Patient's question:
Four days after onset, a large pustule developed overnight. The past two days have been the most painful, making walking and standing unbearable. I basically avoid moving my leg, and have to sleep with my legs apart because of the pain. It’s just excruciating. When I went to the hospital for examination, the pustule broke on its own, releasing a lot of pus with an extremely foul odor, which was quite unbearable. I’m not sure, but previously, washing with plain water was fine. Using sanitary pads made my skin feel irritated, and after using Fuyinjie for a week to clean the external genital area, I wonder if it has anything to do with Zhengguanghe? It swelled up overnight and by the third day, the pain became unbearable for walking. After the pus drained, I could walk again, but there’s still a lump inside.Doctor's answer:
1. Acute inflammation: bed rest, antibiotic treatment;2. Local heat application or sitz bath;
3. Incision and drainage after abscess formation, followed by fistula creation.
Guidelines for medication:
1. In the early stage of Bartholin gland abscess, sitz bath with 1:5,000 potassium permanganate solution, heat application, and oral metronidazole and antibiotics are the primary treatments.
2. After abscess formation, incision and drainage combined with antibiotics are recommended.
3. Patients with high fever should receive intravenous medication, with supportive therapy and antibiotic selection based on drug sensitivity tests.
Prevention knowledge:
This condition is primarily caused by bacterial contamination of the labia majora, leading to inflammation of the Bartholin glands. Therefore, the key to prevention is maintaining good hygiene of the labia majora and eliminating all sources of infection. Early diagnosis and treatment can prevent the need for incision and drainage after abscess formation.
Medical advice:
Laser surgery:
Treatment includes fistula creation and cyst excision.
- Fistula creation is suitable for larger and recurrent acute cysts.
- Excision is recommended for infected cysts.
For larger cysts, use a CO? laser (25W power) to focus on the lowest point and make a 0.5 cm incision in the skin, or use a D:YAG laser fiber (20W power) to make a 0.5 cm incision at the lowest point of the mass. Drain the cyst contents and perform daily cleaning and dressing changes for the drainage site.
Excision:
The swollen Bartholin gland is removed.
- Use a CO? laser (25W or higher power) for focusing.
- Perform the surgery with routine sterilization, aseptic dressing, and strict procedures.
- Local anesthesia (1% lidocaine) is used.
- (Spare instruments): one skin clamp and one mastoid retractor.
- Make an incision along the skin crease with the laser, using a curved hemostat to assist in cyst wall dissection.
- Do not incise the cyst wall; use the retractor to widen the incision.
- Use a curved hemostat along the cyst wall for protection and adjust the laser output power gradually as the cyst wall is dissected.
- After completely dissecting the cyst, rinse the wound with sterile saline to remove any carbonized tissue, then remove the retractor.
- Suture from the inside out, leaving no dead space.
- Remove stitches after 7–10 days.
- Monitor the incision daily postoperatively; replace dressings if they become wet from urination.
- For smaller cysts, the skin incision can be sutured, and sterile dressings can be applied externally for protection.
Postoperatively, a special balloon can be made from a double-layer condom and placed in the vagina, with appropriate inflation.
- Monitor the gas volume to ensure the cyst wall is pressed together.
- Change the balloon once daily or every other day.
- Ensure the balloon is sterile to prevent infection.
- Remove the balloon after 7–10 days.
- Clinical studies have shown that simply suturing the incision and using the balloon for expansion and cyst wall repair is equally effective and causes no discomfort.
Postoperative support:
Administer auxiliary antibacterial and anti-inflammatory medications, as well as multivitamin preparations, for patients with poor physical condition to provide supportive treatment.