A minimal invasive management of Recurrent Bartholin Cyst by Kshara Karma - A...

[Full title: A minimal invasive management of Recurrent Bartholin Cyst by Kshara Karma - A Case Report]

Journal of Ayurveda and Integrated Medical Sciences 2025 Volume 10 Number 4 APRIL E-ISSN:2456-3110 Case Report Recurrent Bartholin Cyst Publisher www.maharshicharaka.in A minimal invasive management of Recurrent Bartholin Cyst by Kshara Karma - A Case Report Nidhish Kumar S 1* , Anupama V 2 , Chaithra N 3 DOI:10.21760/jaims.10.4.48 1* Nidhish Kumar S, Final Year Post Graduate Scholar, Dept of Prasuti Tantra Evam Stri Roga, Sri Kalabhyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bangalore, Karnataka, India 2 Anupama V, Professor and HOD, Dept of Prasuti Tantra Evam Stri Roga, Sri Kalabhyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bangalore, Karnataka, India 3 Chaithra N, Assistant Professor, Dept of Prasuti Tantra Evam Stri Roga, Sri Kalabhyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bangalore, Karnataka, India When the ducts of the Bartholin glands become blocked. Bartholin cyst is formed, leading to swelling and discomfort in the vaginal region. Though most Bartholin cysts are asymptomatic, they can cause significant pain and complications, especially when infected. This case report discusses the management of a recurrent Bartholin cyst in a 37-year-old female patient with a history of multiple surgeries for the same. The patient presented with swelling, pain, and difficulty in daily activities due to a recurrent cyst on the right labia majora. Previous treatments had included excision and marsupialization, but the cyst recurred multiple times despite medical management. Given the patient's unwillingness to undergo further invasive surgical procedures, an Ayurvedic approach using Pratisaraneeya Kshara Karma was chosen. The treatment involved Bhedana (Incision) and Visravana (Drainage) followed by the application of Palasha Teekshna Kshara. The procedure was minimally invasive, with no complications, and the patient experienced significant relief. No recurrence was noted after six months, suggesting Kshara Karma as a promising alternative to traditional surgery for managing recurrent Bartholin cysts. Further studies are needed to evaluate its long-term effectiveness and cosmetic outcomes Keywords: Bartholin cyst, Ayurveda, Pratisaraneeya Kshara Karma, Chedana, Minimal invasive treatment, Recurrence Corresponding Author How to Cite this Article To Browse Nidhish Kumar S, Final Year Post Graduate Scholar, Dept of Prasuti Tantra Evam Stri Roga, Sri Kalabhyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bangalore, Karnataka, India Email: Nidhish Kumar S, Anupama V, Chaithra N, A minimal invasive management of Recurrent Bartholin Cyst by Kshara Karma - A Case Report . J Ayu Int Med Sci 2025;10(4):316-320 Available From https://jaims.in/jaims/article/view/4266/ Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2025-03-13 2025-03-27 2025-04-07 2025-04-17 2025-04-27 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note None Nil Not required 11.65 © 2025 by Nidhish Kumar S, Anupama V, Chaithra N and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0] J Ayu Int Med Sci 2025 ; 10 ( 4 ) 316

Introduction The Bartholin glands are a pair of small, pea-sized glands located in the superficial perineal pouch, near the posterior end of the vestibular bulb at the 5 and 7 o’clock positions [1 ] Measuring about 0.5 cm in size, these glands play a crucial role in female reproductive health by secreting an alkaline mucus during sexual arousal. This secretion aids in natural lubrication. Each gland has an efferent duct approximately 2 cm long, which opens into the vestibule just outside the hymenal ring. These glands are homologous to the bulbourethral glands in males and generally remain non-palpable unless affected by pathological conditions A Bartholin cyst occurs when the duct of the gland becomes blocked, leading to fluid accumulation. This cyst presents as a firm, non-cancerous lump that may or may not cause discomfort. The size of the cyst can vary, with larger ones often resulting in pain and difficulty in movement. Although most Bartholin cysts are asymptomatic, infection can sometimes occur, leading to the formation of an abscess. A Bartholin abscess is characterized by intense pain, swelling, redness, and fever due to pus accumulation within the cyst In Ayurveda, this condition is described under Yonikanda , with references in classical texts such as Madhava Nidana . It is believed to arise due to factors like Diwaswapna (daytime sleep), Ati Krodha (excessive anger) , Ati Vyayama (overexertion), and injuries caused by Nakha-Danta-Kshata (nails, teeth, or thorns) [2] The aggravated Doshas lead to the formation of a protuberant structure resembling the Nikucha or Lakucha fruit [2] Based on the predominance of Doshas , Yonikanda is classified into four types: 1. Vataja : Characterized by a dry, rough, and discolored mass with a cracked surface, resembling an early-stage Bartholin cyst 2. Pittaja : Marked by redness, burning sensation, and fever, indicating an acute inflammatory phase 3. Kaphaja : Displays a bluish discoloration similar to Atasi flowers, accompanied by persistent itching, resembling a chronic cystic stage 4. Sannipatika : A severe form combining features of all three Doshas , often corresponding to an advanced abscess with chronic infection This Ayurvedic perspective provides insights into the pathogenesis and symptomatology of Bartholin gland disorders, emphasizing the role of dosha imbalance in theirmanifestation Case Report A 37-year-old married nulliparous women, software engineer by occupation, came to Prasuti & Stree Roga OPD of Sri Kalabyraveshwara Swamy Ayurvedic Medical College and Hospital, complaining of swelling and mild pain in right lateral of labia majora from 6 days associated with difficulty in walking sitting and doing daily activities. H/O Present illness: Patient was apparently normal 6 days back Initially swelling was unnoticed, she noticed a swelling in her vaginal region after getting pain associated with redness. After one year of marriage, She had similar complaint (B/L Swelling) and underwent left sided Bartholin cyst excision and right sided Marsupialization. Patient had 3 episodes of pain and swelling in the Right side in last 6 months and the symptoms subsided due to oral medications but relapsed later. Patient had experienced the same symptoms 2 months back. Symptoms exaggerated when the patient went on trekking 2 week back which might have contributed for the above said complaints H/O Past illness: No other surgical history, no history of thyroid disorder, diabetes, hypertension Menstrual history: Menarche: 13 years LMP: 11/9/2024 Duration of flow: 3 days Cycle interval: 28-30 days Regularity: regular Flow: 2-3 pads/day Family History: Nothing specific Personal history: Appetite - good Micturition - 3-4 times/day, 1-2 times/night Diet - Veg Allergic history - Nil Bowel - Once in a day Sleep - Normal Exercise - Nil Addiction - Tea twice in a day Nidhish KS et al. Management of Recurrent Bartholin Cyst by Kshara Karma J Ayu Int Med Sci 2025 ; 10 ( 4 ) 317

