The Bartholin glands are located on both sides of the inner labia and primarily function to produce mucus that moisturizes the vaginal mucosa. The mucus 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 and potentially 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 usually requires incision and must be drained surgically.
- ∼ 2% of women are affected at some point in their lives by a Bartholin gland cyst or abscess.
- Peak incidence: women in the reproductive age group
Epidemiological data refers to the US, unless otherwise specified.
- Pathophysiology: blockage of the duct by inflammation or trauma → accumulation of secretions from gland → cyst formation
- Clinical features: often asymptomatic but can cause mild dyspareunia
- Indicated for smaller, asymptomatic cysts ≤ 3 cm
- Involves sitz baths to facilitate rupture of the cyst and/or warm compresses
- Indicated for larger cysts > 3 cm and/or infected cysts
- See “Treatment” of Bartholin gland abscesses below.
- Conservative approach
- Pathophysiology: Bartholin gland or cyst becomes infected
- Clinical features
Treatment: surgery 
- Indicated in all cases of abscess formation and large cysts (> 3 cm)
- Involves incision and drainage followed by marsupialization or fistulization with a Word catheter
Marsupialization: indicated for recurring abscesses
- Evert and suture the edges of the cyst wall to the cut edges of the vestibule.
- This creates a new opening that allows free drainage.
Fistulization with a Word catheter
- Catheter is left in the abscess cavity for four weeks
- Facilitates drainage and allows for reepithelialization
- In case of suspected malignancy: biopsy
- Surgical excision: indicated in the presence of features suggestive of malignancy (e.g., invasion of surrounding tissue) or failure of less invasive measures
- Bartholin gland carcinoma
- Inclusion cysts
The differential diagnoses listed here are not exhaustive.