Near
the introitus (that is, the opening of the vagina, but we need to talk
in proper medical terms, this is not a cosmopolitan blog…), there are
two glands, one on each side, just behind the labia. They are called
Bartholin glands, named after a Danish anatomist, Caspar Bartholin in
the 17th century.
They
are small, you cannot palpate them and they produce a thick secretion,
in order to lubricate and protect the lining of the vagina. They were
thought to be related to lubrication during sexual arousal but, alas,
their contribution is minimal. The glandular fluid enters the vaginal
epithelium through a narrow tube, the duct.
Occasionally,
for unknown reasons, the duct will get blocked and the sticky fluid
will accumulate within the gland and the gland will become
swollen. This is a bartholin cyst, and it affects 2% of women, mostly
aged between 20 and 30. It may be asymptomatic, with just a local
swelling and minor discomfort. If the cyst becomes infected, it then
becomes an abscess, very tender indeed, the patient may find it
difficult to walk and it needs urgent treatment.
It
is not related to sexual intercourse and don’t blame your partner for
transmitting the infection- there are many other reasons to blame your
partner but not Bartholin issues.
It
is equally not related to poor hygiene, tight underwear, sweating,
swimming, the duct somehow decides to block itself and there is nothing
you can do to prevent it from happening- frequent question when someone
already suffered from one gland and wishes to avoid trouble from the
other side in the future.
We
tend to give a short course of antibiotic when a cyst appear, to
prevent infection and this may delay the process but eventually things
will get worse. The cyst will need to be drained and ideally a new duct
should be surgically created. This procedure is called marsupialisation (
from Latin marsūpium, from Ancient Greek μαρσίππιον (marsippion), diminutive of μάρσιπος (marsipos, “pouch”))- yes, blame the Greeks for everything… This
is a minor operation, it needs anaesthetic and it involves
exteriorisation of the gland internal to the vaginal lining so that the
fluid will readily be expelled in the future.
It
is therefore a rather nasty situation but it is benign and will not
affect your future sex life or fertility. Having said that, in older
women (above the age of 40) we have the extremely rare bartholin gland
cancer, so all labial swellings should be reviewed by a gynaecologist.
To summarise, when in pain, see your doctor and blame Caspar Bartholin …