Re: Marcia/Bartholin's Glands Removal

[Guest guest]

Hi nne and Dee: Thanks for your input. I thought you (and

everyone) might be interested in the article below. Dr. Baggish

pioneered this surgery and he would be performing the surgery on me:

 

PALM BEACH, FLA. -- Up to 97% of patients with vulvar vestibulitis

can become totally pain free after surgical excision of the

Bartholin's glands, said Dr. Baggish, one of the pioneers of

this technique.

 

" It's my belief that this problem, which I am now seeing in almost

epidemic proportions in the United States, stems from dysfunctional

mucous glands in the vulva. You can pinpoint this in virtually every

case of vestibulitis, and the Bartholin's glands seem to be the most

frequently affected, " Dr. Baggish noted during an interview.

 

Other vulvar glands that are less often involved include Skene's, as

well as the paraurethral glands, he said at an ob.gyn. meeting

sponsored by the University of Chicago.

 

A more commonly used surgery involves the simple excision of the

hymen and perihymenal tissues or photocoagulation of the vestibular

dermis and epidermis.

 

The problem with simple excision is that it simply excises the

glandular ducts, leaving the glands themselves still in place.

 

About 45% of patients report good results with the simple vestibular

excision technique, said Dr. Baggish, who is professor of ob.gyn. at

the University of Cincinnati.

 

" Results are objectively better with removing the gland, rather than

just excising the skin. It's not a skin-deep problem. If you're going

to take the duct of the gland, what happens to the gland? In some

cases it will atrophy, " he said at the meeting.

 

In a variation of the more common technique, Dr. Baggish performs an

excision of the vestibule and excision of the Bartholin's glands and

sometimes other glands, as well as advancement of the vagina.

 

This treatment provides the most consistent and long-lasting relief,

compared with any other treatments for vulvar vestibulitis.

 

In a series of 250 patients with vulvar vestibulitis whom Dr. Baggish

has treated, a total of 95%-97% have had complete relief of pain with

intercourse, he said.

 

Patients with vulvar vestibulitis are typically nulliparous (66%),

almost exclusively white (96.5%), and invariably have a long history

of recurrent vaginal fungal infections.

 

The fungal etiology is seldom documented by culture evidence.

 

Vulvar vestibulitis usually presents abruptly with burning pain that

is limited to the vestibule and is instigated by such things as

sexual intercourse, tampon insertion, wearing constricting pants, and

bicycle or horseback riding.

 

" Gynecologists need to be aware this is the typical way this syndrome

starts--they shouldn't just dismiss this as recurrent fungal

infections. The simplest thing is to examine the patient, " said Dr.

Baggish, who is also chair of obstetrics and gynecology at Good

Samaritan Hospital in Cincinnati.

 

The condition is easily recognized. " The patient is red over the

Bartholin's ducts, and where the gland is located, a light cotton

swab touch will elicit an unusual response, pain way out of

proportion to te touch. In addition, even slight pressure such as

spreading the labia will cause discomfort, and since the skin remains

chronically inflamed, many of the patients will have skin that splits

and tears very easily, " he said.

 

The etiology of vulvar vestibulitis remains unknown, but Dr. Baggish

said that he believes it is caused by a chemical sensitivity that may

be induced by a variety of agents, including contact with topical

anrifungals, iodine preparatory solutions, topical or laser

treatments for human papillomavirus, lubricating agents, or chlorine

agents that are present in feminine hygiene products or swimming

pools.

 

He performs surgery only on those patients who have undergone a 3- to

4-month trial of conservative therapy, although he noted that only

15% of his patients have had relief of symptoms with this treatment.

 

Conservative treatment involves no topical applications, abstention

from intercourse for a total of 6 weeks, postvoid irrigation with

distilled water to negate the possible irritation of high urinary

oxylate, and low-dose Elavil to interrupt pain signals.

 

Dr. Baggish cautioned that excision of the Bartholin's glands is a

surgically challenging procedure that can take more than an hour per

gland and requires intraoperative visualization with a microscope to

ensure accuracy.

 

He suggests that physicians who are not familiar with this technique

should consider referring their patients to a specialist to avoid

potential serious complications, such as significant blood loss,

wound infection, entry into the urethra or rectum, or scar formation.

 

COPYRIGHT 2001 International Medical News Group

COPYRIGHT 2002 Gale Group

*******************************

I will certainly discuss the procedure THOROUGHLY with him before I

consider it. I actually know someone who had one of her glands

removed and said she was back to work in 2 days. I think she is an

exception though! She didn't have a vestibulectomy though, she had a

cyst on the gland.

 

I am trying to hold off til the end of summer. I will keep everyone

informed.