abscess can cause a significant amount of pain in addition to the swelling the woman experiences. The swollen area is very tender and the skin becomes extremely reddened. Women experiencing an abscess may find both sitting and walking to be very painful. While women with a Bartholin abscess usually do not have a fever, vaginal discharge can be present, particularly if the infection is caused by a sexually transmitted organism.
Exams and Test
A diagnosis of a Bartholin cyst or abscess is generally made through a physical examination, with no additional testing required. At times, a culture is taken in order to determine the type of bacteria that has caused the infection. The culture involves using a swab of the material that has drained from the abscess, or from another area such as the woman's cervix. The results of the test are commonly available around forty-eight hours later, and do not cause an immediate change in the form of treatment. The test results might indicate the need for additional treatment with antibiotics.
Knowing when to seek medical attention is important in relation to Bartholin cysts. If a genital lump or mass continues to grow, or doesn't improve within a few days, it is time to see a doctor. If the lump or mass becomes painful, it suggests that an abscess has developed which needs to be drained. Other symptoms, such as fever, vomiting, or vaginal discharge, are also reasons to call a doctor. The primary reason to seek medical attention in relation to Bartholin cysts and abscesses is acute pain. Women who are unable to either sit or walk comfortably should call a doctor as soon as they can. While a fever and abdominal pain are not usually caused by Bartholin abscesses, it is important to seek medical attention if these symptoms arise.
Home treatment of Bartholin cysts and abscesses involves the use of sitz baths, something that promotes drainage. The simplest method available is to sit in a bathtub with a few inches of warm water, although there are specialty sitz bath basins available. The water in the bathtub should only be hot to the point where it does not burn the skin. The soaks should last for ten to fifteen minutes each, three or four times per day. Many times, this form of treatment is all that is needed for Bartholin cysts. Abscesses; however, may require drainage by a doctor. Recurrent cysts may require administration of antibiotics in conjunction with sitz baths.
Abscesses that are infected are in an enclosed space and antibiotics do not enter the space adequately. Treatment of a Bartholin abscess nearly always requires drainage, which can be done in either a doctor's office, or in a hospital emergency room. A local anesthetic is injected over the abscess, and an incision is made on the inner surface of the entrance to the woman's vagina. Once the infected material has been drained, the abscess cavity is packed with gauze or a small catheter, holding the cavity open to promote additional drainage. The packing is removed about twenty-four to forty-eight hours later, although if a small catheter is used it will be left in place for several weeks in order to minimize the chance of a recurrence.
Local anesthetics do not always work well in tissues that are inflamed, meaning that drainage of an abscess may be uncomfortable. A doctor might prescribe medications for sedation, as well as for pain relief during the procedure, depending on the preferences of the woman and her doctor. Once the abscess has been drained, antibiotic treatment is usually not needed. If there is evidence of a vaginal infection, urinary infection, or sexually transmitted disease, a doctor may prescribe an antibiotic.
When a recurrent Bartholin cyst has cooled off, there is a procedure referred to as, 'marsupialization,' that may be performed. The procedure is commonly done on an outpatient basis in a surgical setting. An incision is made into the skin over the cyst, then down into the cyst wall. The incision drains fluid from the cyst, after which the lining of the cyst wall is stitched to the overlying skin in order to create a permanent drain site with the intention of preventing the recurrence of the cyst. Most women feel much better twenty-four hours after drainage of a Bartholin abscess.
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