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The greater vestibular gland (Bartholin’s) is a small lump that can be easily felt on the labia majora. It is responsible for the production of secretions that appear during sexual arousal, thanks to which it moisturizes the vaginal vestibule and facilitates intercourse. The cyst of this gland is formed when the tubules that drain the mucus are blocked.
What are the greater vestibular (Bartholin) glands?
Bartholin’s glands are located inside the labia majora (in their middle-lower part). They are primarily responsible for the production of mucous discharge that flows through the lines leading to the side walls of the vaginal vestibule. It is thanks to this that the entrance to the vagina is moist and slippery during sexual arousal. The formation of a cyst means that the secretion cannot be secreted, which in turn causes abscesses to form in this place.
Vestibular gland cyst – causes
If the gland ducts are blocked, it will form a cyst or abscess. These are the most common diseases of the Bartholin gland. They mainly occur in women between the ages of 20 and 40, who have disturbed the bacterial flora of the vagina. Change is usually one-sided.
Both in the case of a cyst and an abscess, the exit ducts are closed. Blockage can be caused by an accumulation of epithelial cells or bacteria, for example. As a result, the mucus produced by the vestibular glands builds up in their lumen, forming a cyst. If bacteria (superinfected cyst) get inside, an abscess will form.
The cyst is a non-inflammatory lesion – hence it is also painless. It may not cause any discomfort. Sometimes cysts – if they are small – empty themselves and then reabsorb. In the case of large cysts, the only option is surgical treatment (enucleation). You may feel moderate pain after such surgery. Often there is also swelling and hematomas that will disappear once the wound heals.
A gland abscess is an inflammatory lesion. It is the result of bacterial superinfection of the cyst by staphylococci, streptococci or cocci. Therefore, its occurrence is accompanied by pain (increasing when sitting or walking) and swelling. Occasionally a fever may occur. Sometimes abscesses rupture on their own. If this does not happen, the abscess should be cut by a doctor. If it turns out that the infection was caused by gonococci, your doctor may advise you to take antibiotics.
Diagnosis and treatment of Bartholin’s cyst
Larger (small) vestibular cysts are usually diagnosed by a gynecologist through endoscopy. However, when it becomes large, e.g. a chicken egg, a woman herself is able to sense the change with a disease around the vaginal opening.
Treatment of large cysts
1. The first way is surgical enucleation of the cyst (completely) together with the secretion inside. Unfortunately, the healing of the wound is a bit painful because the cyst is very much innervated. The enucleation procedure is performed under general anesthesia and takes about 30 minutes. After the procedure, patients may be hospitalized for up to a week. It is recommended to rest and avoid physical exertion. In addition, patients should not lift heavy objects after surgery to avoid vaginal bleeding.
2. The second way is marsupialization of Bartolini’s cyst. It is a procedure aimed at opening and cleaning the inside of the resulting cyst. After cleaning the lesion, the doctor sews the gland walls to the skin at the border with the vaginal vestibule. This procedure is aimed at enlarging the mucus outlet and preventing recurrence of symptoms. Similarly to enucleation, this procedure takes about half an hour, but with the difference that it is performed under local anesthesia or a short intravenous general anesthesia. Women after such procedures can leave the hospital on the same day. Post-operative recommendations include: doing a sitz bath after each bowel movement (preventing infection), taking a shower instead of bathing, using pads instead of tampons (preventing infection). You should also refrain from intercourse (it is worth asking your doctor).
3. The most recent treatment for Bartholin’s cyst is the use of a silicone balloon drainage catheter. The catheter is inserted under local anesthesia, there is no need for further hospitalization.
Can cysts and abscesses be prevented?
So far, no effective methods have been developed to prevent the formation of Bartholin’s gland cysts or abscesses. Of course, it is important to follow the rules of personal hygiene. It is also good to do the so-called a sage soup or use a liquid for intimate hygiene (preferably containing lactobacilli).
Text: lek. med. Matylda Mazur