Acute condition that cannot be delayed
An abscess of the Bartholin gland develops quickly: within 2–3 days, a sharply painful, tense formation appears at the entrance to the vagina, it becomes impossible to walk or sit, and the temperature rises. Antibiotics at this stage no longer help - the pus is limited by the capsule, and the drugs do not penetrate into it. The only solution is an autopsy with evacuation of pus and drainage of the cavity; relief comes almost immediately. It is important to understand the continuation: a simple opening often ends in relapse, because the excretory duct of the gland remains closed. Therefore, after the inflammation subsides, a radical stage is discussed - marsupialization or removal of the gland cyst.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.