Pocket ObGyn – Bartholin Gland Cyst and Abscess
See Abbreviations
Definition (J Obstet Gynaecol 2007;27:241)
- Bartholin gland secretes mucous vaginal Located at ~4- & 8-o’clock on labia minora bilaterally. Not palpable unless pathology. Usually women b/w 20–30 yo.
Etiology & Pathophysiology
- Blockage of gland outflow ® accum of mucous ® Bartholin duct
- Superficial infxn of a Bartholin cyst ® Bartholin duct Polymicrobial. Most common bacteria are anaerobic & facultative aerobes.
- Bartholin cyst & abscess uncommon >40 Consider biopsies of cyst wall to r/o cancer.
Clinical Manifestations and Physical Exam
- Small cysts are Larger ® vaginal pres or dyspareunia.Typically unilateral, round, & tense.
- Abscess = sev pain ® difficulty walking, sitting, engaging in May be tender w/ erythema/induration, purulent drainage.
- DDx: Epidermal inclusion cysts, mucous cyst of vestibule, cyst of canal of Nuck, Skene’s duct cyst (J Obstet Gynaecol 2007;27:241)
Treatment (See also Appendix of Common Procedures)
- Small, asx cyst requires no OTC analgesics, warm compresses, & sitz baths may provide sx relief.
- Abscess may drain Immediate pain relief will occur w/ drainage.
- Surgical mgmt reserved for recurrences, abscesses, or large symptomatic
- I&D: Relief but incision can reseal ® reaccumulation of Word catheter (or pediatric Foley) allows continued drainage & tract epithelialization. High recurrence rates after I&D. Leave catheter 4–6 w. May fall out before then.
- Marsupialization: Create new drainage Incise roof of cyst ® sew edges of cyst wall to adj skin edge. Requires anesthesia, time, & placement of sutures. Low recurrence after marsupialization.
- Bartholin gland excision: Reserved for cyst that recurs risk of bleeding. Not performed if active infxn.
Antibiotic therapy often prescribed after surgical rx. Cx rarely change mgmt (Am Fam Physician 2003;68:135). Use broad spectrum abx, failure of clinical improv, consider MRSA.