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Vulvar and Vaginal Trauma and Bartholin Gland Disorders
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Malak El Sabeh, Mostafa A. Borahay
Small cysts usually resolve on their own. In the case of large, symptomatic cysts or abscess formation, treatment is incision and drainage. Incision and drainage alone can often lead to recurrence, so a Word catheter is placed for 4 to 6 weeks until epithelialization of the cyst and tract. Alternatively, marsupialization is usually done for recurrent Bartholin cysts or abscesses where the entire cyst or abscess is incised. Other reported treatments include silver nitrate gland ablation, use of carbon dioxide laser to create an opening in the skin, alcohol sclerotherapy, and needle aspiration [32]. Antibiotics are not usually indicated, but in the case of recurrent Bartholin cyst abscesses, antibiotics with polymicrobial coverage are considered. They should also be given if the cultured organism was N gonorrhoeae, which is the case approximately 10% of the time. If the patient is older than 40 years, a biopsy should be performed to rule out Bartholin gland carcinoma.
Vulvar procedures
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Allison Jackson, Danielle Cooper, E. J. Mayeaux
In the 1960s, Dr. Word introduced a simple fistulization technique using a small, inflatable, self-sealing, bulb-tipped catheter (Figure 15.9) (31). The catheter is placed following incision and drainage to allow formation of the fistulous tract in order to maintain future drainage. The recurrence rate is between 2% and 15% (32,33). Other options for the treatment of a Bartholin’s gland abscess include the marsupialization or “window” procedure, carbon dioxide laser excision, or surgical excision. The marsupialization procedure is a relatively straightforward procedure that can be performed in the office or in the outpatient surgical suite. It can be used as a primary treatment or can be used if a cyst or abscess recurs after treatment with a Word catheter. The recurrence rate after marsupialization is less than with Word catheter use (27). The Word catheter has been found to be easy to use and well tolerated for the treatment of Bartholin’s cysts and abscesses, with few to no serious side effects and little impingement of sexual health (33,34).
The impact of CO2 laser for treatment of Bartholin’s gland cyst or abscess on female sexual function: a pilot study
Published in Gynecological Endocrinology, 2019
Violante Di Donato, Flaminia Vena, Assunta Casorelli, Claudia Marchetti, Angela Musella, Federica Tomao, Giorgia Perniola, Innocenza Palaia, Ludovico Muzii, Marco Monti, Pierluigi Benedetti Panici
The second important finding of the present study is that any kind of treatment of BG cyst or abscess determines an improvement of sexual function. The present data are consistent with a recent report, which assessed the quality of life and sexual activity after treatment with the Word-catheter [17]. This technique involves the fenestration of the cyst and the introduction of a catheter, which is kept onsite for 4 weeks. Word-catheter positioning requires at least twice post-operative controls, the first time for catheter removal or substitution, and the second for a further postoperative assessment. A preliminary study on Word-catheter positioning showed that patients reported sexual activity during the long time of treatment (4 weeks) in 9% of cases [18]. Conversely, another study reported a higher rate of sexual activity (81%) probably, as explained by the author, this higher rate is explained by non-penetrative vaginal intercourse [17]. Although it is a safe and simple technique able to alleviate symptoms, Word-catheter positioning provides a mechanical obstruction to penetrative vaginal sexual intercourse. Furthermore, the presence of foreign body, coming out from the genitals, could prove an embarrassment for patients [17].