Bartholin’s Gland

We’ve all been told to pick up a hand mirror and study our vagina, right? This way we can get to know it and understand ourselves more intimately. But a mirror won’t show you where and what the Bartholins glands do for you and your sex life.

I was giggling-high on morphine on a hospital bed in Thailand, while a pleasant Thai man was speaking to me in broken English, and positioned between my openwide legs with a stern face and a scalpel in his hand.

Let me just state, for the record, that he was a doctor and he was situated there for medical reasons, as for one solid week prior to this dubious circumstance I now found myself in, I had been walking with a hobble, sitting down on my left cheek only, and not having sex – not to mention enduring serious agony from an unknown cause. It was only the day before that I learned I had a Bartholins gland abscess. A million questions raced through my mind, but the first and foremost: ‘A Bartholin what?’ And then a close second: ‘… An abscess … like, in my vagina?’

What are Bartholins Glands?

To answer the above questions is Cape Town gynaecologist and endoscopic surgeon Dr Natalia Novikova. ‘The Bartholin’s glands are situated around the opening of the vagina, inside the small lips, and are ideally located to produce lubrication for sex,’ she says.

Okay, so they aren’t in the vagina per se, but still… Many women do not know that Bartholin’s glands even exist in their bodies, let alone know their function. There is one on each side of the vaginal opening. They are approximately 2- to 2.5cm-long ducts, which open on the surface of the vulva, secreting relatively minute, but necessary amounts of fluid to moisten both the lips and the opening of the vagina. This ensures that any contact with the sensitive area is comfortable.

‘The opening of the vagina is the most narrow part of the whole organ. This is why lubrication for penetration is so important, and the glands assist with that naturally,’ says Natalia.

I had noticed a hard lump to the right of my outer lips one day and made a mental note to keep an eye on it. I was living in Thailand at the time and access to medical care proved difficult, as well as pricey for my non-existent budget. I wasn’t too worried – that is, until after a few days the lump continued to grow in size and become increasingly hard. Eventually it became debilitating and particularly painful.

Do I have an STD? Am I sick? Do I need to see a gynaecologist? What is this grape-sized lump in my most precious of places? When a Bartholin’s gland forms a blockage of fluid, it is possible for it to develop into a cyst. The cyst can form either in the gland itself or in the duct that drains the gland of its fluid. A cyst is usually between one and three centimetres in size and there is little to no pain associated with it.

‘A cyst forms due to an obstruction of the duct between the gland and the vagina. Much like a pimple, there are many causes for this type of blockage,’ says Natalia.

A Bartholin’s abscess on the other hand is either an infection of the gland itself, or an infection of the cyst. Usually the abscess forms unilaterally, although it is not impossible for both to be infected at the same time.

‘An abscess is a collection of puss in a certain area, in this case within the cyst in the gland,’ says Natalia. ‘The size of a Bartholin’s abscess can vary dramatically. I have seen some as big as 10cm in diameter.’

The Bartholins gland abscess is associated with acute pain that only gets worse with time, high fever, inflammation and infection of the tissue surrounding the mass, as well as difficulty in walking and sitting, and in some cases lying down. Natalia says that, anatomically, the abscess is in an awkward position, explaining why women suffer when sitting and walking around. ‘The bigger it is, the more discomfort the woman will feel,’ she says.

I don’t remember a time that I have been in more pain. It was physically exhausting and, mentally, I was on the edge. The thought of your womanhood fraught with something so invasive is traumatising. Worse still is that for the few days before I sought help, I did not know what it was. It made me realise that there was so much I didn’t know about my own body – and particularly my vagina.

Was this normal? Did other women suffer from the same thing? Did I do something irresponsible that lead to this unfortunate situation? ‘Cysts are more common than abscesses, but as doctors we see more cases of the latter because they are more painful and that’s when people seek help,’ says Natalia

Cysts and abscesses develop in sexually active women between the ages of 20 and 30, but Natalia has seen cases in women both older and younger than that.

It was first believed in the 70s and 80s that Bartholin’s cysts and abscesses were caused by Neisseria gonorrhoeae and Chlamydia trachomatis, the pathogens responsible for STDs gonorrhea and chlamydia. ‘That’s something that we used to think back then, yes. But I have hardly ever seen a case associated with STDs,’ says Natalia.

Instead there is the predominance of opportunistic bacteria found around the world such as staphylococcus, streptococcus, and especially Escherichia coli (E.coli) as common causes. A study was conducted between 2004 and 2013 that examined 267 women with the average age of 33. The results were published in the European Journal of Clinical Microbiology & Infectious Diseases in 2016 and showed that 57.7% of the abscess cases were caused by undetermined bacteria, 22% E.coli, and 10% streptococcus.

Natalia was particularly passionate when we spoke about misinformation given on many Internet sites. Women will research their problem on the Internet before seeing a doctor and panic because the website they’re reading tells them they’re likely to have an STD.

