The Bartholin’s Glands are bilateral structures, present in women on the labia minora and adjacent to the posterolateral aspect of the vaginal introitus. Each gland is approximately pea-sized, producing a mucoid substance which is secreted through an inch-long duct during sexual arousal. The glands are named after Thomas Bartholin, best known for the discovery of the Lymphatic System, in the 17th century. Pathology of the glands is relatively common.
A blockage in the duct may cause a cyst to develop, termed Bartholin’s Cyst, and occurs at any age in around 2% of women during their life. The cyst may be complicated by infection and become a Bartholin’s Abscess. Bacterial abscess can occur in conjunction with Sexually-Transmitted Infections (STIs), or due to skin or faecal flora. Common pathogens include:
A Bartholin’s cyst is usually of little concern, being asymptomatic in the majority of cases and resolving spontaneously. The cyst may enlarge enough to cause irritation during sitting or intercourse. Concomitant infection leads to abscess formation with which the patient may experience extreme pain due to expansion of the gland against the ligaments of the perineum and pelvis. Cysts and abscesses are usually unilateral.
Diagnosis of Bartholin’s cyst and abscess is clinical, although any vulval lump should be cast with a suspicious eye to exclude malignancy particularly in older women as Bartholin’s glands shrink post-menopause. Both Lichen Sclerosus and Human Papilloma Virus (HPV) infection are risk factors for development of Vulval Squamous Cell Carcinoma (SCC). The four classic signs of inflammation suggest an infection: rubor (heat), dolor (pain), calor (erythema) and tumor (mass). Infection necessitates a different management plan. Any associated vaginal discharge should be swabbed and sent to microbiology for culture.
Other less common causes of a lump around the Bartholin’s gland should be considered:
Cysts are usually managed conservatively with:
The majority of cysts will resolve spontaneously. If large enough, some cysts may be managed as abscesses, described below.
Smaller abscesses will respond to a course of antibiotics, particularly if an underlying STI has been cultured. Larger abscesses may need to be referred to surgery as pharmacologic agents will prove futile. Abscesses that require surgical intervention may be approached in one of three ways:
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