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Bartholin Gland Diseases
Updated: Dec 2, 2009
Introduction
Background
Bartholin glands were first described by Caspar Bartholin, a Dutch anatomist, in 1677. These paired glands are approximately 0.5 cm in diameter and are found in the labia minora in the 4- and 8-o’clock positions. Typically, they are nonpalpable. Each gland secretes mucus into a 2.5 cm duct. These two ducts emerge onto the vestibule at either side of the vaginal orifice, inferior to the hymen. Their function is to maintain the moisture of the vaginal mucosa's vestibular surface.
This article focuses on the most common Bartholin gland diseases, cysts and abscesses. Although rare, carcinoma of the gland should be considered in women with an atypical presentation.
Pathophysiology
Bartholin glands are known to form cysts and abscesses in women of reproductive age. Cysts and abscesses are often clinically distinguishable. Bartholin cysts form when the ostium of the duct becomes obstructed, leading to distention of the gland or duct with fluid. Obstruction is usually secondary to nonspecific inflammation or trauma. The cyst is usually 1-3 cm in diameter and often asymptomatic, although larger cysts may be associated with pain and dyspareunia.
Bartholin abscesses result from either primary gland infection or infected cyst. Patients with abscesses complain of acute, rapidly progressive vulvar pain. Studies have shown that these abscesses are usually polymicrobial and rarely attributable to sexually transmitted pathogens.
Adenocarcinoma of the Bartholin glands is rare, accounting for 1-2% of all vulvar malignancies. Typically, this lesion presents as a gradually enlarging gland in an asymptomatic, postmenopausal woman.
Frequency
United States
Approximately 2% of women of reproductive age will experience swelling of one or both Bartholin glands.
Mortality/Morbidity
Bartholin gland diseases are rarely complicated by systemic infection, sepsis, and bleeding secondary to surgical treatment. Missed diagnosis of malignancy may result in poorer outcome for those patients.
Race
No difference exists in the frequency of Bartholin gland diseases among different races.
Sex
Bartholin glands are present only in females.
Age
These diseases typically occur in women between the ages of 20 and 30 years. Bartholin gland enlargement in patients older than 40 years is rare and should be referred to a gynecologist for possible biopsy.
Clinical
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)
Physical
The following physical examination findings are seen in Bartholin abscess, as shown in the image below.
Bartholin abscess.
- 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.
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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References
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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].
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].
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].
Further Reading
Keywords
Bartholin gland cyst, Bartholin gland swelling, Bartholin gland abscess, Bartholin's gland, Bartholin's cyst, Bartholin cyst, Bartholin abscess, Bartholin's abscess, bartholinitis, Neisseria gonorrhoeae, N gonorrhoeae, Chlamydia trachomatis, C trachomatis, Bartholin gland drainage
