The greater vestibular gland and its diseases

Proven content

The greater vestibular glands, often better known as Bartholin’s glands, are inconspicuous paired structures in the female vulva that properly play a large role in sexual pleasure and, in pathological conditions, can cause the woman suffering and require medical intervention.

Where are they located?

The greater vestibular gland is located symmetrically, laterally in the rear part of the vestibule and the greater labia. It is similar in size to a bean. The main function of the gland is to produce and secrete mucus. Further, this mucus is transported through 2 cm long discharge lines to the vaginal vestibule. The work of the gland is regulated by the parasympathetic nerve, and it is activated during sexual arousal and excitement, and during sexual intercourse. The mucus itself is intended to moisten the vestibule and the vagina itself during the sexual act. Larger vestibular glands slowly disappear in women with age. This is physiology, but what about disorders and pathologies? What could be wrongs?

Inflammation of the Bartholin’s gland

As mentioned above, the gland openings are located in the vestibule of the vagina and, due to their location, are the gateway to frequent infections. The most common pathogens that infect the gland are staphylococci, streptococci and Escherichia colialthough most infections are of mixed etiology anyway. As a result of infection, inflammation and closure of the discharge canal, an abscess develops. The disease can appear at any age, but it is more common in young women. The abscess of the greater vestibular gland causes a visible bulging and reddening of the overlying skin. The size that it can reach can be considerable and may even be as large as a hen’s egg. The swelling affects the lower part of the labia majora, but very often it covers the labia minora and even bulges towards the entrance to the vagina. It causes discomfort or pain of varying intensity under pressure, especially when moving, sitting and walking. A woman with this condition simply feels bad.

Treatment of Bartholin’s abscess

It is important to self-monitor and see a doctor at an early stage when the first symptoms of inflammation in this area of ​​the vulva appear, because then there is a possibility of conservative treatment. Usually, administration of an antibiotic is sufficient, although sometimes neither antibiotic therapy, nor therapeutic baths are able to prevent the formation of an abscess. Unfortunately, the vast majority of women visit a gynecologist in such a late stage of the disease that a more decisive intervention is required. In such a situation, incision of the abscess and its surgical drainage are necessary, sometimes combined with excision of skin elements and the abscess. An abscess can also rupture and empty itself. Complementary treatment is the introduction of antibiotic therapy empirically, but preferably after determining the responsible pathogen in the study of purulent discharge.

In some patients, inflammation and / or abscess may recur chronically, even after surgical treatment.

Gland cyst

Blockage of the exit duct opening prevents the free outflow of the produced mucus, which in turn leads to the formation of a cyst. The cyst may be painless and can be felt at the back of the labia minora. It becomes painful when the cyst becomes overloaded or during intercourse.

The treatment of a Bartholin’s gland cyst consists in marsupialization, i.e. an appropriate incision of the cyst and suturing its fragments with the mucosa.

Gland cancer

However, it does not end with inflammation or an abscess. Much less often, neoplastic changes in the structures of the gland and cancer can occur. It is several times more common in postmenopausal women. What are the symptoms? It can very much resemble a Bartholin gland cyst or abscess, as the cancer initially manifests as a tumor in the vulva or as pain in the perineum. The cancer then causes ulcers as it infiltrates the skin. The remains of a functioning gland may secrete mucus that leaks over the surface of the lesion. Further, the tumor may infiltrate the vaginal wall.

How is it treated?

This cancer is extremely rare, therefore the therapeutic experience is limited. Nevertheless, the treatment of choice is surgical removal of the lesion with radical excision of the vulva along with the appropriate lymph nodes. Radiotherapy is the recommended complement to surgical treatment. The success of treatment depends on many factors, including the size of the tumor, its type, possible infiltration of other structures, and whether there are cancerous cells in the lymph nodes. As in all neoplasms, the later it is detected, the worse the prognosis is. Unfortunately, it is one of the late diagnosed ones, because women delay visiting the gynecologist for a long time, despite the appearance of very disturbing changes. The intimate area, the vulva, the vagina and the cervix are still taboo for many women. In this way, they risk their own health, and often their lives.

In any case of discomfort and pain in the intimate area, you should see a gynecologist. This is particularly important because not only is the period of development of a possible neoplastic process shortened, but most of all, the treatment brings relief to the suffering woman. The vestibular greater gland plays an important role in sexual life and any changes in it negatively affect the health and well-being of a woman and her relationship with her partner.

Literature:

1. Gynecology. JSBerek, E. Novak. Red. J. Kotarski. Medipage. Volume 4, 2008

2. Gynecology. JSBerek, E. Novak. Red. J. Kotarski. Medipage. Volume 2, 2008

3. Oncological gynecology Ed. J.Markowska Tom 1. Urban & Partner. 2006

4. Obstetrics and gynecology. Textbook for students. Ed. T. Pisarski PZWL 2001

5. Human anatomy. A. Bochenek PZWL 1998

6. Practical gynecology. Ed. W. Pschyrembel, F. Strauss, E. Petri. PZWL 1994