Ashtavidha Pariksha Nadi - Vata Kapha Mala - once a day Mutra - 3-4 times/day Jihva - Alipta Shabda - Prakrutha Sparsha - Anushnasheetha Drik - Prakrutha Akruthi - Madhyama Dashavidha Pariksha Prakruti - VK Vikruthi - Dosha -Tridosha Dushya - Rasa,Rakta,Mamsa Sara - Medosara Samhanana - Madhyama Pramana – Madhyama Satva - Madhyama Satmya - Madyama Aharashakti - Madhyama Vyayamashakti - Madhyama Vaya - Madhyama Physical Examination Weight - 84 kg Height - 160 cm BMI - 32.8 Pulse - 80/min BP - 110/80 mmhg Breast examination - NAD Respiratory rate - 20/min Pallor - Absent Systemic Examination Respiratory system: normal CVS: S 1, S 2 heard. CNS: Conscious and oriented GIT: liver, spleen not palpable Gynaecological Examination O/E: A unilateral swelling on right labia major, measuring 5 cm*3 cm, reddish, & smooth surface with punctum. Previous Surgical Scar mark is noted on left side of vaginal opening. On palpation cystic mass felt with tenderness on right side Investigation HB: 10 gm/dl HIV: Non-reactive WBC: 12000 /cmm VDRL: Non-reactive Platelets: 275800 /cmm TSH: 3.45 MIU/ml Treatment Given Bhedana followed by Pratisarana with Palasha Teekshna Kshara Poorva Karma 1. Pre Informed Consent Taken 2. Part Preparation done 3. Lignocaine Test Dose Given 4. Trolley for Ksharakarma 5. Patient has been made to lie down in Lithotomy position. 6. Part painted with Betadine. 7. Hole Towel Placed on the Operation site Pradhana Karma 1. Local anaesthesia (Inj. Lignocaine) given around the cyst. 2. With the Scalpel Blade No 11. A Vertical incision is made on the dependable Part. 3. Collections are drained out and wiped out properly with a Mop. 4. A finger with gauze was introduced into the cyst to clear loculations, if any. 5. Sides of Cyst is held with the help of Allis forceps. 6. With the help of Scoop, Palasha Teekshna Kshara has been applied to the internal capsule of the cyst 7. Pakwa Jambu Phala Varna attained 8. The site is irrigated with Lemon juice ( Jambu Swarasa ) using 5 ml syringe 9. Site irrigated with NS until patients feel relief from burning sensation. 10. The Gauze is packed in the site Paschat Karma 1. Patient tolerated the procedure well and patient was discharged after 2 hrs of observation Advice during discharge Nidhish KS et al. Management of Recurrent Bartholin Cyst by Kshara Karma T Triphala Guggulu 2-2-2 (A/F) Dashanga Lepa with luke warm Tila Taila for external application X 3 days Planned for Bhedana followed by Pratisarana with Palasha Teekshna Kshara T Grab 1-1-1 A/F Vranaharin lotion for E/A J Ayu Int Med Sci 2025 ; 10 ( 4 ) 318

