Benign vulval problems
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
The mons pubis is the soft mound of the anterior vulva formed by fatty tissue covering the pubic bone. This separates into two folds known as the labia majora. Between the labia majora is the pudendal cleft and posteriorly between the pudendal cleft and the anus is the flat hairless area of the perineum. The labia minora are two folds of skin within the labia majora which originate with the covering of the clitoris, the clitoral hood. Between the labia minora is the vestibule which contains the urethral and vaginal openings. The opening of the vagina is known as the introitus. This may be partly covered by the hymen, a mucosal membrane or, more commonly, its remnants known as carunculae myr-tiformes which can be mistaken for skin tags or polyps. Posteriolateral on the left and right of the introitus are two Bartholin glands and the ducts from these open into the lower, posterior vagina.
Practice circuit 1
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith in Get Through MRCOG Part 3, 2019
Superficial dyspareunia in the absence of all the skin disorders: Essential dyspareunia – This is a diagnosis of exclusion.Vulvodynia (dysaesthetic [essential] vulvodynia) – NAD or mild erythema, marked tenderness.Vulva vestibulitis (subset of vulvodynia) – Erythema, intensity varies; exquisite tenderness on touch of cotton-tipped applicator.Vaginismus – Palpable spasm of vaginal musculature; difficulty inserting speculum.Atrophic tissue or impaired lubrication – Sparse pubic hair, labial fullness, integrity of vaginal mucosa, vaginal depth, vaginal mucosal friability, fissures; atrophy unlikely in a patient this age without associated symptoms of ovarian failure.Infection (acute/chronic infections – Candida, BV, TV, HSV) – discharge, typical lesions, tenderness over urethra/anterior wall of urethritis.Vulvovaginal cysts/varicose.Bartholins gland – Recurrence, inflammation, scarring from previous surgery (tender/erythema ± lesion over Bartholin gland openings).
Clinical examination
Sarah Bekaert, Alison White in Integrated Contraceptive and Sexual Healthcare, 2018
Palpate the following structures: Inguinal area - appreciate abnormal lymphadenopathy.Labia majora - appreciate Bartholin gland (pea size).
Risk factors associated with recurrent referral to the emergency room following surgical treatment of Bartholin’s gland abscess
Published in Journal of Obstetrics and Gynaecology, 2020
Reut Rotem, David Yahoy, Chagit Diamant, Noa Greenberg, Misgav Rottenstreich, Boaz Sheizaf, Adi Y. Weintraub
The Bartholin glands secrete mucous for vulvar and vaginal lubrication during sexual intercourse (Lee et al. 2015). They are located deep to the posterior aspects of the labia majora, just below the hymenal ring and drain through ducts into the vestibule (Sośnik et al. 2007). Most lesions of the Bartholin gland are cysts or abscesses with a ratio of 1:3 (Heller and Bean 2014) with an estimated incidence of 2% worldwide (Omole et al. 2003). While a simple cyst may remain asymptomatic, an abscess usually presents with painful vulvar swelling and dyspareunia and, at times, even systemic fever (Kessous et al. 2013). A higher prevalence of Bartholin’s gland cysts and abscesses is seen in the early reproductive years and this may be attributed to a gradual involution of the glands that may occur at the age of 30 and onwards (Stillman 1995). The known risk factors, other than the age and a previous occurrence of a cyst or an abscess, have not been clearly identified (Heller and Bean 2014). The knowledge with regard to the microbiological characteristics of an abscess has evolved over time. Initially thought to be a sexually transmitted disease (Aghajanian et al. 1994), recent studies have demonstrated a polymicrobial origin that most commonly involves Escherichia coli (Kessous et al. 2013; Lee et al. 2015).
Recurrence of Bartholin gland mucinous adenocarcinoma managed with posterior exenteration: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Nikolaos Blontzos, Christos Iavazzo, Eirini Giovannopoulou, Natasa Novkovic, Victoria Psomiadou, George Vorgias
BGC affects predominantly postmenopausal women—with a mean age of 53 years (Ouldamer et al. 2014)—and it presents as a painless mass in the posterior part of labium major, or less commonly as abnormal bleeding, burning sensation, pruritus or dyspareunia. The potential etiologic role of high risk HPV has been recently demonstrated by Nazeran et al (2019). Because of its nonspecific symptoms, it is crucial to be differentiated from benign Bartholin gland pathologies such as cysts, abscesses, endometriosis, chanchroid and syphilis, as well as vulvar cancer. A biopsy, thus, should be performed in any suspicious lesion, in order to diagnose BGC based on the criteria set by Chamlian and Taylor (1972). US have applications in the pre-operative assessment of complicated superficial lesions and MRI is an advanced modality for Bartholin glands pathology (Chaudhari et al. 2010).
The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals
Published in Expert Opinion on Drug Delivery, 2020
Peter Boyd, Ruth Merkatz, Bruce Variano, R. Karl Malcolm
Even though the ring resides around the cervix, expulsion can occur during sexual arousal since the vaginal vault undergoes physical transformation known as tenting or ballooning [86,87]. Just prior to coitus, there is increased muscular tension in the body that draws the uterus upward resulting in more space in the vaginal vault. There are also increased secretions from the vaginal wall, the cervix, and the two Bartholin glands located at the entrance to the vagina that keep the vagina lubricated during arousal and reduce friction during penetration. Depending upon the extent of these physical changes, which vary widely between women, the ring may be expelled. After sex, the vaginal canal rapidly returns to its previous size. If the ring has been expelled, it can be reinserted in accordance with specific product instructions (Table 2).
Related Knowledge Centers
- Bulbourethral Gland
- Homology
- Urogenital Sinus
- Vaginal Lubrication
- Vulva
- Vagina
- Alveolar Gland
- Superficial Perineal Pouch
- Deep Perineal Pouch
- Fossa of Vestibule of Vagina