Guidelines for Nurse Practitioners in Gynecologic Settings 2016
Care Plan – Bartholin’s Cyst, Bartholinitis
N75.0: Cyst of Bartholin’s gland
I. DEFINITION
Bartholin’s duct cyst is a postinflammatory pseudocyst that forms proxi- mally to the obstructed duct of a Bartholin’s gland. The obstruction leads to dilation of the duct. Bartholinitis is inflammation of one or both of the Bartholin’s glands.
II. ETIOLOGY
A. Responsible organisms include
1. Staphylococcus aureus
2. Streptococcus faecalis
3. Escherichia coli
4. Pseudomonas
5. Gonococcus
6. Chlamydia trachomatis
7. Trichomonas vaginalis
8. Bacteroides
III. HISTORY
BARTHOLIN’S CYST, BARTHOLINITIS 205
A. What the patient may present with
1. Deep, diffuse, painful, swollen lump, and/or swelling in posterior vaginal (vestibular) area—can be unilateral, bilateral, or asymptomatic
2. Can become large
3. Difficulty sitting and walking because of severe pain and swelling as a result of trauma or infection
B. Additional information to be considered
1. Previous infection of a Bartholin’s gland or duct; if yes, how was it treated
2. History of STI
IV. PHYSICAL EXAMINATION
A. Vital signs
1. Temperature
2. Blood pressure
B. Visual examination of external genitalia
1. Cyst is characteristically located in the lower half of the labia, with its inner wall immediately adjacent to the lower vaginal canal.
2. Lesions may vary in size from 1 to 10 cm.
3. The involved area may be painfully tender.
4. There may be no subjective symptoms.
5. Diagnosis is usually made by clinical appearance at the vulva.
6. Histology examination of the lesion presents atypically.
V. LABORATORY EXAMINATION
A. Culture lesion at time of incision and drainage
B. Consider cervical cultures for Chlamydia and gonorrhea
VI. DIFFERENTIAL DIAGNOSIS
A. Lipoma
B. Fibroma
C. Hydrocele
D. Carcinoma of Bartholin’s gland (extremely rare); suspicion arises if the cyst is firm or irregular to palpation
E. Inclusion cysts, sebaceous cysts
F. Congenital anomaly
G. Secondary metastatic malignancy
H. Hernia
VII. TREATMENT
A. May not be necessary unless it is quite large, symptomatic, or infected
B. Sitz bath several times a day for 3 to 4 days as needed, then reexam- ine. If size has increased or there is no change, perform incision and drainage or refer to physician for possible marsupialization (surgical
excision and unroofing of lesion). If cyst or gland is extremely painful or large, immediately refer to a physician.
C. Antibiotics as appropriate to organism; most common is ampicillin, 500 mg four times a day for 7 days; ceftriaxone 125 mg im single dose; cefixime 400 mg orally in single dose; azithromycin 1 g orally in a single dose; or doxycycline 100 mg orally twice a day for 7 days
VIII. COMPLICATIONS
A. Recurrence
IX. CONSULTATION/REFERRAL (SEE TREATMENT, VII.A AND VII.B)
X. FOLLOW-UP
At the clinician’s discretion after incision and drainage or marsupialization
See Bibliography.