Bartholinitis is a process of serious inflammation that occurs in the area of the Bartholin gland, which is located in a woman on the eve of the vagina. As a rule, such inflammation is unilateral.
In most cases, it is caused by infections such as gonococcus, staphylococcus, trichomonas and E. coli, which can be extremely dangerous during pregnancy.
The penetration of any infection through the important excretory duct of the gland always leads to serious blockage and a false abscess. Often, such inflammations pass into the parenchyma, when all the released fluid is purulent in nature. In this case, the formation of a true abscess is diagnosed. In extremely rare cases, dangerous suppuration may not be observed at all, but the gland will be dense and enlarged. After a certain period of time, the disease will resume only with serious complications.
The release of purulent contents, in other words, self-opening of the abscess, significantly improves the well-being of a particular patient. But during pregnancy, it can cause serious consequences. Without treatment, a relapse of this disease is not ruled out, as well as the risk of transition of bartholinitis into a dangerous chronic form. The presence of any sexually transmitted infections during pregnancy in almost all cases has an extremely adverse effect on the fetus itself.
In some cases, the protective mechanisms existing in the body of the expectant mother do not help at all. The baby can be infected by the hematogenous method directly through the blood inside the mother’s womb. The blood infected with the infection first enters the placenta, and then through it and into the umbilical cord, after which the body of the fetus becomes infected. Serious infection of the fetus with gonococcus or Trichomonas is considered dangerous, since inevitable changes may begin during the formation of the organs and systems of the child themselves.
As a rule, only infection in the period from 5 days to 13 weeks from the moment of conception leads to the death of the fetus. During this period, any pathogenic microflora is detrimental to the child. If, with bartholinitis, the expectant mother does not go to the doctor, then serious complications of pregnancy with various vaginal infections are not excluded. Individually with each patient, the doctor raises the question of terminating the pregnancy or treating the woman.
Causes of bartholinitis
It has been proven that the factors that provoke the development of bartholinitis can be a wide variety of microorganisms that penetrate the tissues of the Bartholin gland under certain conditions. The disease develops in case of penetration of various microorganisms into the gland, located on the eve of the vagina, through the excretory duct. The duct always opens only on the inner surface of the labia minora.
Usually, all infectious agents – microbes enter immediately into the gland from the urethra or vagina. Harbingers of bartholinitis can be urethritis and colpitis. Very rarely, the cause of bartholinitis is infection directly through the blood.
The most dangerous pathogens include microbes such as chlamydia, staphylococci, streptococci, gonococci, E. coli and Trichomonas. The most severe and dangerous course of this disease often develops due to a typical gonorrheal pathogen.
There are also other contributing factors. Bartholinitis can occur due to hypothermia, neglect of the basic rules of personal hygiene, stress, weakened immunity, beriberi, sexual intercourse during heavy monthly bleeding, promiscuity with a large number of men, sexually transmitted diseases, and also due to complications after abortion and various uterine surgeries.
Symptoms of bartholinitis
According to the clinical course, the disease is mainly distinguished by the following types – acute and chronic. Usually, with acute bartholinitis, there is always a general malaise, fever, body weakness, swelling in any area of the external genital organs.
For the development of the disease, favorable conditions are violations of the outflow of the secretion of the gland, which is usually observed due to the narrowing of the excretory duct. It should also be noted discomfort and soreness in the genital area, and severe suppuration with the typical formation of an abscess of the gland.
In various cases, the chronic course of bartholinitis occurs without pronounced main symptoms. However, during exacerbations during hypothermia of the female body, during menstruation or after illnesses, typical chronic bartholinitis becomes painful. At the same time, patients begin to be very disturbed by small pains in the labia, discomfort during intercourse, and even rather unpleasant sensations when walking.
In the absence of the necessary treatment, chronic bartholinitis turns into the formation of a cyst, and inflammation has a repeated repetition. Some pregnant patients try to squeeze out such an abscess on their own. Such a procedure at home can be extremely dangerous for both the woman and the fetus. Even a spontaneous breakthrough of an abscess does not guarantee its complete emptying, therefore modern surgical intervention is mandatory.
Treatment of bartholinitis
Proper diagnosis of the presented disease allows you to carry out therapy without delay. It should be noted that the ability of the Bartholin gland to penetrate modern antibacterial drugs is quite poor, as a rule, the complete cure of dangerous bartholinitis in pregnant women is gradual, the disease directly depends on the stage of the disease.
In acute bartholinitis, it is recommended to observe bed rest, abstain from sexual activity for a long time, and with severe pain, you can put ice on a specific inflamed area. Antibacterial therapy includes such groups of drugs as cephalosporins, penicillins, fluoroquinolones and imidazoles.
Anti-inflammatory therapy is based on treating the inflamed area with a special ointment (for example, Vishnevsky), as well as applying small swabs with ichthyol ointment or levomekol. You can use solutions with chlorhexidine or miramistin. However, only a doctor should prescribe treatment, who will accurately determine the stage of the disease. Often, due to the rapid progression in pregnant women, standard surgical intervention is used.
For the treatment of Bartholin gland cysts, marsupialization and extirpation are used. Marsupialization is the surgical opening of the cyst capsule, which is filled with pus, using a simple linear incision. In this case, the edges of the capsule are always sutured to the very edges of the skin wound. This allows you to form the desired outer hole. In the future, a drainage tube or catheter is quickly inserted through it to create an artificial duct of the gland, as well as an obligatory outflow of the contents of the cyst.
After such a procedure, there is usually a significant narrowing of a typical external opening and the obligatory formation of a new excretory duct. Another method – extirpation is always performed if a relapse of the disease occurs. In this case, when performing the necessary longitudinal incision of the labia minora, the gland is easily separated with a scalpel and then removed. After removal, interrupted sutures are applied to the wounds using a catgut thread.
After surgery, a pregnant woman should refrain from sexual intercourse until the disease is completely cured. If necessary, the doctor will prescribe physiotherapy and magnetotherapy, as well as modern ultraviolet irradiation.
[Video] Obstetrician-gynecologist Svidinskaya M.V. — causative agents of bartholinitis, types, complications, methods of treatment: