La Bartholinite est une infection gynécologique courante. On estime que 2% des femmes seraient concernées par cette infection au cours de leur vie, principalement entre 20 et 29 ans.
Comment se manifeste cette inflammation (d’origine infectieuse) de la glande de Bartholin ? Comment guérir un abcès ou un kyste de la région vulvaire ? Mia fait le point sur les causes et les traitements de la Bartholinite.
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La Bartholinite désigne une inflammation localisée de la glande de Bartholin. C’est une pathologie vulvaire assez fréquente, qui peut se manifester par des kystes ou des abcès.
Cette glande de Bartholin tire son nom de l’anatomiste danois Gaspard Bartholin. Il s’agit en fait de deux glandes hormonodépendantes, responsables notamment de la lubrification vaginale. Sa forme est aplatie et allongée et elle mesure environ 10 à 15 mm.
Les deux glandes de Bartholin sont localisées en profondeur, proche du vestibule, et entourent de part et d’autre l’anneau hyménéal (orifice vaginal). Elles sont vascularisées grâce à plusieurs artères (bulbaire et périnéale) et un réseau veineux complexe.
Les glandes de Bartholin sont retenues par le muscle constricteur de la vulve ; leur canal excréteur aboutit finalement entre les petites lèvres, près de l’hymen. La taille de ces glandes augmentent rapidement de volume après la puberté et ont tendance à diminuer de volume avec la ménopause.
La fonction des glandes de Bartholin est de lubrifier le vagin continuellement, grâce à leurs sécrétions, notamment lors des rapports sexuels. Lorsqu’elles s’enflamment, les glandes de Bartholin peuvent être le siège d’une infection.
Dans de rares cas, leur ablation est parfois nécessaire, notamment en cas de Bartholinites récidivantes. Cela n’empêche cependant pas le vagin d’être lubrifié par d’autres glandes vaginales sous l’influence des œstrogènes.
Quels sont les symptômes de la Bartholinite ?
La Bartholinite se caractérise par une douleur aiguë et localisée au niveau du vagin. Elle peut aussi s’accompagner de rougeurs ou d’une sensation de chaleur dans la même zone.
Le diagnostic médical validera la présence d’une boule ferme (un kyste ou un abcès) lors d’une palpation. Ce diagnostic est confirmé par la présence bien visible d’une tuméfaction au niveau de la vulve et du périnée.
Cette tuméfaction est responsable d’une douleur lancinante et d’une déformation de couleur rouge et chaude.
A lire aussi : comment combattre le vaginisme ? Comment faire disparaitre cette difficulté à se faire pénétrer ?
Quelles sont les causes de la Bartholinite ?
L’infection de la glande de Bartholin provient de germes d’origine vaginale (sexuellement transmissibles) : des mycoplasmes, la chlamydia ou encore le gonocoque. L’infection remonte ensuite par voie canalaire.
Mais la Bartholinite peut aussi être d’origine digestive et causée par des entérobactéries. D’ailleurs, les abcès de la glande de Bartholin sont majoritairement causés par des bactéries d’origine digestive et moins souvent par des IST.
Dans la réalité, les IST tels que la chlamydia ou la gonorrhée sont essentiellement responsables des Bartholinites en cas de co-infection par le VIH. Elle peut aussi être une complication d’une intervention chirurgicale vulvovaginale.
Dans d’autres situations, un kyste se forme près du canal excréteur ou de la glande elle-même, avec pour conséquence une surinfection. Ce kyste peut être causé par une obstruction du canal excréteur et peut aussi provenir d’un rétrécissement congénital.
Certains médecins évoquent également le traumatisme d’un accouchement ou de l’épisiotomie comme causes possibles de la Bartholinite.
Diagnostic et examen
Seul un examen clinique assure un diagnostic fiable. Il permettra notamment, grâce à des prélèvements, de rechercher d’éventuelles IST (syphilis, chlamydia, gonorrhée ou autres) comme causes de la Bartholinite.
Ces prélèvements sont particulièrement indiqués chez les personnes à risques, dont les femmes jeunes ou qui ont plusieurs partenaires. La recherche de germes est parfois nécessaire chez le ou la partenaire, en fonction de la nature du germe retrouvé lors des prélèvements.
Quels sont les traitements de la Bartholinite ?
Le traitement de première intention repose sur une mise à plat chirurgicale de l’abcès. Pour cela, une incision est nécessaire au niveau de la muqueuse vestibulaire, verticalement, dans le sillon nympho-hyménéal.
Une incision au niveau du dôme saillant de la glande de Bartholin est aussi possible. Lorsque l’abcès présente déjà des fistules, l’opération chirurgicale consistera à élargir suffisamment l’orifice du drainage.
Un prélèvement bactériologique de pus (après incision de la muqueuse vestibulaire) devra également être réalisé. Après avoir ouvert largement l’abcès, un nettoyage abondant de sa cavité est effectué à l’aide d’une solution antiseptique.
Un drainage sera mis en place pendant 24 à 48 heures grâce à une mèche iodoformée ou une lame de type Delbet.
Afin de limiter le risque de récidive, une marsupialisation peut être réalisée : il s’agit d’une technique chirurgicale visant à drainer le kyste ou l’abcès. Elle consiste à suturer la paroi de l’abcès à la muqueuse vestibulaire située autour.
Cependant, la marsupialisation a l’inconvénient d’accentuer le risque de douleurs lors de la cicatrisation. Une antibioprophylaxie est généralement pratiquée lors de l’intervention chirurgicale par injection intraveineuse.
Après l’opération, la prescription d’antalgiques est conseillée. La patiente peut ensuite sortir au bout de 24 à 48 heures qui suivent l’intervention. La convalescence est organisée autour de soins infirmiers, qui veillent à la bonne cicatrisation de l’orifice du drainage.
On estime le taux de récidives des Bartholinites à hauteur de 10 à 15% après un premier épisode. Lorsqu’elles récidivent trop fréquemment, l’ablation de la glande de Bartholin peut être envisagée.
Evolution et complications possibles
Généralement, la Bartholinite est une pathologie bénigne, qui évolue favorablement, lorsqu’elle est correctement traitée. La principale complication est la récidive, dans 5 à 15% des cas, malgré le drainage ou la marsupialisation.
En cas de récidives trop fréquentes, une ablation de la glande de Bartholin peut être proposée.
Dans 5% des cas, des hématomes peuvent survenir après l’intervention chirurgicale, mais aussi des septicémies, et à long terme des dyspareunies (douleurs lors des rapports) ou des douleurs chroniques.
Ce qu’il faut retenir sur la Bartholinite
Les Bartholinites sont le plus souvent bénignes mais constituent un motif fréquent de consultation. Un examen clinique est nécessaire et le traitement est chirurgical, afin de drainer l’abcès de la glande de Bartholin.
Des antibiotiques sont souvent administrés en association de la chirurgie. Quand le traitement est correctement conduit, les complications d’une Bartholinite sont rares. L’évolution est donc le plus souvent favorable.
Le principal risque est la récidive.
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