Bartholin Gland Diseases Clinical Presentation

  • Author: Antonia Quinn, DO; Chief Editor: Erik D Schraga, MD   more...
 
Updated: May 11, 2012
 

History

Patients with cysts may present with painless labial swelling. Abscesses may present spontaneously or after a painless cyst with the following symptoms:

  • Acute, painful unilateral labial swelling
  • Dyspareunia
  • Pain with walking and sitting
  • Sudden relief of pain followed by discharge (highly suggestive of spontaneous rupture)
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Physical

The following physical examination findings are seen in Bartholin abscess, as shown in the image below.

Bartholin abscess. (Image courtesy of Dr. Gil ShlaBartholin abscess. (Image courtesy of Dr. Gil Shlamovitz.)
  • Patients typically have an exquisitely tender, fluctuant labial mass with surrounding erythema and edema.
  • In some cases, areas of cellulitis surrounding the abscess may be present.
  • Fever, though not typical in healthy patients, may occur.
  • If the abscess has spontaneously ruptured, purulent discharge may be noted. If completely drained, no obvious mass may be observed.

The following physical examination findings are seen in Bartholin cysts:

  • Patients may have a painless, unilateral labial mass without signs of surrounding cellulitis.
  • If large, the cyst may be tender.
  • Discharge from ruptured cyst should be nonpurulent.
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Causes

Uncomplicated Bartholin cysts are filled with nonpurulent mucous. Several studies have aimed to identify the most common bacterial pathogens responsible for Bartholin abscess formation. Studies from the 1970-1980s named Neisseria gonorrhoeae and Chlamydia trachomatis as common pathogens . More recent studies report the predominance of opportunistic bacteria such as Staphylococcus species, Streptococcus species, and most commonly, Escherichia coli.

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Contributor Information and Disclosures
Author

Antonia Quinn, DO  Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate Medical Center/Kings County Hospital Center; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Antonia Quinn, DO is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Coles Schecter, MD  Staff Physician, Department of Emergency Medicine, Lahey Clinic, Burlington, MA

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard H Sinert, DO  Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Howard A Blumstein, MD, to the development and writing of this article.

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Tyson Pillow, MD.

References

  1. Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv. Jun 2009;64(6):395-404. [Medline].

  2. Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. May 2009;36(4):388-90. [Medline].

  3. de Góis Speck NM, Belfort PN, Mendes P, Kang HJ, Ribalta JC. Carbon dioxide laser treatment of Bartholin's gland cyst. Clin Exp Obstet Gynecol. 2007;34(1):50-1. [Medline].

  4. Benedetti Panici P, Manci N, Bellati F, Di Donato V, Marchetti C, Calcagno M, et al. CO2 laser therapy of the Bartholin's gland cyst: surgical data and functional short- and long-term results. J Minim Invasive Gynecol. May-Jun 2007;14(3):348-51. [Medline].

  5. Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, et al. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol. May-Jun 2008;15(3):327-31. [Medline].

  6. Aghajanian A, Bernstein L, Grimes DA. Bartholin's duct abscess and cyst: a case-control study. South Med J. Jan 1994;87(1):26-9. [Medline].

  7. Eppel W, Frigo P, Worda C, Bettelheim D. Ultrasound imaging of Bartholin's cysts. Gynecol Obstet Invest. 2000;49(3):179-82. [Medline].

  8. Goldberg JE. Simplified treatment for disease of Bartholin's gland. Obstet Gynecol. Jan 1970;35(1):109-10. [Medline].

  9. Heah J. Methods of treatment for cysts and abscesses of Bartholin's gland. Br J Obstet Gynaecol. Apr 1988;95(4):321-2. [Medline].

  10. Kdous M, Hachicha R, Iraqui Y, Jacob D, Piquet PM, Truc JB. [Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess]. Gynecol Obstet Fertil. Nov 2005;33(11):887-90. [Medline].

  11. Tanaka K, Mikamo H, Ninomiya M, Tamaya T, Izumi K, Ito K, et al. Microbiology of Bartholin's gland abscess in Japan. J Clin Microbiol. Aug 2005;43(8):4258-61. [Medline].

  12. Wheelock JB, Goplerud DR, Dunn LJ, Oates JF 3rd. Primary carcinoma of the Bartholin gland: a report of ten cases. Obstet Gynecol. Jun 1984;63(6):820-4. [Medline].

  13. Woida FM, Ribeiro-Silva A. Adenoid cystic carcinoma of the Bartholin gland: an overview. Arch Pathol Lab Med. May 2007;131(5):796-8. [Medline].

  14. Wydra D, Klasa-Mazurkiewicz D, Emerich J, Milczek T. The problem of accurate initial diagnosis of Bartholin's gland carcinoma resulting in delayed treatment and aggressive course of the disease. Int J Gynecol Cancer. May-Jun 2006;16(3):1469-72. [Medline].

 
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Word catheter. (Image courtesy of Dr. Gil Shlamovitz.)
Word catheter with inflated balloon. (Image courtesy of Dr. Gil Shlamovitz.)
Bartholin abscess. (Image courtesy of Dr. Gil Shlamovitz.)
 
 
 
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