Result Follow-up: 1. On 7 th day Pain, Redness and swelling were reduced No discharge, no induration Wound was healthy 2. After 6 month - No recurrence noted Discussion The history and clinical features are pathognomonic for the diagnosis of a Bartholin cyst. The primary objective in this case is to prevent recurrence, which was the patient’s primary concern. Given the patient's surgical history of left Bartholin cyst marsupialization, the only remaining option was excision of the cyst. This is an inpatient procedure that requires general or spinal anesthesia, along with a hospital stay, and is expensive. However, the patient was unwilling to bear the cost due to her multiple previous surgeries for the same condition To overcome the limitations of the afore mentioned contemporary techniques and highlight the potential of Ayurvedic approaches, Pratisaraneeya Kshara Karma was chosen for this case. As the pathogenesis of Yonikanda and Granti are similar, the line of management for Granti , which involves Bhedana (incision) and Visravana (drainage) was adopted, followed by Kshara Karma. [3] In Kshara Yogya (~ who is fit for Kshara Karma ), the chronicity, recurrence tendency were the key factors in choosing this intervention. Pratisaraneeya Kshara has Dahana (~cauterize), Pachana (~suppurates), Vilayana (~sloughing off), Shoshana (~to shrink/dry), Shodhana (~cleanse/ purifies), Ropana (~healing property) Karma , as its innate property [4 ] To initiate the process of Paka (maturation) as a prerequisite for the Bhedana (incision), Dashanga Lepa [ 5 ] mixed with luke warm Tila Taila was applied. The ingredients in Dashanga Lepa - includes Shirisha, Yashti, Ela, Chandana, Jatamasi, Haridra, Daruharidra, Kushta, Tagara, and Hribera possess properties which additionally help in alleviate pain for momentary relief The Kshara application causes protein coagulation and cauterization leading to columnar tissue necrosis and gradual sloughing off there by destructing the Bartholin cyst. Care was taken not to damage the adjacent healthy vaginal mucosa and skin during Kshara application. Though there were no complications encountered in this case, postoperative pain or burning sensation were expected and accordingly post-operative care was planned Kshara Karma , a minimal invasive procedure with no intraoperative bleeding, minimal postoperative pain, reduced surgical time, no need of sutures and dressing, has proven to have better outcome in the present case. Patient was comfortable both intraoperative and post operatively wherein patient was able to carry out his daily routine without any discomfort Conclusion Surgical innovations focus on reducing hospital stays, postoperative recovery times, and overall cost of procedures. Utilizing Ayurvedic treatments such as Kshara in conditions like Bartholin cysts may provide improved outcomes by minimizing complications, postoperative discomfort, and expenses. Additionally, risk of recurrence appears to be minimal with this approach. However, further prospective studies are needed to assess reproducibility, advantages, and disadvantages of this procedure, as well as to enhance cosmetic outcomes, particularly regarding location of incision References 1. Dutta DC. Textbook of Obstetrics. 7 th ed. Kolkata: New Central Book Agency(P) Ltd. ; 2005. p. 157-8 [Crossref][PubMed][Google Scholar] 2. Awasthi C. Madhav Nidan (Hindi Anuwad). 5 th ed. Lucknow: Tejkumar Book Depo (P) Ltd. ; 2009. p. 456 [Crossref][PubMed][Google Scholar] 3. Sushrutha. Sushrutha Samhita with commentary of Dalhana, edited by Acharya VJ. Varanasi: Chowakhamba Subharti Prakashan; 2014 Chikitsasthana, 18 th Chapter, Verse. p. 824-80 [Crossref][PubMed][Google Scholar] 4. Jadavaji T, editor. Susruta Samhita of Susruta, Nidhanasthana. Ch. 11, Ver. 7. Varanasi: Chaukhambha Orientalia; 2014. p. 46 [Crossref] [PubMed][Google Scholar] Nidhish KS et al. Management of Recurrent Bartholin Cyst by Kshara Karma Sitz bath with Panchavalkala Kashaya Maintain local hygiene Review after 7 days J Ayu Int Med Sci 2025 ; 10 ( 4 ) 319

5. Jain J, Chaudhary P, Dave HH. Complete cure of recurrent Yonikanda (Bartholin gland abscess) with Ayurveda: A case report. World J Pharm Res. 2018;8(12):1014-22. ISSN 2277-7105 [Crossref] [PubMed][Google Scholar] Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content Nidhish KS et al. Management of Recurrent Bartholin Cyst by Kshara Karma J Ayu Int Med Sci 2025 ; 10 ( 4 ) 320

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Ayurveda, Chedana, Paka, Bhedana, Sannipatika, Tridosha, Kaphaja, Visravana, Vataja, Hiv, Dosh, Pittaja, Incision, Daily activities, Physical examination, Clinical feature, Ayurvedic treatment, Kshara-Karma, Case report, Ayurvedic approach, BMI, Surgical Procedure, Dashanga Lepa, Oral medication, Cosmetic Outcome, Local anaesthesia, Ethical approval, Postoperative Pain, Hospital stay, Postoperative recovery, Marsupialization, Surgical history, WBC, TSH, Lignocaine, Surgical time, Internal capsule, Platelet, Hb, Vaginal region, BP, LMP.