Marcia/Bartholin's Glands Removal

[Guest guest]

Yikes! – Good luck to you Marcia – you are very

fortunate to have this doctor so close to you so that you can have it done. I

had pudendal decompression surgery, and that didn’t scare me, when everybody

else couldn’t believe that I would take the chance in having it done. For

some reason, in my heart, I felt it would be OK. But just reading the details

on the surgery that Dr. Baggish performs really makes me nervous. “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”. Wow! But you have

to have faith in the doctor and the procedure, and if you feel it will turn out

OK, then it will. And as you said, you would discuss it with him

thoroughly before you had it done. It would be wonderful if it worked and you

were back on your feet in a short amount of time – for me that would be a

miracle. Please keep us informed and let us know if you decide to go ahead with

it and the date, so that I can put you in my prayers the day of the surgery.

nne

From:

VulvarDisorders [mailto:VulvarDisorders ] On

Behalf Of Marcia Gallas

Sent: Friday, May 16, 2008 5:32 PM

To: VulvarDisorders

Subject: Re: Marcia/Bartholin's Glands Removal

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.

Hugs to all! Marcia

[Guest guest]

HI Marsha...

awhhh

Hon how confusing all this must be as to whether or not to do that kind of a surgery. *sigh* I can imagine how up in the air I'd feel if I were in pain and nothing has helped and a doctor almost guarantees me that surgery will work that I'd be considering it as well.

It is more involved if the bartholin glands are fully removed as well, I can see that. Just curious, do you have any signs of the Bartholin glands being infected or swollen at all right now? Forgive me hon I forgot if you told us.

It's just my opinion here but I have to say that right now after reading that article I sure can't agree with his statement where he says that in ''virtually every case of vestibulitis'' it stems from dysfunctional mucus glands and most often it's the Bartholin glands. I'd have to see a lot more research to believe that's true in 'virtually every case'? I'm sorry hon I simply can't see that.

I'm not saying he's not a good doctor, I've no idea, and he's up there in title from the little I've gathered, and I'm sure it's what he truly believes so it's just my uneducated opinion. If it were me? I think I'd ask for him to put me in touch with at least 5 previous patients that I could talk to to see their experiences.

If it's needed of course it makes sense, if they're diseased yes... but if you remove the glands and the tissue over them.. I'm thinking then what is left 'to' hurt? So it's easy to claim a high success rate. From that point of view it makes sense. But to ''me'' it's like cutting off your finger, so of course your finger no longer hurts, (but it's because it's gone).

If that is the answer to all this V pain with vestibulitis, my goodness I'd tell everyone, ''don't waste your time trying anything else just go immediately and get the surgery.''

I did see a good article that he wrote about post surgery & the unsuspected nerve damage and the things that can go wrong afterwards...even mentions those retractors or the position of the body during the surgery, it's at:

http://findarticles.com/p/articles/mi_m0CYD/is_18_36/ai_79586717?tag=rel.res1

That ''Trendelenburg position' he mentions in there as suggested to 'not' use, means where the patient is flat on their back with the feet raised higher than the head during the surgery and there is a 'gait' also called the Trendelenburg 'gait' one can be left with as a result from surgery done with that position.

It's definitely all very interesting. If you find out anything else hon be sure to let us know. He may just have something there but like I said it seems to 'me' that the removal of the bartholin glands in his vestibulitis patients as a cure to be extreme. (but I could be wrong)

I can imagine the questions I'd have, but just know we're behind you 100% whatever the decision is.

BIG hugs Dee

[Guest guest]

Why would the doctor want to remove the glands in addition to doing the vestibulectomy? Did he/she explain to you the point of removing the glands? I am only asking because I have had vulvar vestibulitis for 7 years, recently had a successful partial vestibulectomy that completely took away my pain with intercourse, and never once has my doctor mentioned the Bartholin's Glands. They were not removed during my surgery, and we never discussed them. I am sure that I'm partial, but my doc is great, knowledgeable, and extremely thorough, so I think he would have mentioned them to me.

For a regular vestibulectomy, the recovery time is about 2-3 weeks out of work (in my experience), with additional discomfort for about 6-8 weeks post surgery, but it's not horrible. Most of it can be controlled with advil, ice, and if you need, percocet or another narcotic, which i took for about a week or so after the procedure. it is well worth the discomfort if your doctor thinks you are a good candidate!

amy:)

[Guest guest]

Hi Amy, Dee, nne, and all: Thanks to everyone for their input.

I haven't personally discussed this procedure with my doctor since I

have only seen him twice and not for over a year! It's just that in

doing my research it SEEMS that this is the procedure of

vestibulectomy that he uses. The article I posted IS 7 years old.

Perhaps he has changed his philosophy and doesn't just shotgun ALL

vestibulectomies to include the removal of the Bartholin's Glands.

Having said that however, it seems to me that he is pretty sure of

himself in his belief that this procedure is the best way to a pain-

free outcome. Maybe when I am ready to discuss the procedure with

him I will find out otherwise. I was just throwing this out there to

all of you to find out if any of you had had this particular

procedure.

I agree that it IS a radical and MAJOR surgical procedure. I sure

wouldn't want to have anything " extra " done if it wasn't absolutely

necessary. I am grateful to all of you for your opinions and

for " listening " . I must admit that it is hard not to think of all of

this constantly. I am sitting here in pain and so tired of it after

2 years. I know some of you have gone through it much longer. I

don't think I can wait TOO much longer without having surgery since

I've tried and failed with all of the medications. I still have to

wait until at least the end of the summer due to obligations and

responsibilities. You know how that goes. Oh and Dee, you asked if I

was having any swelling or issues with the glands and I would have to

say, " Not that I know of. " My vestibulitis is the result of a

traumatic injury so I don't know if the glands are at all a

contributing factor.

I will DEFINITELY keep all posted as to when I go for a consultation

and what the doctor has to say. Needless to say, I will tell you

when the surgery will be. I will be needing everyones' prayers at

tha point.

Hugs to all.

Marcia