Ayurvedic Management of Recurrent Bartholin’s Cyst - A Case Report

Introduction

The Bartholin’s glands are situated symmetrically on either side of the labia, near the posterior end of vestibular pouch. They secrete vaginal lubricating fluid and helps in protecting vaginal tissues during sexual intercourse. Bartholin’s cyst is a fluid-filled swelling on one of the Bartholin’s glands which usually develops in women of reproductive age after puberty and also before the menopause.¹

The Bartholin’s glands contain small ducts or openings that allow fluid to flow out. The main cause for cyst formation is the backup of fluid that occurs when the ducts become blocked. The symptoms associated with the development of this cyst include, pain and swelling around the vaginal opening, along with fever and chills. When a cyst becomes infected, it is referred to as an abscess.

According to Ayurveda, Yonikanda is a disease of vulva or lower vaginal wall.^2,3 The presence of pus or blood, along with pain and swelling in vulva are few of the primary clinical features of this disease; therefore, it can be correlated with a Bartholin’s cyst.

Ayurveda provides promising results in the treatment of Bartholin’s cyst and permanently prevents the recurrence.

Case Presentation

A 31-year-old married female patient presented to the Striroga OPD of SDM College of Ayurveda and Hospital, Hassan, with c/o small swelling and discomfort in the vulval region, associated with pain while walking and mild itching for one month. She underwent treatment for the same at a Government hospital for 15 days, but did not experience any relief.

Past history

History of recurrence of similar complaints since f ive years was noted for which the patient was taking symptomatic treatment. Prior to six months, a huge swelling was noted in the right labia majora which initially started as a small swelling, and then increased in size. This developed into a large, tender swelling involving right labia majora, with shiny and smooth surface, with no punctum, measuring 5 cm in length and 4 cm in width. She underwent marsupialization at our hospital before six months as per the reference of Pakwa granti hara line of management i.e., Patana karma.⁴

Family history: None of the family members had similar complaints.

Menstrual history: Regular cycle of 28-30 days, menstrual phase of 4-5 days, 2-3 pads/day with mild pain in abdomen and bleeding without clots.

Obstetric history: P2L2

L1- 8 years, FTNVD, Male baby

L2- 5 years, FTNVD, Female baby

Contraceptive history: Permanent, tubectomized, one year back.

Personal history: Patient predominantly consumed Katu pradhana diet and consumed non-vegetarian diet once a week.

Appetite - Moderate

Bowel - Regular

Micturition - Regular

Sleep - Sound

Per abdomen examination: Soft, non-tender.

Astasthana Pariksha

Nadi - Prakruta, 82 beats/min

Mala - Prakrutha

Mutra - 7-8 times / day

Jihwa - Alipta

Shabda - Prakruta

Sparsha - Sheeta

Druk - Prakrutha

Akruti - Madhyamam

Dashavidha Pareeksha

Prakriti: Vata kapha

Vikruti: Kapha pitta

Saara: Medosara

Samhanana: Madhyama samhanana

Satwa: Madhyama satwa

Satmya: Sarvarasa Sathmya

Ahara shakti - Pravara

Abyavaharana shakti - Pravara

Jarana shakti - Madhyam

Pramana:

Height - 160 cm

Weight - 72 kg

Vyayama shakti: Madhyama

Vaya: Madhyama

General & systemic examination: Within normal limits

Local examination

Size of swelling: 2 x 3 cm behind right labia majora

Redness +

Swelling +

Tenderness +

Discharge - Absent

Investigations: Routine blood investigations, urine examination, serological investigations were found within normal limits.

Chikitsa Siddanta⁵

According to Bhavaprakasha,

Yonipoorana with Gairika (red ochre), kernel of mango, janthughna, rajana, anjana and katphala mixed with honey. Triphala kashaya with honey was used for Prakshalana.

Therapeutic Intervention

Table 1

For preventing further recurrence

Once the patient experienced relief from symptoms, she was advised for Kaya shodhana with Vamana and Virechana, as per the reference of Vangasena.⁶ Classical Vamana and Virechana are done after menstrual cycle.

Follow up & Outcomes

1. Redness, itching and pain reduced within three days and, swelling and vaginal discharge reduced at the end of seven days after the initiation of treatment.
2. After Shodhana karma, the patient was followed up every three months in the OPD.
3. 3. No recurrence of the complaints were noted at six month follow-up.

Discussion

The patient presented with recurrent right labial swelling and pain in vulval region. Oral medications prescribed provided only temporary relief lasting for few weeks, with the complaint recurring, even after marsupialization performed before six months.

The treatment provided in the present case resulted in reduction of redness, itching, pain within three days of commencement of the treatment and the swelling reduced after seven days of treatment. Triphala guggulu and Gandhaka rasayana have the Vrana shodhana (wound purification), anti-inflammatory and analgesic effects. Marmani vati exerts localized effects of shodhana and ropana on this condition. Triphala kwatha, Tridosha shamaka and Shothahara Guna property based on Kashaya Rasa Pradhana Dravyas directly act on all stages of Dushta Vrana. The use of oral and local Ayurveda treatments demonstrated positive effects on the patient’s progress during follow up. Then, the patient was treated with Kaya shodhana⁶ as per the reference of Vangasena after cyst reduction, for prevention of further recurrence of the disease. In Vangasena, the swedana was mentioned as treatment of Vataja yonikanda, Virechaana for Pittja yonikanda, Vamana for kaphaja yonikanda and mixed treatment for the management of Saannipatikaa yonikanda.

The management of Bartholin’s cyst with the aid of Ayurveda treatment modalities in oral and local forms has demonstrated effective results. The Kaya shodhana proved its effectiveness by preventing the recurrence of symptoms.

Patient Perspective

I was suffering from swelling and pain in my genital parts very frequently. I even underwent surgery for the same but the condition recurred. With the hope of getting effective treatment, I approached doctor and they treated me with different procedures. I noticed improvement in the issues, and therefore agreed for panchakarma treatment prescribed for me. I underwent the treatment a year back and experienced complete relief, with successful prevention of its recurrence.

Conflict of Interest

None