Bartholin gland cyst and abscess

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

References:^[1][2]

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
• Diagnostics
  • Pelvic exam: unilateral, palpable mass in the posterior vaginal introitus
  • 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
  • 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][2][3][4]

• 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
  • 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 abscess is displayed, it is slit open longitudinally and drained. The slit edges of the cyst or abscess are then everted and sutured to the slit edges of the labia minora, which forms a new opening to allow free drainage.

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

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

• 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:^[4][5]

The differential diagnoses listed here are not exhaustive.