Bartolinit – an inflammatory disease of the large gland which is at an entrance to a vagina. Uncomplicated forms do not lead to deterioration in the general state and decrease in working capacity, are followed by insignificant pain and a swelling in vulvar lips, poor allocations, small temperature increase. The diagnosis usually is established during gynecologic survey, for the choice of antibacterial treatment the cultural analysis of a secret of gland is made. Treatment conservative – medicamentous, physical therapy, in case of purulent complications is necessary surgical intervention.
Bartolinit – unilateral, is more rare – a bilateral infectious inflammation of a steam room bartolinovy (big vestibular) than the gland located in the field of a threshold of a vagina and called by name the Danish anatomist Caspar Bartolin who described it in the 17th century. This disease, widespread in gynecology, to which women of reproductive age are subject the peak of incidence falls on 20-30 years, the frequency of occurrence makes 15%. At girls the disease is not registered, at women in a postmenopause is observed extremely seldom as at children of iron it is not developed adequately, and at elderly is exposed to involute changes. Bilateral forms are characteristic of high-contagious infections (for example, gonorrhoeas, are more rare - trichomoniasis) or develop against the background of considerable decrease in immune activity.
Bartolinit – a consequence of defeat of fabrics of gland specific (gonokokky, a trichomonad, pathogenic types of hlamidiya, ureaplasmas) and nonspecific (colibacillus, streptococci, stafilokokka, peptokokka, bakteroidy, a klostridiya) infectious agents. The infection can get into gland both exogenous (from the outside) and an endogenous way (distribution of the activators which are present at an organism). Infection with specific microorganisms most often comes from external sources whereas the autoinfektion is more characteristic of defeat by nonspecific bacteria.
- Endogenous infection. In most cases occurs at sexual contact. Other sources of infection - others objects of personal use, dirty hands, badly processed medical tools. Thus, it is possible to refer sexual contact with the infected partner, neglect to risk factors of external infection with personal hygiene. By an exogenous way not only specific (venereal) infections, but also opportunistic, for example, in case of presence at the sexual partner of a nonspecific urogenital infection can be transmitted.
- Endogenous infection. The main sources of endogenous infection – the infection centers in the departments of a sexual path located above (the bacterial vaginosis, a colpitis, tservitsit), an urinary system (cystitis, uretrit, pyelonephritis), intestines (enterokolita).
The contributing conditions of development of nonspecific bartolinit are injuries and genitalia operations, wearing close linen, immune frustration. Endocrine and exchange diseases (diabetes, pathologies of ovaries and a thyroid gland), hypovitaminosis, reception of antibiotics, corticosteroids, tsitostatik, overfatigue, stresses, frequent change even of healthy sexual partners (promotes development of a bacterial vaginosis), frequent abuse of alcohol, intensive tobacco smoking belong to the factors increasing probability of a nonspecific infection. The expressed immunodeficiency can lead to hematogenic infection which sources are cholecystitis, caries, chronic LOR-infections (tonsillitis, sinusitis).
Bartolinova glands are located in the thickness of the lower third of big vulvar lips, their channels open on inside of small lips. The body produces the slime moisturizing a vagina threshold under the influence of estrogen. With age, when the level of female sex hormones in blood considerably decreases, bartolinova of gland lose activity, and together with it a susceptibility to development of inflammations. At hit of the infectious agent the inflammation of its mucous at first develops in the mouth of the removing channel – kanalikulyarny bartolinit (kanalikulit). At spread of an infection deep into inflammatory process occupies smaller canals and parenchymatous fabric of body where there are inflammatory infiltrates. On any of these stages the inflammation can be resolved as a result of treatment or is more rare - spontaneously.
Further progressing of a bartolinit leads to purulent complications. As a result of the pathological changes connected with inflammatory process (hypostasis, adhesion of walls of the channel, its obstruction by slushchenny epitelialny cages), there comes impassability of an output channel with a congestion of purulent exudate in his cavity – false abscess, or an empiyema of gland is formed. More rare complication – true abscess, the characterized purulent resorption of ferruterous fabric with education around the center of a restrictive piogenny membrane.
As an inflammation allocate serous and purulent bartolinit. The serous inflammation develops as a result of infection negnoyerodny (hlamidiya, trikhomony, colibacillus) microorganisms, proceeds easier. The purulent inflammation is result of infection piogenny (stafilo-, strepto-, gonokokky, Proteus) bacteria and quickly leads to complications. As the inflammation is followed by the uncontrollable growth of all opportunistic microflora, serous bartolinit over time quite often passes into purulent. On a clinical current allocate three forms of a bartolinit:
- Sharp. It is usually observed at a disease demonstration, characterized by the most expressed symptoms, the best response to treatment, permission within three-four weeks.
- Chronic (recurrent). Recidivous bartolinit proceeds it is long (quite often for years), almost asymptomatic phases of remission alternate with aggravation phases. The chronic form hardly gives in to conservative treatment.
