They are a pair of small glands located just at the entrance of your vagina. They cannot be seen or felt unless swollen or infected. Bartholin glands make mucus that drains out towards the entrance of the vagina, keeping it moist.
If the small gland opening gets blocked (usually due to unknown reasons), it becomes swollen and fluid-filled (Bartholin’s cyst). A Bartholin’s cyst is quite common and can vary in size. It can stay the same size, or gradually become bigger. Most of the time, it does not cause discomfort (unless it is fairly sizable) or affect your health. You may only feel a small, non-painful lump on one side of your vaginal entrance. However, if an infection occurs in the Bartholin’s gland, or if the Bartholin’s cyst gets infected, pus can form and a Bartholin’s abscess can result. This can cause pain, redness, fever or pus discharge.
Visit your gynaecologist to have it checked. A Bartholin’s cyst or abscess can be diagnosed through a physical examination as its appearance is characteristic.
If your Bartholin’s cyst is small, not causing you any symptoms and is stable in size, you may leave it alone and observe. A small Bartholin’s abscess can be treated with antibiotics if infection is mild; larger/recurrent cysts or abscesses will need drainage. Drainage can either be done through marsupialization under local or general anaesthesia. In marsupialization, a small cut is made to widen the gland opening and drain the pus and stitches placed to attach the cyst lining to the skin to create a new permanent gland opening. Another method is Word’s catheter insertion performed under local anaesthesia, where a small cut is made to widen the gland opening and drain the pus. A thin rubber tube with a small balloon at its tip is inserted through the cut, inflated and kept in for a few weeks until healing occurs with formation of a new permanent gland opening around the tube before the tube is removed.
In some cases, pus may be sent for testing and you may require a course of antibiotics even after drainage.
The risks are minimal and usually related to mild discomfort around your wound, which should resolve in a few days.
You can go about your daily activities with no problems. Avoid swimming and sex until your Word’s catheter is removed (if one was inserted) and your wound heals. Keep your vaginal area clean and dry at all times. Your Word’s catheter may drop out before your follow-up appointment with your gynaecologist – if you do not experience any troubling symptoms, there is no need to worry.
If you had marsupialization or Word’s catheter, it is unlikely to recur. If you were treated with antibiotics only, or had a simple aspiration (where a needle was used to deflate the cyst/abscess), there is a higher chance of recurrence.
A surgical evacuation of the uterus involves dilation of the cervix (neck of womb) to allow a wash-out of the contents inside your uterus. This is usually a day surgery procedure performed under general anaesthesia.
A surgical evacuation may be recommended if you have:
The steps of the procedure are similar to a surgical abortion, and is generally a safe and commonly done procedure.
Risks of surgical evacuation of uterus include:
Common
Uncommon
Rare
This article focuses on ovarian cystectomy.
An ovarian cystectomy is a surgical procedure for the removal of one or more cysts from one or both ovaries. This is done under general anaesthesia by:
In rare cases, a cystectomy may be technically difficult (e.g. very stuck to the ovarian tissue) and an oophorectomy (removal of ovary) may be required for proper treatment. Ovarian cysts may also recur in the future, requiring repeat surgery.
The risks of an ovarian cystectomy may include:
The alternative of surgery for an ovarian cyst include observation and regular ultrasound scans to monitor for changes in the cyst – this may not be suitable for all types of cysts and you should speak to your gynaecologist about your options.
This article focuses on myomectomy for uterine fibroids.
Fibroids that are small, do not cause symptoms, or occur in a woman near to her menopause can usually be observed with regular ultrasound scans to monitor for changes in the fibroids. Surgery is usually recommended for fibroids that cause heavy periods, painful periods, bleeding in between periods, anemia (low blood count), pressure symptoms, abdominal bloatedness, miscarriages and infertility.
A myomectomy is a surgical procedure to remove one or more fibroids from the uterus (womb). This is done under general anaesthesia by:
In rare cases, a fibroid previously seen on ultrasound may turn out to be an adenomyoma (adenomyosis) that is technically difficult to remove from the uterus and a hysterectomy (removal of uterus) may be required for proper treatment. Fibroids may also recur in the future, requiring repeat surgery.
The risks of myomectomy may include:
Common (affecting 1-5% of patients):
Uncommon (affecting 0.1-1% of patients):
Rare (affecting <0.1% of patients):
Alternatives for myomectomy include hysterectomy and hysteroscopic resection (depending on fertility plans and the number, size and location of fibroid.
A laparoscopy (keyhole) is a minimally invasive surgery performed under general anaesthesia with a 1cm cut in the umbilicus and three to four 0.5cm cuts in the abdomen. The abdomen is inflated with carbon dioxide gas, and a laparoscope (camera) is inserted through the umbilicus with other instruments inserted through the smaller cuts, so as to perform the surgery.
Laparoscopic surgery is frequently performed for gynaecological conditions including:
Laparoscopy is generally a safe and commonly done procedure. Overall risk of complications is low but can be higher in certain conditions e.g. endometriosis, obesity, previous abdominal surgeries, previous infections, cancers – you should discuss these with your gynaecologist.
Risks of laparoscopy include:
Common (affecting 1-5% of patients):
Uncommon (affecting 0.1-1% of patients):
Rare (affecting <0.1% of patients)
Death: the risk is approximately less than 3-8 in 100,000.
Photo credit: BruceBlaus / Wikimedia Commons
What is a hysteroscopy?
A hysteroscopy involves the insertion of a telescope camera through the cervix (neck of womb) into the uterus, with fluid instilled inside the uterus to open up the uterine cavity. This allows diagnosis (and in some cases, treatment) of abnormalities of the uterine cavity and lining.
Hysteroscopy is frequently performed to achieve a diagnosis when the following gynaecological conditions are suspected:
Hysteroscopy can also be used to treat some of the above conditions when combined with other procedures such as polypectomy (removal of endometrial polyps), excision of fibroids/septum, division of scar tissue, dilation and curettage etc.
Hysteroscopy is generally a safe and commonly done procedure.
Risks of hysteroscopy include:
Common risks:
Uncommon but potential serious risks:
Photo credit: BruceBlaus / Wikimedia Commons
A hysterectomy is the removal of the uterus with the cervix (total hysterectomy) or without the cervix (subtotal hysterectomy). This can be done abdominally or vaginally, depending on the size of the uterus and other factors. Your ovaries may or may not need to be removed at the same time, depending on your medical condition.
If your hysterectomy is to be done abdominally, this will be performed under general anaesthesia by:
Risks of hysterectomy include:
Common (affecting 1-5% of patients):
Uncommon (affecting 0.1-1% of patients):
Rare (affecting <0.1% of patients):
Photo credit: BruceBlaus / Wikimedia Commons
A D&C involves dilation of the cervix (neck of womb) to allow a curettage (washing out, or scraping) of the uterine lining. This is usually a day surgery procedure performed under general anaesthesia, and may be combined with other procedures such as hysteroscopy and polypectomy (removal of endometrial polyps).
D&C is frequently performed to obtain a sample of your uterine lining for microscopic assessment of the cells, and may be recommended if you have:
The main objective is to rule out endometrial hyperplasia, or endometrial cancer. The alternative of a D&C is endometrial pipelle, where a small thin straw is inserted into your uterus through your cervix and biopsy of tissue from your uterine lining obtained through gentle suction – this can generally be done in the clinic unless you are unable to tolerate this or have never had sex before.
D&C is generally a safe and commonly done procedure.
Risks of D&C include:
Common
Uncommon/rare
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