Summary
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.
Epidemiology
- ∼ 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
References:[1][2]
Epidemiological data refers to the US, unless otherwise specified.
Bartholin gland cyst
- 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
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Diagnostics
- Pelvic exam: unilateral, palpable mass in the posterior vaginal introitus
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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
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Management [1][2]
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Conservative approach
- Indicated for smaller, asymptomatic cysts ≤ 3 cm
- Involves sitz baths to facilitate rupture of the cyst and/or warm compresses
- Surgery
- Indicated for larger cysts > 3 cm and/or infected cysts
- See “Treatment” of Bartholin gland abscesses below.
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Conservative approach
A Bartholin gland cyst is generally a clinical diagnosis based on physical examination.
Bartholin gland abscess
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Pathophysiology: Bartholin gland or cyst becomes infected
- Usually a polymicrobial infection: E. coli ; (most common), Staphylococcus species, Streptococcus species, N. gonorrhoeae, C. trachomatis
- Clinical features
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Diagnosis
- 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)
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Treatment: surgery [1][2]
- 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
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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.
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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
Differential diagnoses
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Bartholin gland carcinoma
- Epidemiology: primarily found in postmenopausal women
- Symptoms: gradual, solid, and painless enlargement of the Bartholin gland
- Diagnostics: biopsy
- Treatment
- Resection of the lesion
- If surgery is not possible or as adjuvant therapy: chemotherapy and radiation
- Folliculitis
- Inclusion cysts
- Leiomyomas
- Fibroma
References:[3][4]
The differential diagnoses listed here are not exhaustive.