Symptoms of a bartolinit
The first symptoms – reddening of a small vulvar lip in the field of an exit of a channel of gland with education small (the size from grain to a pea) a small knot or a tyazh, swelling mucous, feeling of weak burning. Later moderately painful or painless swelling of the lower third of a big vulvar lip, insignificant serous or purulent allocations, temperature increase of a body to 37-37,5 °C joins. The local itch, a small general malaise, slight discomfort when walking is sometimes observed.
Development of purulent forms of a disease is followed by rapid growth of education in the thickness of vulvar lips, intensive, often the intolerable pulsing local pain (including at rest) giving to a hip, walking difficulty, fever attacks, deterioration in the general state – weakness, oppression, a loss of appetite. Especially expressed symptomatology is characteristic of true abscess of bartolinovy gland. Recidivous bartolinit in a phase of remission proceeds asymptomatically or with uncertain discomfort in a vulva, dispareuniy. Periods, intensive sex life, overcooling, an interkurrentny disease can provoke an aggravation. In the period of an aggravation the symptomatology corresponds to a sharp bartolinit.
The most frequent complication of a bartolinit – the abscesses considerably worsening quality of life capable at permission to lead to deformation of vulvar lips, formation of vaginal fistulas, a septic state. Other widespread complication which is usually accompanying a recidivous bartolinit is connected with formation of a retentsionny cyst of the bartolinovy gland tending to frequent suppurations with development of pseudo-abscess. Nelechenny bartolinit at pregnant women complicates the course of natural (vaginal) childbirth, can be a source of obstetric sepsis, entail perinatal infections of a fruit and neonatal infection of the newborn.
The diagnosis is exposed by the gynecologist and includes an objective research of genitals and analyses of dabs. Differential diagnostics of a bartolinit is carried out with other purulent educations (a furuncle of a vulvar lip, an inflammation of okolovlagalishchny cellulose, paraproktity), infectious processes (an atypical form of a syphilitic shankr, a tubercular natyochnik), and also cancer of bartolinovy gland. For differentiation of these pathologies advisory receptions of an onkoginekolog, the dermatovenerologist, proctologist, etc. can be required.
- Gynecologic survey. At survey and a palpation of a vulva hyperaemia and maceration of a small lip, consolidation, reddening and convex "roller" around the mouth of a canal of bartolinovy gland for which when pressing serous or purulent exudate is emitted is found.
- Identification of the activator. The microscopy and bacterial crops of inflammatory exudate and vaginal dab is applied to identification of the infectious agent. Besides, the cultural analysis allows to define sensitivity to antibiotics. For exact diagnosis of gonorrhea, a chlamydial infection the PTsR-research is conducted.
At a frequent recurrence of a bartolinit identification and elimination of the contributing factors require comprehensive examination with involvement of the therapist and narrow experts – the urologist, the endocrinologist, the gastroenterologist. In case of the persistent, not giving in to treatment inflammation with infiltrate rapid growth, especially at patients in a postmenopause, the cytologic research for a carcinoma exception is required.
Treatment of a bartolinit
Uncomplicated sharp forms of a disease successfully recover by conservative methods – application of antibiotics inside, local processings and physical therapy. The main method of treatment of abscesses is surgery. At the frequent aggravations of a chronic bartolinit connected with a retentstonny cyst surgical treatment (a marsupialization, removal of a cyst) is also shown.
- Drug treatment. Empirical therapy of a bartolinit includes antibiotics of a broad spectrum of activity – ingibitorozashchishchyonny penicillin, ftorkhinolona, macroleads. Treatment is locally carried out by antiseptics. After verification of the activator antibacterial means are appointed depending on results of the cultural analysis and PTsR. Nonsteroid resolvents are applied to knocking over of a pain syndrome, heat.
- Physical therapy. It is appointed for the purpose of the prevention of a recurrence after subsiding of a sharp phase of an inflammation, during remission of chronic bartolinit. At acute inflammations Ural federal district, UVCh, SMT on area of a crotch is carried out, at chronic – treatment by the infrared laser, applications of dirt, paraffin, ozokerite.
Forecast and prevention
The forecast at sharp bartolinita favorable, the majority of cases comes to an end with full treatment, however approximately at a quarter of patients the disease passes into a recurrent form, as a rule, interfaced to formation of a cyst. Prevention includes observance of rules of personal hygiene, an exception of the casual unprotected sexual contacts, wearing free underwear from natural fabric, timely identification and treatment of a disbioz of a vagina, inflammatory diseases of an urogenital path and intestines, chronic infections of an oral cavity, ENT organs, pathologies of exchange and endocrine system. The healthy lifestyle (observance of a work-rest schedule, physical activity, reception of the balanced food, refusal of addictions) helps to minimize probability of nonspecific bartolinit.