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.
Epidemiology
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.
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].
Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. May 2009;36(4):388-90. [Medline].
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].
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].
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].
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].
Eppel W, Frigo P, Worda C, Bettelheim D. Ultrasound imaging of Bartholin's cysts. Gynecol Obstet Invest. 2000;49(3):179-82. [Medline].
Goldberg JE. Simplified treatment for disease of Bartholin's gland. Obstet Gynecol. Jan 1970;35(1):109-10. [Medline].
Heah J. Methods of treatment for cysts and abscesses of Bartholin's gland. Br J Obstet Gynaecol. Apr 1988;95(4):321-2. [Medline].
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].
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].
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].
Print
