Bartholinitis | Clinique Omicron Quebec
Anatomy and Pathophysiology
Understanding the location and function of the Bartholin glands helps to grasp the mechanism of bartholinitis:
- The Bartholin's glands are about 0.5 to 1 cm in size and are located at the 4 o'clock and 8 o'clock positions on the vaginal orifice clock face.
- Each gland is connected to the vulvar surface by an excretory duct about 2 cm in length.
- Blockage of the canal, due to trauma, inflammation, or mucus thickening, leads to cyst formation.
- Bacterial colonization of the cyst triggers abscess formation with a buildup of pus under pressure.
- In the absence of drainage, the abscess can reach several centimeters and become very painful, making walking and sitting difficult.
Causes and infectious agents
Bartholinitis is most often polymicrobial. The responsible agents vary depending on whether it is an endogenous flora infection or a sexually transmitted infection:
| Category | Frequent agents | Context |
|---|---|---|
| Endogenous vaginal flora | Escherichia coli, streptococci, staphylococci, anaerobic bacteria (Bacteroides, Peptostreptococcus) | Most common cause, independent of sexual activity |
| Sexually transmitted infections | Neisseria gonorrhoeae (gonorrhea), Chlamydia trachomatis | Less frequent, but always to be ruled out by sampling in case of bartholinitis |
| Other agents | Mycoplasma hominis, Ureaplasma urealyticum, Trichomonas vaginalis | Agents less frequently involved, detected during expanded microbiological cultures |
| Non-infectious cause | Mechanical obstruction of the canal without secondary infection | Formation of a simple cyst, often asymptomatic, without inflammation or fever |
Risk factors
Certain situations increase the risk of developing bartholinitis or a Bartholin's gland cyst:
- History of bartholinitis or bartholin cyst: high risk of recurrence
- Recurrent or untreated genital infections
- Unprotected sex with multiple partners: increased risk of STIs
- Local trauma: waxing, shaving, micro-abrasions
- Inadequate vulvar hygiene: irritating products, douching disrupting flora
- Immunosuppression: HIV, poorly controlled diabetes, prolonged corticosteroid therapy
- Wearing too-tight clothing promotes maceration and local irritation
Symptoms
The clinical presentation varies depending on whether it is a simple uninfected cyst or a developed bartholin abscess:
| Stadium | Clinical presentation | Associated symptoms |
|---|---|---|
| Uncomplicated, non-infected cyst | Soft, rounded mass, painless or slightly uncomfortable to the touch, located at the base of a labium majus. | Often asymptomatic; sensation of discomfort during intercourse or walking if voluminous |
| Bartholinitis debutante | Progressive swelling, localized redness and warmth, pain on palpation | Discomfort when walking and sitting, slight sensitivity during intercourse |
| Bartholin's abscess formed | Fluctuating, very painful, red and hot mass, measuring up to 3 to 5 cm or more | Intense and pulsating pain, inability to walk or sit normally, possible fever, purulent discharge if spontaneous rupture |
| Recurrent bartholinitis | Recurrence of cyst or abscess in the months following a treated initial episode | Symptoms similar to previous episodes; scar tissue that may promote relapses |
Diagnosis
The diagnosis of bartholinitis is clinical in the majority of cases. Further examinations are indicated to identify the infectious agent and to rule out STIs or a tumorous cause:
- Complete gynecological examination: vulvar inspection and palpation, mass location and characterization
- Pus sample during drainage: aerobic and anaerobic bacterial culture for antibiogram
- STI Screening: NAT (nucleic acid amplification test) for Neisseria gonorrhoeae and Chlamydia trachomatis
- Blood count if fever or signs of systemic infection: complete blood count, C-reactive protein
- Blood glucose or HbA1c if it's the first episode in a woman with no history, to rule out diabetes as a contributing factor
- Biopsy of the cystic wall in any woman over 40 or in case of atypical recurrence
Treatments
Treatment depends on the stage of Bartholin's gland cyst. A simple asymptomatic cyst may not require immediate treatment, while a formed abscess requires surgical drainage.
| Treatment | Terms and conditions | Indications |
|---|---|---|
| Simple surveillance | Therapeutic abstention with reevaluation | Small, asymptomatic simple cyst in a woman under 40 years old |
| Warm sitz baths | Soak in warm water for 10 to 15 minutes, 3 to 4 times a day. | Cyst or early abscess; may promote spontaneous drainage and reduce inflammation |
| Antibiotic therapy | Amoxicillin-clavulanate, metronidazole, or doxycycline depending on the suspected or identified agent | Documented bacterial infection, associated STI, systemic signs (fever); antibiotics alone are not sufficient to drain a formed abscess |
| Incision and drainage and marsupialization | Surgical incision of the abscess and creation of a permanent opening for continuous drainage of glandular contents | Standard treatment for a Bartholin's abscess; performed in consultation or under local anesthesia depending on size and pain |
| Word catheter | Insertion of a small inflatable balloon catheter into the incised abscess, kept in place for 4 to 6 weeks for tract epithelialization | Alternative to marsupialization; less invasive technique, usable in an outpatient setting |
| Removal of the gland (bartholinetomy) | Complete surgical excision of the gland under general or regional anesthesia | Multiple relapses despite conservative treatments, suspected tumor lesion, refractory form |
Possible complications
In the absence of treatment or in case of inadequate management, several complications can arise:
| Complication | Description | Contributing factors |
|---|---|---|
| Abscess or cystic recurrence | Recurrence of cyst or abscess after treatment, related to recanalization or reinfection | Insufficient drainage, absence of marsupialization, immunocompromised host |
| Perivulvar cellulite | Spread of infection to surrounding soft tissues, with diffuse redness and hardening | Large undrained abscess, aggressive germs, immunosuppression |
| Necrotizing fasciitis | Severe and rapidly progressive infection of the deep fascia, which can be life-threatening. | Rare but very serious; favored by diabetes, obesity, and immunodeficiency |
| Persistent dyspareunia | Pain during intercourse related to scars or anatomical deformation after repeated infection | Multiple recurrences, iterative marsupialization |
| Undiagnosed ITS | Untreated gonorrhea or chlamydia may progress to upper genital tract infection (salpingitis, pelvic peritonitis). | Absence of systematic screening during the initial episode |
Certain situations require immediate medical attention: very large abscesses with disabling pain making it impossible to walk or sit, high fever with chills and general deterioration, rapid spread of redness and swelling beyond the vulvar region, or localized skin necrosis suggesting necrotizing fasciitis. These scenarios constitute surgical and infectious emergencies.
If these signs are present, call 911 immediately.
or go to the nearest emergency room without delay. For any abscess or painful cyst without signs of severity, a prompt consultation at Clinique Omicron is recommended.
Consult at Clinique Omicron
Clinique Omicron offers gynecological consultations for the assessment and management of vulvar conditions, including bartholinitis, at several service points in Quebec. A physician or nurse practitioner specializing (IPS) can examine the lesion, order appropriate microbiological samples, initiate antibiotic treatment if indicated, and refer to a gynecologist for surgical drainage or marsupialization if necessary. In-person and telemedicine consultations are available depending on your situation. To make an appointment at one of our branches in Quebec, visit cliniqueomicron.ca.
The content of this page is provided for informational purposes only and is not intended to replace the advice of a qualified healthcare professional. Consult a physician for any symptoms, questions or decisions you may have regarding your health.
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