Differential diagnosis of Bartholinitis

Bartholinitis is an inflammation of the Bartholin's glands. The Bartholin's glands are located in the lower 1/3 of the labia majora on both sides, with a diameter of about 0.5-1.0 cm. Their exit gland ducts are about 1.5-2.0 cm long, and the gland openings are located on the inner side of the labia minora near the hymen. Under the stimulation of sexual intercourse, mucus is secreted for lubrication. Due to the particularity of the anatomical position, pathogens can easily invade and cause Bartholinitis. Bartholinitis should be differentiated from Bartholin's gland abscess and Bartholin's gland cyst. Let's take a look at the differential diagnosis below:

[Cause] This disease generally occurs in women of childbearing age. The main pathogens are Staphylococcus, Escherichia coli, Streptococcus, Enterococcus, Neisseria gonorrhoeae and anaerobic bacteria. In recent years, the incidence of Bartholinitis caused by gonococci has increased significantly.

[Clinical manifestations] This disease is often a mixed infection. When acute inflammation occurs, bacteria first invade the glandular ducts. The glandular duct openings are blocked due to inflammation and swelling, and the exudate cannot be discharged, which can form abscesses.

1. The initial infection stage of Bartholin's glanditis is mostly ductitis, with local redness, swelling, pain and sexual intercourse pain. Examination can show small white dots at the opening of the Bartholin's gland on the affected side, which are obviously tender to the touch.

2. Bartholin's gland abscess: The opening of the duct is blocked, and purulent secretions cannot be discharged. Bacteria multiply in the gland, accumulate in the duct and gland, and gradually expand to form a Bartholin's gland abscess. The patient complains of swelling and severe pain in the vulva on the affected side, even pain during urination and difficulty walking. During the examination, the vulva on the affected side is red, swollen, hot and painful, and a lump is palpated on that side. If an abscess has formed, the lump can be felt to have a sense of fluctuation and obvious tenderness. It is mostly unilateral, with an abscess size of 3-6cra in diameter. The skin becomes thinner, and the abscess continues to grow and may rupture on its own, and the symptoms are relieved accordingly. If the rupture is small and the pus is not drained smoothly, the symptoms may recur. Systemic symptoms include fever, increased white blood cell count, and enlarged inguinal lymph nodes on the affected side.

3. After the acute phase of inflammation of Bartholin's gland cyst, the pus is absorbed and the fluid in the gland is replaced by mucus, which becomes Bartholin's gland cyst. Some patients' cysts are not caused by infection, but because during delivery, the gland duct is cut off during episiotomy, and the fluid in the gland cannot be discharged. After long-term accumulation to a certain extent, it will cause Bartholin's gland cyst. When the cystic tumor is small, the patient is mostly asymptomatic. After the tumor grows, the affected side of the vulva swells. During the examination, the affected side of the vulva is swollen, and the cystic tumor can be touched. There is adhesion with the skin. The labia minora on this side is flattened, and the vaginal opening is squeezed to the healthy side. When the cyst is large, there may be a sense of local swelling and discomfort in sexual intercourse. If it is not treated in time, once bacterial infection is combined, it will cause Bartholin's gland abscess. Some patients are because the previous treatment was not effective. When the body's resistance is reduced, bacteria take the opportunity to multiply in large numbers and form new abscesses. This process can be repeated many times, forming a vicious cycle.

[Diagnosis] If the lower 1/3 of the labia majora is red, swollen, and hardened, with obvious tenderness and even difficulty walking, then Bartholinitis should be considered. It is usually unilateral, with or without adhesion to the vulvar skin. The secretions squeezed out from the opening can be examined for pathogenic microorganisms and antibiotic sensitivity tests. The diagnosis can generally be made based on the location, shape, presence or absence of acute inflammation, and other characteristics of the lump. If necessary, puncture can be used for diagnosis. Pus is drawn out of an abscess, while serous fluid is drawn out of a cyst.

For ordinary people like us, it is enough to simply understand some knowledge about this aspect. In this way, we can take some corresponding precautions for our health status in time in our daily life in the future, so as to detect the disease early and treat it as soon as possible.