Practice Essentials
The Bartholin glands are paired glands approximately 0.5 cm in diameter and are found in the labia minora in the 4- and 8-o’clock positions. Typically, they are nonpalpable. Each gland secretes mucus into a 2.5 cm duct. These two ducts emerge onto the vestibule at either side of the vaginal orifice, inferior to the hymen. Their function is to maintain the moisture of the vaginal mucosa’s vestibular surface. This article focuses on the most common Bartholin gland diseases, cysts and abscesses (see the image below). Although rare, carcinoma of the gland should be considered in women with an atypical presentation. Primary carcinoma of the Bartholin gland accounts for approximately 5% of vulvar carcinomas.
Patients typically have an exquisitely tender, fluctuant labial mass with surrounding erythema and edema. Patients may have a painless, unilateral labial mass without signs of surrounding cellulitis. Bartholin abscesses are very rarely caused by sexually transmitted pathogens.
A patient whose presentation is concerning for malignancy should receive close outpatient gynecologic follow-up for biopsy and possible excision. Those with an uncomplicated, asymptomatic cyst may be discharged with sitz bath instructions. Sitz baths (3 times daily) for several days may promote improvement with resolution or spontaneous rupture with resolution of the cyst.
A Bartholin abscess is generally painful, and, thus, usually requires incision and drainage. In one study, Word catheter treatment was successful in 26 of 30 cases (87%) of Bartholin cyst or abscess.
Patients with an abscess often feel immediate pain relief after the drainage procedure; however, they may require oral analgesia for several days after the procedure.
Medications used in the treatment of Bartholin abscesses include topical and local anesthetics. Antibiotics for empiric treatment of STDs are advisable in the doses usually used to treat gonococcal and chlamydial infections. Ideally, antibiotics should be started immediately prior to incision and drainage.
Bartholin abscess. (Image courtesy of Dr. Gil Shlamovitz.)