‘Women who have had one sexual partner all their lives and are in faithful relationships can develop the infection. It is not because of STDs,’ she says.

I asked Dr Elna Rudolph, sexologist and head of My Sexual Health clinic in Johannesburg what women can do to avoid the glands from developing into cysts, and ultimately abscesses: ‘There is not much you can actually do to prevent infection. The area cannot be kept sterile and so it is susceptible to bacteria getting in there.’

However, just being aware of the glands and their positioning will help. Safe sex and maintaining good hygiene habits will promote continued health of the glands, especially when considering they’re prone to infection from bacteria, which fester in unhygienic, moist, body-temperate conditions and climates. Often, a Bartholin’s cyst does not require medical treatment – but this does depend on its size and symptoms, and your discomfort level.

However, should a cyst become infected, there are multiple treatment options, the most practised and effective being marsupialisation.

‘Marsupialisation comes from the word marsupial (kangaroo), an animal that has a pouch in which to carry their young,’ says Natalia. ‘We cut the abscess open, and stitch the lining of it to the outside skin of the vulva to keep it open, allowing the fluid to still lubricate the vaginal opening.’

The reason marsupialisation is more effective than simply draining the abscess is because the tissue deep within needs to heal from the infection. So keeping the wound open is key. And the treatment results are almost always effective. Unfortunately, my procedure was a little different – ‘oldfashioned’ Natalia informed me.

Luckily, I had a friend come along for emotional support, and to endure my adrenalin-strong hand squeezes. The doctor injected me with morphine that completely calmed my manic state, and numbed the area for an incision to drain the pus inside. ‘The size of the hole that is left depends on how big the abscess was,’ says Natalia.

Mine was large and to keep it open, instead of stitching me, the doctor stuffed the hole with three layers of saline-soaked medical gauze – I have never had children, but I am certain this pain was worse than natural childbirth without drugs. I left the clinic in an adult nappy, with two-weeks worth of strong antibiotics.

Some women undergo major surgery to have the gland completely removed. This only happens if the same gland continues to become infected and marsupialisation ceases to work. But Natalia confirms that this isn’t common, nor ideal. ‘Removal of the gland can lead to pain during intercourse or failure to lubricate,’ she says. I ask her if my having had an abscess could be the reason I struggle to get as wet as I did before. ‘The gland could have been damaged and therefore doesn’t function at its optimum, but it’s unlikely.’ Photogra Ok then – it must be age.

Feeling on the dry side? Here’s why you might be:

It’s hormonal

Oestrogen and testosterone are the two hormones responsible for keeping your vagina lubricated. An imbalance in either could mean uncomfortable dryness, both on a daily basis and when you want to get jiggy. Low levels of oestrogen, in particular, is associated with a lack of natural lubrication and it’s a condition that can be affected by menopause, childbirth and breast-feeding, medications, and some cancer treatments. Women who suffer from this can try a daily vaginal moisturiser.

You’re stressed

Anxiety can bug out your system, throwing your stress hormones into overdrive and prompting your body to put functions it considers unnecessary to your survival on the back burner for resources, including your digestive and reproductive systems. Sorry glands, no love for you there.

You’ve been douching

Your eyes and your vagina are the body’s only two self-cleaning organs – they don’t need soaps or scrubbing to do the job. When you introduce harsh chemicals in the form of soaps, bubble baths or sprays to the vaginal environment, you upset its delicate pH balance and host of happy flora that keeps everything lubing along nicely.

It’s your medication

Many medications, from birth control and antidepressants to blood pressure and cancer inputs, can affect your body’s capacity to selflubricate. Chat to your GP or gynae about the side effects you’re experiencing with your meds.

Illness

Diabetes, in particular, has been associated with vaginal dryness and the inability to orgasm. Impaired blood flow to the genital tissues, nerve damage and hormonal imbalances associated with the disease cause terrible discomfort, both physically and emotionally.

Trauma, depression and a lack of attraction to your partner

‘Getting wet’ should never be solely associated with arousal. While there are many causes for a lack of easy lubrication, it’s important to acknowledge the role your emotional wellbeing and situation plays in your body’s sexual experience. Negative emotional responses specific to sex may also include pain and vaginismus (pain on vaginal penetration) during intercourse.

FYI

Dry sex is an act commonly practised in sub-Saharan Africa. Women remove natural lubrication through various and dangerous means such as wiping with household detergents, antiseptics and even placing dry leaves inside the vagina. What would make women go through such drastic measures to keep their vaginas painfully dry? Their men believe that a ‘wet’ woman is unchaste, and that a dry vagina means a ‘tighter’ one, increasing their pleasure during sex. The risks involved in this type of sex include increased vulnerability to STDs and HIV/AIDS: increased friction during dry sex causes lacerations in vaginal tissue prone to infection; wiping the vagina of its natural fluids removes natural antiseptic lactobacilli that help prevents STDs; and dry sex causes condoms to break.

Written by: Jessica Sorensen for Marie Claire (August 2017)