• Clinical science

Bartholin gland cyst and abscess

Abstract

The Bartholin glands are located in both sides of the inner labia and serve primarily to produce the mucous that moisturizes the vaginal mucosa. The mucous is secreted into two ducts that appear in the posterior vaginal introitus. A Bartholin gland cyst is usually caused by blockage of the duct as a result of inflammation or trauma; a Bartholin gland abscess occurs when the obstructed duct becomes infected. The most common symptoms are swelling and, in the case that an abscess develops, pain as well as possibly fever. Both Bartholin gland cysts and abscess are clinical diagnoses. First-line treatment includes sitz baths, which may promote spontaneous rupture or resolution of the cyst after a few days. An abscess, however, usually requires incision and must be drained surgically.

Epidemiology

  • ∼ 2% of women are affected at some point in their lives by a Bartholin gland cyst or abscess.
  • Peak incidence: 20–30 years

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Bartholin gland cyst

  • Pathophysiology: blockage of the duct by inflammation or trauma
  • Clinical features: often asymptomatic but can cause mild dyspareunia
  • Diagnostics
    • Pelvic exam: unilateral, palpable mass in the posterior vaginal introitus
    • STD testing at the request of the patient
    • Biopsy is indicated if any of the following apply :
      • > 40 years of age
      • Progressive, solid, and painless mass found during pelvic exam
      • Not responsive to treatment
      • History of malignancy in the labia
  • Treatment:
    • Sitz baths to facilitate rupture of the cyst A specially designed plastic basin can be placed over the toilet for the purpose of sitz baths. Alternatively, a bathtub filled with just 3 inches of warm water may also be used.
    • Consider surgery for symptomatic cysts (see “Treatment” of Bartholin gland abscesses below)

A Bartholin gland cyst is generally a clinical diagnosis based on physical examination!References:[1][4][2][3]

Bartholin gland abscess

  • Pathophysiology: Bartholin gland or cyst becomes infected
  • Clinical features
    • Acute unilateral pain and tender swelling
    • Dyspareunia
    • Pain especially while walking and sitting
    • Fever (∼ 20% of cases)
    • Prompt pain relief with discharge (indicates spontaneous rupture of abscess)
  • Diagnostics
    • Pelvic exam: unilateral, tender mass surrounded by edema and erythema in the posterior vaginal introitus
    • Possible culture
    • STD testing at the request of the patient .
    • Consider biopsy to rule out malignancy (see “Diagnostics” of Bartholin gland cyst above)
  • Treatment
    • Incision and drainage followed by irrigation and packing
    • Fistulization with a Word catheter
    • Marsupialization
      • Indicated for recurring abscesses
      • The labia minora is cut longitudinally to expose the cyst or abscess. Once the cyst or absess is displayed, it is slit open longitudinally and drained. The slit edges of the cyst or absess are then everted and sutured to the slit edges of the labia minora, which forms a new opening to allow free drainage.
    • Excision: a very invasive procedure that is mainly used to treat malignancies
    • The application of ablation, laser, and sclerotherapy to Bartholin gland abscesses is currently being investigated.

Bartholin gland abscess is usually a clinical diagnosis based on physical examination!

References:[1][4][2][3]

Differential diagnoses

References:[4][5]

The differential diagnoses listed here are not exhaustive.