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Bartholins Gland Marsupialisation

 
 

What is it?

You have a swelling on one side of the vulva at the opening of the vagina. The swelling is a build up of liquid under the skin. The liquid is made in glands called Bartholin's glands.

These are like the sweat glands you have in your armpit. Normally the liquid seeps out to keep the skin of the vulva moist. If the exit from a Bartholin's gland gets blocked, the liquid builds up as a swelling. Sometimes the liquid will build up for a time and then seep away again. Sometimes germs grow in the liquid, infecting it. This makes the swelling much bigger and painful. This can happen within a few hours, and needs an operation right away.

The Operation

You will have a general anaesthetic, and be completely asleep during the operation. Alternatively the operation can be done under local anaesthetic (by numbing the area with a local anaesthetic injection, like when you go to the dentist).

Although a few centres do this operation successfully under local anaesthetic, many perform it under general anaesthetic since this is a very sensitive area of the body and you can sometimes feel rather uncomfortable during the procedure.

A cut is made about an inch long through the skin into the swollen gland. This lets the liquid drain out through a wide opening. The gland then forms a little pouch. This is called marsupialisation. You will recall that an animal with a pouch, such as a kangaroo, is a marsupial. A dressing will be put over the wound and sometimes a length of dressing is packed inside as well to help healing. Antibiotics are given if there is any infection. You should be able to have the operation on the day you come in to hospital, and go home the same day.

Any Alternatives

If you leave things as they are, the infected gland will burst in a week or so. This will be a most painful time for you. The opening will not be big enough to drain properly. You may find the swelling comes back again. Sometimes, antibiotics alone will settle the infection. You will probably have more trouble in the future. The best plan for you is this operation.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first day after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. If you come into hospital as an emergency, you will bypass all these arrangements.

After - In Hospital

You will have a sanitary pad held on with elasticated net pants. Any packing in the wound will be taken out after 24 hours or so. There may be some staining with old blood during the first day or two. You can put a new sanitary pad on as often as you like. The vulva will feel a little painful for 24 hours or so after the operation. You will be given painkilling tablets to control this, and antibiotics if there was any infection. Injections are given for severe pain if needed. Take shallow baths three times a day to keep the vulva clean and to help healing. You need to pass urine before you leave the ward. If you have any difficulty, tell the nurses. You can wash the wound area as soon as you wish. Soap and tap water are entirely adequate. Salted water is not necessary. You can bathe or shower as often as you wish. You will be able to drink within an hour or two of the operation as long as you are not feeling sick. The next day you should be able to manage small helpings of normal food. You should plan to leave hospital the day of your operation. The District Nurse may call on you at home as required. You will be able to stay in hospital longer, if you are not ready to go home the same day. Some hospitals arrange a check-up about one month after you leave hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc. You should be able to return to a light job after about one week, and any heavy job within two weeks.

After - At Home

Go to bed and rest for at least six hours. You can start sexual relations again when you feel comfortable, usually after a week or two.

Possible Complications

This operation is a minor one. Complications are very rare. Severe infection can slow healing down. Very rarely there is bleeding from the wound which needs stitches or packing. Sometimes the swellings refill or appear in a different part of the vulva. These can always be treated again. There is sometimes some bleeding after two weeks or so. This will settle down.

If the same gland gets swollen again and again, then, it may be, that at some stage (when there is no swelling and you are well) it has to be removed completely. This requires another operation under general anaesthetic. The skin is cut around the gland and the gland is removed along with the skin which lies on top of it. The wound (which is about an inch long) is then closed with dissolvable stitches. It is a relatively simple and successful operation with very low chances for complications.

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