Bartholinitis
It is the infection and inflammation of the major vestibular glands, or Bartholin's glands, whose function is related to lubrication during sexual intercourse.
They are found in the lower third of the labia majora on their inner side.
Causes
These glands can become blocked, forming an elastic lump in the labia majora which can reach several centimetres in size. It is generally asymptomatic and known as Bartholin's cyst.
Sometimes this gland can be colonised by bacteria present in the perineal area. The most common ones are gram-positive aerobes, such as staphylococcus, streptococcus and Enterococcus faecalis, although sometimes the infection can also be caused by gram-negative bacteria, such as Escherichia coli, Klebsiella or Proteus, or be due to sexually transmitted bacteria, such as Gonococcus, producing in any of the cases, a well-known clinical picture with acute bartholinitis, which causes intense pain.
The predisposing factors include the patient's anatomical characteristics, history of obstructive processes of the gland, of an inflammatory or infectious nature, trauma, wearing tight clothing and previous vulvar surgery.
Diagnosis
The diagnosis is basically clinical, and antibiotic therapy should be established in all cases, prior to or concomitantly with surgical treatment.
Treatment
This will basically consist of the drainage and debridement of the above-mentioned abscess, with the option of marsupialisation, which consists of suturing, with resorbable threads, the drainage hole in such a way that it prevents this from closing up again, or the placement of a drainage tube with the same objective, which may be removed after 2 or 3 days.
The antibiotics of choice are amoxicillin alone or combined with clavulanic acid and clindamycin in the event of allergy. This surgery is normally performed on an outpatient basis with local anaesthesia and sedation if necessary.
In some cases of recurrent bartholinitis, it may be necessary to take a culture of the purulent material prior to the establishment of antibiotic treatment, and, in extreme cases, the surgical removal of the gland may be required.