Bartholin’s Cyst or Abscess
Jill C. Cash and Rhonda Arthur
Definition
A.The Bartholin’s glands are small, round, nonpalpable mucous-secreting organs. They are located bilaterally in the posterolateral vaginal orifice. Obstruction of the duct causes the gland to swell with mucus and form a Bartholin’s cyst. The cause of obstruction is usually unknown but may be due to mechanical trauma, thickened mucus, neoplasm, stenosis of the duct, or infectious organisms not limited to sexually transmitted infections (STIs). The cyst may become infected, resulting in an abscess. Cysts develop more commonly in younger women and occurrence decreases with aging; therefore, it is important to rule out neoplasm in women over 40 experiencing Bartholin’s cyst.
B.The majority of women with Bartholin’s cyst are asymptomatic, but large cysts can cause pressure and interfere with walking and sexual intercourse. Abscesses generally develop rapidly over a 2- to 3-day period and are painful. Some abscesses may spontaneously rupture and often reoccur.
Predisposing Factors
A.History of STIs.
B.Local trauma.
Common Complaints
A.Cysts can be asymptomatic and are found incidentally on physical exam.
B.Localized pain/irritation.
C.Dyspareunia.
D.Difficulty walking or sitting due to edema.
Subjective Data
A.Elicit onset, duration, and course of presenting symptoms.
B.Review any changes in the characteristics and color of vaginal discharge. Does the patient’s partner(s) have any symptoms?
C.Review any symptoms of pruritus, perineal excoriation, burning; signs of urinary tract infection (UTI).
D.Review the patient’s medication and medical history.
E.Determine if the patient is pregnant; note the date of last menstrual period (LMP).
F.Question the patient for a history of STIs or other vaginal infections.
G.Review previous infection, treatment, compliance with treatment, and results.
H.Note last intercourse date.
Physical Examination
A.Inspect: Examine external vulva and introitus for discharge, irritation, fissures, lesions, and rashes. Bartholin’s cyst will appear as a round mass, usually near the vaginal orifice causing vulvar asymmetry. Cysts are usually unilateral, tense, nontender, and without erythema. An abscess is usually unilateral, tense, painful, and erythematous.
B.Palpate: Palpate the external labia and lateral posterior introitus for enlarged cyst, mass, or tenderness; note discharge if present.
Diagnostic Tests
A.Culture and sensitivity of purulent abscess fluid.
B.Cervical culture for STI (Neisseria gonorrhea and Chlamydia trachomatis [CT]).
C.Excisional biopsy in women older than 40.
Differential Diagnoses
A.Bartholin’s cyst.
B.Bartholin’s abscess.
C.Neoplasm.
D.STI.
E.Sebaceous cyst.
Plan
A.General interventions: Reassurance is indicated for women younger than 40 with asymptomatic cysts. Incision and drainage (I&D) with culture and sensitivity is often required for symptomatic cysts and abscesses. Because cysts and abscesses often reoccur, surgery to create a permanent opening from the duct to the exterior is often the definitive treatment. Two such surgical methods are placement of a wards catheter or marsupialization. Referral is indicated for I&D and other surgical intervention if the provider is not experienced with the procedures.
B.Warm sitz baths three or four times a day may encourage spontaneous rupture of abscess and provide comfort.
C.Pharmaceutical therapy:
1.Recurrent abscesses are treated with oral broad-spectrum antibiotics such as cefixime 400 mg three times a day for 7 days and clindamycin 300 mg every day for 7 days. If STI is present, treat according to Centers for Disease Control and Prevention (CDC) STI treatment guidelines.
Follow-Up
A.Report to healthcare provider if symptoms reoccur.
Consultation/Referral
A.Refer the patient to a physician for recurrence that is unresponsive to therapies.
B.Women older than 40 must be referred for surgical exploration and excision biopsy.